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New CDC Study Shows States Not Doing Enough to Help Smokers on Medicaid Quit

17 States Provide No Coverage; Only One State, Oregon, Provides Complete Drug and Counseling Services
November 08, 2001

Washington, DC — While more states are providing Medicaid coverage for cessation services to help smokers quit, 17 states still provide no coverage for such services, according to a new study released today by the U.S. Centers for Disease Control and Prevention. Only one state, Oregon, provides coverage for all of the drug and counseling services recommended by the U.S. Public Health Service in its clinical practice guidelines on treating tobacco use and dependence.

The study recommends that states increase Medicaid coverage of tobacco dependence treatments and that Congress provide a comprehensive tobacco dependence treatment benefit as part of the core benefit package under Medicaid, which is jointly funded by federal and state governments. Federal legislation (S. 854) to do this has been introduced in the U.S. Senate by Sens. Richard Durbin (D-IL), Sam Brownback (R-KS), Bob Graham (D-FL) and Jeff Bingaman (D-NM).

Medicaid coverage for smoking cessation services is cost-effective, according to the study, because it reduces the incidence of tobacco-related diseases and the amount that Medicaid spends to treat them. For example, reducing smoking among pregnant women would reduce rates of low-birth-weight babies, which can be caused by smoking during pregnancy and result in far greater medical costs than normal weight births.

The Campaign for Tobacco-Free Kids is calling on state and federal legislators to enact laws that will provide this needed coverage.

“Providing Medicaid coverage for smoking cessation products and services is a smart investment that will save lives and save money,” said Matthew L. Myers, President of the CAMPAIGN FOR TOBACCO-FREE KIDS. “A majority of pregnant smokers in America are on Medicaid. These women deserve all the help possible to quit smoking. Congress can give them that help without a net cost to the taxpayers. Today’s study is a wake-up call to Congress to pass comprehensive cessation coverage under Medicaid.”

The number of states providing at least some Medicaid coverage for smoking cessation services increased from 25 in 1998 to 34 in 2000, according to the study, which surveyed all 50 states and the District of Columbia.

However, only 13 states provide coverage for counseling services that are considered critical to helping smokers succeed in quitting, while 31 states provide coverage for prescription drugs and 23 states provide coverage for over-the-counter drugs. Only 11 states provide coverage for at least one form of drug treatment and one form of counseling.

Federal coverage of cessation products and services as proposed by Senators Durbin (D-IL) and Brownback (R-KS) would pay for themselves by reducing Medicaid expenditures for health care costs caused by smoking. Currently, Medicaid spends $17 billion every year to treat illnesses caused by tobacco use, according to a Centers for Medicare and Medicaid Services (formerly HCFA) publication.

Numerous studies have underscored the difficulties faced by smokers trying to quit. These studies show that nicotine is as addictive as heroine or cocaine, most smokers attempt to quit five to seven times before they succeed and only about 2.5 percent of smokers succeed in quitting each year. As a result, public health advocates believe tobacco dependence needs to be viewed as a chronic illness from the standpoint of treatment.

According to the study, the high cost of smoking cessation services and the lack of health insurance coverage for them are among the biggest obstacles to smokers who want to obtain such services to help them quit. Expanded health insurance coverage for such services would increase both quit attempts and quit rates among smokers, according to the study.

The study was based on surveys sent to directors of all state Medicaid programs (including the District of Columbia) in 1998 and again in 2000. The study was conducted by Helen H. Schauffler, Ph.D., Professor at the University of California, Berkeley; Dianne Barker, MHS, Barker Bi-Coastal Health; and C. Tracy Orleans, Ph.D., of the Robert Wood Johnson Foundation. The study, Update on State Medicaid Coverage for Tobacco Dependence Treatments--United States, 1998 and 2000, is available at

View Campaign factsheets: Cessation: Federal & State Programs to Help Smokers Quit