State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2018–2022

Anne DiGiulio1; Michael A. Tynan, MPH2; Anna Schecter, MPH2; Kisha-Ann S. Williams, MPH2; Brenna VanFrank, MD2 (View author affiliations)

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Summary

What is already known about this topic?

More than one in five adults enrolled in Medicaid smokes cigarettes. Comprehensive, barrier-free insurance coverage of tobacco cessation treatments can increase smoking cessation.

What is added by this report?

From 2018 to 2022, the number of states with comprehensive Medicaid coverage of tobacco cessation treatment increased from 15 to 20; states with no treatment access barriers increased from two to three. Coverage gaps and access barriers remain in many states.

What are the implications for public health practice?

State Medicaid programs can improve the health of enrollees who smoke and potentially reduce health care expenditures by providing barrier-free coverage of all evidence-based tobacco cessation treatments and promoting this coverage to enrollees and providers.

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Abstract

The prevalence of cigarette smoking among U.S. adults enrolled in Medicaid is higher than among adults with private insurance; more than one in five adults enrolled in Medicaid smokes cigarettes. Smoking cessation reduces the risk for smoking-related disease and death. Effective treatments for smoking cessation are available, and comprehensive, barrier-free insurance coverage of these treatments can increase cessation. However, Medicaid treatment coverage and treatment access barriers vary by state. The American Lung Association collected and analyzed state-level information regarding coverage for nine tobacco cessation treatments and seven access barriers for standard Medicaid enrollees. As of December 31, 2022, a total of 20 state Medicaid programs provided comprehensive coverage (all nine treatments), an increase from 15 as of December 31, 2018. Only three states had zero access barriers, an increase from two; all three also had comprehensive coverage. Although states continue to improve smoking cessation treatment coverage and decrease access barriers for standard Medicaid enrollees, coverage gaps and access barriers remain in many states. State Medicaid programs can improve the health of enrollees who smoke and potentially reduce health care expenditures by providing barrier-free coverage of all evidence-based cessation treatments and by promoting this coverage to enrollees and providers.

Introduction

Although the prevalence of cigarette smoking among U.S. adults has been declining for decades (reaching 11.5% in 2021), tobacco-related disparities persist among population groups (1). In 2021, smoking prevalence among adults enrolled in Medicaid (21.5%) was higher than it was among adults with private insurance (8.6%) (1). In addition, although interest in quitting and quit attempts are similar among adults enrolled in Medicaid and those with private insurance, successful cessation prevalence is lower among those enrolled in Medicaid (2). The high prevalence of smoking in this population not only contributes to a substantial health burden for this population but also to the cost of health care. Smoking-attributable health care spending was $225 billion in 2014, more than one half of which was paid by Medicare and Medicaid (3).

Effective treatments for smoking cessation include seven Food and Drug Administration (FDA)–approved medications* as well as individual, group, and telephone counseling (4). The U.S. Surgeon General has concluded that “insurance coverage for smoking cessation treatment that is comprehensive, barrier-free, and widely promoted increases the use of these treatment services, leads to higher rates of successful quitting, and is cost-effective” (4). Although states are required to provide Medicaid expansion enrollees with coverage for all tobacco cessation treatments,§ coverage for standard (i.e., traditional) Medicaid enrollees varies. Standard Medicaid enrollees are persons enrolled in Medicaid under traditional Medicaid eligibility criteria (e.g., low-income pregnant women, children, and persons with a disability), as opposed to Group XIII, or expansion, eligibility. Nationwide, approximately 80% of Medicaid enrollees are covered under standard Medicaid. To assess cessation coverage policies among Medicaid programs, the American Lung Association collects state-level** information regarding coverage for nine tobacco cessation treatments†† and seven access barriers§§ for standard Medicaid enrollees.

