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CMS expands Medicaid coverage for smoking cessation services

The Centers for Medicare and Medicaid Services has informed state Medicaid directors of new smoking cessation services and reminded them that Medicaid programs are now required to fully cover those services for pregnant women.

The Centers for Disease Control estimates that smoking results in more than $96 billion in healthcare services annually and costs another $97 billion in lost productivity. While 45 of 51 Medicaid programs already offer some form of smoking cessation services or coverage, most beneficiaries and doctors aren't aware of them. A 2004 study found that 36 percent of Medicaid-enrolled smokers and 60 percent of Medicaid physicians knew that their state Medicaid program offered any coverage for tobacco-dependence treatment.

CMS also wants to increase awareness among doctors and pregnant women that these benefits are now required by law under health reform.

[See also: Medicare expands coverage for tobacco counseling]

"In pregnant women, smoking can cause serious complications," said CMS Administrator Donald M. Berwick, MD, in a blog post touting the new regulations. "Babies born to mothers who smoke are more likely to be lower birth weight, have lung problems and other health problems. They're more likely to die from sudden infant death syndrome."

To help get the word out to all Medicaid-covered smokers, CMS is making federal Medicaid matching funds available to states for the costs associated with telephone services.

"We urge all states to offer comprehensive cessation benefits, including telephone quitlines, to all Medicaid recipients and to aggressively promote the availability of the services in order to achieve the maximum public health benefit," said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, in a statement. "There is strong evidence that Medicaid coverage to help smokers quit is highly cost-effective and saves money."

Myers cited a Massachusetts program, which has provided Medicaid coverage of smoking cessation services since 2006, that saw a 26 percent decline in the smoking rate among beneficiaries in the first two-and-a-half years. Those who used the benefit also showed a 46 percent decrease in hospitalizations for heart attacks and a 49 percent decrease in hospitalizations for cardiovascular disease.

To help guide the states in covering smoking cessation programs and treatments, CMS is recommending guidelines proposed in a May 2008 Public Health Service report, "Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline."

According to that report:

  • Tobacco dependence is a chronic disease that often requires repeated intervention, so there are often multiple attempts to quit.
  • Counseling and medication as effective treatments, and while each is effective alone, they are more effective together.
  • Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity.

For pregnant individuals, the report indicates:

  • Because of the serious risk of smoking to the mother-to-be and the fetus, whenever possible, pregnant smokers should be offered person-to-person counseling that exceeds minimal advice to quit.
  • Pharmacotherapy for pregnant women isn't recommended because there is insufficient evidence of its safety and effectiveness. However, it may be evaluated on a case-by-case basis as determined by the woman and her physician.

According to a report from the Congressional Budget Office, providing smoking cessation benefits, which don't include co-payments, can positively impact a state's Medicaid program. A 2007 study by the American Legacy Foundation estimated that if all smokers enrolled in Medicaid programs stopped smoking, the Medicaid program would save $9.7 billion after five years.

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