The impact of tobacco dependence treatment coverage and copayments in Medicaid

The Affordable Care Act (ACA) expands Medicaid's tobacco dependence treatment (TDT) coverage; however, these expansions differ in comprehensiveness based on Medicaid eligibility category.

To examine whether more generous Medicaid TDT coverage (in terms of cost-sharing requirements and treatments covered) is associated with greater likelihood of quit attempts and successful quit rates.

This study used repeated cross-sections from the Current Population Survey (2001-2011), linked to state-level survey data on Medicaid TDT coverage. The sample included 3,071 adult Medicaid recipients who reported smoking 12 months prior to the survey and resided in 28 states with consistent TDT coverage across Medicaid fee-for-service and managed care. Logistic regression models, conducted in October 2013, examined the relationship between state TDT coverage and Medicaid recipients' successful quits and attempted quit rates, controlling for individual and state characteristics.

Forty-one percent of Medicaid recipients attempted to quit smoking in the prior year and 7% quit successfully. Medicaid recipients in states with the most generous coverage (counseling without copayment and pharmacotherapy with copayment) had the highest predicted successful quit rates (8.3%). Those living in states with no TDT or pharmacotherapy-only coverage had lower predicted successful quit rates (range=4.0%-5.6%).

These findings suggest that the ACA will increase smoking quit rates among Medicaid recipients. Recipients who have more generous TDT coverage (such as the new Medicaid expansion population and pregnant women) will likely see greater increases in quit rates compared to existing adult Medicaid enrollees.