Methods

During January 1, 2019, to December 31, 2022, the American Lung Association compiled data regarding state Medicaid tobacco cessation coverage from state Medicaid websites, Medicaid managed care plan member websites, provider websites, handbooks, policy manuals, plan formularies, preferred drug lists, Medicaid state plan amendments, regulations, and laws.¶¶ Analysts contacted personnel from state Medicaid agencies, state health departments, or other state government agencies to verify the information collected, retrieve missing documents, and reconcile discrepancies. Information provided by state personnel was considered accurate. As previously published, comprehensive coverage was defined as coverage of all nine assessed treatments (5). Barrier-free coverage was defined as having none of the seven assessed treatment access barriers. Summary statistics were generated and compared with data previously reported through December 31, 2018 (5). This activity was reviewed by CDC, deemed research not involving human subjects, and was conducted consistent with applicable federal law and CDC policy.***

Results

Coverage of Tobacco Cessation Treatment

As of December 31, 2022, all 50 states and the District of Columbia (DC) covered at least one cessation treatment for all standard Medicaid enrollees, which had not changed since December 31, 2018. As of December 2022, a total of 21 states covered both individual and group counseling for all standard Medicaid enrollees, an increase from 16 states in December 2018 (Table 1). Forty-three states covered all seven medications as of December 2022, an increase from 36 in December 2018 (Table 2). Two states (Delaware and Utah), which had covered all seven medications for all standard enrollees in 2018, no longer did so as of 2022 (four medications in Delaware and two medications in Utah changed from being covered for all standard enrollees to being covered for only some standard enrollees). All 15 states that had provided comprehensive coverage as of December 2018 maintained that coverage through December 2022. Five states (Illinois, New York, North Dakota, Pennsylvania, and Virginia) added comprehensive coverage during the study period.

Treatment Access Barriers

During December 2018–December 2022, the number of states with a treatment access barrier decreased for all seven barriers. For example, the number of states not requiring copayments increased from 28 to 39. However, some barriers continue to be common. As of December 2022, the three most common barriers (that apply to all or some standard Medicaid enrollees) were duration limits (39 states; 76%), annual limits on the number of covered quit attempts (35; 69%), and requirement for prior authorization (30; 59%) (Table 3). These three barriers were also the most common in December 2018. As of December 2022, only three states (Kentucky, Missouri, and Wisconsin) provided barrier-free coverage, an increase from two (Kentucky and Missouri) in December 2018. All three of these states provided comprehensive coverage.

Discussion

During 2018–2022, states continued to add coverage of tobacco cessation treatments and to remove treatment access barriers for standard Medicaid enrollees. However, coverage gaps and access barriers remain in many states. Although the number of states with comprehensive coverage increased from 15 in 2018 to 20 in 2022, this increase falls short of the Healthy People 2030 target of all 50 states and DC.††† In 2022, only three states provided coverage without any barriers. Increasing cessation coverage and decreasing barriers increases access to effective treatments that can increase the likelihood of successful quitting and improve health outcomes for persons who smoke (4).

The increase in the number of states with comprehensive treatment coverage and without barriers is likely related to state legislative actions. For example, Ohio passed legislation in 2020 requiring the state Medicaid program to cover a comprehensive cessation benefit with minimal barriers; Illinois passed similar legislation in 2021.§§§ These laws not only improve coverage and removed barriers, but also ensure that managed care plans will maintain this level of coverage in the future, even if new carriers are selected via competitive state bidding processes.

Laws like those passed in Ohio and Illinois can also help standardize tobacco cessation benefits across plans within a state. In the absence of such laws, treatment coverage and barriers can vary within a state’s Medicaid program, potentially limiting treatment access. Different Medicaid-managed care plans within a state can set different coverage policies. Consistent comprehensive coverage of tobacco cessation treatments with minimal barriers has the potential to increase standard Medicaid enrollees’ access to treatments and minimize confusion for both enrollees and providers.

Improved cessation treatment coverage observed in this study might also be related to some states¶¶¶ implementing Medicaid expansion during the study period (6). Many state Medicaid programs provide the same coverage for standard and expansion enrollees (7). Since states are required to provide expansion enrollees with coverage of all cessation treatments, consistency of coverage between standard and expansion plans might result in improvements in coverage for standard enrollees. Medicaid expansion has been shown to support cessation; states that have implemented Medicaid expansion have witnessed an increase in smoking cessation among lower-income adults (8,9). Opportunities remain for all states to improve coverage and increase promotion of available tobacco cessation benefits to encourage and support successful quitting.

This study demonstrates continued progress in decreasing tobacco cessation treatment access barriers for standard Medicaid enrollees. The biggest improvement in barrier removal was for copayments, with a nearly one third increase in the number of states without copayment requirements. One potential contributor to this change was enactment of the Families First Coronavirus Response Act (FFCRA),**** which increased the federal share of Medicaid spending by 6.2% with the requirement that states limit new cost-sharing for Medicaid enrollees. Continued monitoring of treatment access barriers remains important, particularly because the FFCRA maintenance of effort requirement, which limited cost-sharing, ended in 2023.†††† How this change in policy might affect access barriers for cessation treatments is unknown.

Limitations

The findings in this report are subject to at least two limitations. First, Medicaid-managed care plans can change with little notice and can vary widely between plans, which can make determining up-to-date coverage challenging. Second, information provided by state personnel could not be verified, potentially resulting in data misclassification.

Implications for Public Health Practice

More than one in five adults enrolled in Medicaid smoke cigarettes (1). Increasing comprehensive, barrier-free tobacco cessation insurance coverage for the more than 48 million adults enrolled in Medicaid§§§§ has the potential to reduce tobacco-related disparities in this population by increasing access to and usage of treatments that help persons quit smoking (4). By providing barrier-free coverage of all evidence-based tobacco cessation treatments, and promoting this coverage to enrollees and providers, state Medicaid programs can improve the health of enrollees who smoke and potentially reduce health care expenditures.

Corresponding author: Brenna VanFrank, [email protected].


1American Lung Association, Chicago, Illinois; 2Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Anne DiGiulio reports grants from Amgen, Novartis, the Pharmaceutical Research and Manufacturers of America, and the Biotechnology Innovation Organization. No other potential conflicts of interest were disclosed.


* These include five nicotine replacement therapies (nicotine patch, gum, lozenge, nasal spray, and oral inhaler) and two non-nicotine medications (bupropion and varenicline).

Medicaid expansion, also known as Group XIII eligibility, provides Medicaid coverage to persons ineligible for standard Medicaid who have an income ≤138% of the federal poverty level. Medicaid expansion was created by the Patient Protection and Affordable Care Act and implemented in 2014. https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

§ The Patient Protection and Affordable Care Act (ACA) requires Medicaid expansion plans to cover treatment given an “A” or “B” grade by the U.S. Preventive Services Task Force without cost-sharing (https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf). Tobacco cessation currently receives an “A” grade (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions) and is included in the ACA requirement (https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/aca_implementation_faqs19). Currently, this requirement is being legally challenged. https://www.kff.org/womens-health-policy/issue-brief/explaining-litigation-challenging-the-acas-preventive-services-requirements-braidwood-management-inc-v-becerra/

https://www.kff.org/medicaid/issue-brief/medicaid-expansion-enrollment-and-spending-leading-up-to-the-covid-19-pandemic/

** The term “states” includes DC.

†† Treatments include seven FDA-approved smoking cessation medications and two types of counseling (individual and group). Telephone counseling was not examined because it is available free to callers (including Medicaid enrollees) via state quitlines in all 50 states and DC.

§§ Barriers to treatment include requirements for copayment, prior authorization, counseling for medications, and stepped care therapy, and limits on the duration and number (both annual and lifetime) of covered quit attempts. A barrier was considered to be in place if it existed for any of the nine assessed cessation treatments.

¶¶ Information on state Medicaid cessation coverage compiled by the American Lung Association is available in the CDC State Activities Tracking and Evaluation (STATE) System. Some data presented in this report differ from data available in the STATE System because of differences in coding rules, categories, and reporting periods. https://www.cdc.gov/statesystem

*** 45 C.F.R. part 46; 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d), 5 U.S.C. Sect. 552a, 44 U.S.C. Sect. 3501 et seq.

††† https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-medicaid-coverage-evidence-based-treatment-help-people-quit-using-tobacco-tu-16

§§§ https://www.legislature.ohio.gov/legislation/133/hb11; https://www.ilga.gov/legislation/BillStatus.asp?DocNum=2294&GAID=16&DocTypeID=SB&SessionID=110&GA=102

¶¶¶ During the study period, Medicaid expansion occurred in Maine and Virginia (2019); Idaho, Nebraska, and Utah (2020); and Missouri and Oklahoma (2021).

**** The Centers for Medicare & Medicaid Services has issued guidance to states on implementing this provision (https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf). The FFCRA included a maintenance of effort requirement, meaning that states could not disenroll persons from Medicaid or impose new cost-sharing for Medicaid enrollees while the federal Medicaid payment was increased by 6.2%. www.congress.gov/116/plaws/publ127/PLAW-116publ127.pdf

†††† https://www.medicaid.gov/federal-policy-guidance/downloads/sho23002.pdf

§§§§ Includes both standard and expansion Medicaid enrollees. https://www.medicaid.gov/sites/default/files/2023-03/December-2022-medicaid-chip-enrollment-trend-snapshot.pdf

References

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  2. Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults—United States, 2000–2015. MMWR Morb Mortal Wkly Rep 2017;65:1457–64. https://doi.org/10.15585/mmwr.mm6552a1 PMID:28056007
  3. Xu X, Shrestha SS, Trivers KF, Neff L, Armour BS, King BA. U.S. healthcare spending attributable to cigarette smoking in 2014. Prev Med 2021;150:106529. https://doi.org/10.1016/j.ypmed.2021.106529 PMID:33771566
  4. U.S. Department of Health and Human Services. Smoking cessation: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/tobacco/sgr/2020-smoking-cessation/index.html
  5. DiGiulio A, Jump Z, Babb S, et al. State Medicaid coverage for tobacco cessation treatments and barriers to accessing treatments—United States, 2008–2018. MMWR Morb Mortal Wkly Rep 2020;69:155–60. https://doi.org/10.15585/mmwr.mm6906a2 PMID:32053583
  6. KFF. Status of state Medicaid expansion decisions: interactive map. San Francisco, CA: KFF; 2023. https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
  7. Baumrucker EP. Medicaid alternative benefit plan coverage: frequently asked questions. Washington, DC: Congressional Research Service; 2018. https://sgp.fas.org/crs/misc/R45412.pdf
  8. Koma JW, Donohue JM, Barry CL, Huskamp HA, Jarlenski M. Medicaid coverage expansions and cigarette smoking cessation among low-income adults. Med Care 2017;55:1023–9. https://doi.org/10.1097/MLR.0000000000000821 PMID:29068908
  9. Bailey SR, Marino M, Ezekiel-Herrera D, et al. Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states. Nicotine Tob Res 2020;22:1016–22. https://doi.org/10.1093/ntr/ntz087 PMID:31123754
TABLE 1. Coverage of tobacco cessation counseling for standard Medicaid enrollees,* by state — United States, 2018§ and 2022Return to your place in the text
State Coverage and year
Individual counseling Group counseling
2018 2022 2018 2022
Alabama P P No No
Alaska Yes Yes No No
Arizona P V No V
Arkansas Yes Yes No No
California Yes Yes Yes Yes
Colorado Yes Yes Yes Yes
Connecticut Yes Yes Yes Yes
Delaware Yes Yes No Yes
District of Columbia Yes Yes No No
Florida V Yes V V
Georgia Yes V V V
Hawaii Yes Yes V V
Idaho Yes Yes No No
Illinois V Yes No Yes
Indiana Yes Yes Yes Yes
Iowa V V V No
Kansas Yes Yes Yes Yes
Kentucky Yes Yes Yes Yes
Louisiana Yes P V V
Maine Yes Yes Yes Yes
Maryland Yes V No V
Massachusetts Yes Yes Yes Yes
Michigan Yes Yes V No
Minnesota Yes Yes Yes Yes
Mississippi P P V No
Missouri Yes Yes Yes Yes
Montana Yes Yes No No
Nebraska Yes Yes V No
Nevada V Yes V No
New Hampshire Yes V V No
New Jersey V V V V
New Mexico V V V V
New York Yes Yes Yes Yes
North Carolina Yes Yes No V
North Dakota P Yes No Yes
Ohio Yes Yes Yes Yes
Oklahoma Yes Yes No No
Oregon Yes Yes Yes Yes
Pennsylvania Yes Yes V Yes
Rhode Island Yes Yes Yes Yes
South Carolina Yes Yes Yes Yes
South Dakota P Yes No No
Tennessee V V No V
Texas V Yes V V
Utah Yes Yes P V
Vermont Yes Yes No No
Virginia V Yes V Yes
Washington V P No No
West Virginia Yes Yes V No
Wisconsin Yes Yes Yes Yes
Wyoming Yes Yes No No
Totals
Yes 36 39 16 21
No 0 0 18 18
V 10 8 16 12
P 5 4 1 0

Abbreviations: P = pregnant; V = varied coverage.
* “Yes” indicates treatment is covered for all standard Medicaid enrollees; “No” indicates treatment is not covered for any standard Medicaid enrollee; “V” indicates treatment coverage varies, with treatment covered for some, but not all, standard Medicaid enrollees; and “P” indicates treatment is covered for pregnant women only.
Includes the District of Columbia.
§ As of December 31, 2018.
As of December 31, 2022.

TABLE 2. Coverage of tobacco cessation medications for standard Medicaid enrollees,* by state — United States, 2018§ and 2022Return to your place in the text
State Coverage and year
Nicotine patch Nicotine gum Nicotine lozenge Nicotine nasal spray Nicotine oral inhaler Bupropion Varenicline
2018 2022 2018 2022 2018 2022 2018 2022 2018 2022 2018 2022 2018 2022
Alabama Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Alaska Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Arizona Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Arkansas Yes Yes Yes Yes No Yes No Yes No Yes Yes Yes Yes Yes
California Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Colorado Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Connecticut Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Delaware Yes Yes Yes Yes Yes Yes Yes V Yes V Yes V Yes V
District of Columbia Yes Yes Yes Yes Yes Yes V V V V Yes Yes V Yes
Florida Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes
Georgia Yes Yes Yes Yes Yes Yes V V V V Yes V V V
Hawaii Yes Yes Yes Yes V V V V V V Yes Yes Yes Yes
Idaho Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Illinois Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes V Yes
Indiana Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Iowa Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Kansas Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Kentucky Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Louisiana Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes V Yes
Maine Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Maryland Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Massachusetts Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Michigan Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Minnesota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Mississippi Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Missouri Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Montana Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nebraska Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nevada Yes Yes Yes Yes Yes Yes V V Yes V Yes Yes Yes V
New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
New Jersey Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes Yes Yes
New Mexico Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes Yes Yes
New York Yes Yes Yes Yes Yes Yes Yes Yes V Yes Yes Yes Yes Yes
North Carolina Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
North Dakota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Ohio Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Oklahoma Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Oregon Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Pennsylvania Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes Yes Yes
Rhode Island Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
South Carolina Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
South Dakota No No No No No No No No No No Yes Yes Yes Yes
Tennessee Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Texas Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Utah Yes Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes Yes
Vermont Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Virginia Yes Yes Yes Yes V Yes V Yes V Yes Yes Yes Yes Yes
Washington Yes Yes Yes Yes Yes Yes V Yes V Yes Yes Yes V Yes
West Virginia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Wisconsin Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Wyoming Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Totals
Yes 50 50 50 50 47 49 37 43 37 43 51 49 46 48
No 1 1 1 1 2 1 3 2 3 2 0 0 0 0
V 0 0 0 0 2 1 11 6 11 6 0 2 5 3

Abbreviation: V = varied coverage.
* “Yes” indicates treatment is covered for all standard Medicaid enrollees; “No” indicates treatment is not covered for any standard Medicaid enrollee; and “V” indicates treatment coverage varies, with treatment covered for some, but not all, standard Medicaid enrollees.
Includes the District of Columbia.
§ As of December 31, 2018.
As of December 31, 2022.

TABLE 3. Barriers* to coverage for tobacco cessation treatments for standard Medicaid enrollees, by state§ — United States, 2018 and 2022**Return to your place in the text
State Coverage barrier and year
Copayments required Prior authorization required Counseling required for medications Stepped care therapy Limits on duration Annual limit on quit attempts Lifetime limit on quit attempts
2018 2022 2018 2022 2018 2022 2018 2022 2018 2022 2018 2022 2018 2022
Alabama No Yes Yes Yes No Yes No No Yes Yes Yes Yes No No
Alaska Yes Yes No Yes No No No No Yes Yes Yes Yes No No
Arizona No V No No No V No No Yes Yes Yes V No No
Arkansas No No Yes Yes Yes Yes No No V No Yes No No No
California No No V V No No No No V V V V No No
Colorado No No No No Yes No No No Yes Yes Yes Yes No No
Connecticut No No Yes Yes No No No No Yes Yes No Yes No No
Delaware No No V V V V V V V V V V No No
District of Columbia V No V V No No No No V No V No No No
Florida V No No Yes No No No No Yes Yes Yes Yes No No
Georgia V Yes V V No V No V Yes V Yes V No No
Hawaii No No V V Yes V V No V Yes Yes Yes No No
Idaho No No Yes Yes Yes No Yes Yes Yes No Yes No No No
Illinois V No V No No No V No V V V V No No
Indiana Yes No V No Yes Yes V V Yes V Yes V No No
Iowa No No Yes No Yes No Yes No Yes Yes Yes Yes No No
Kansas No No No No No No No No Yes Yes Yes Yes No No
Kentucky No No No No No No No No No No No No No No
Louisiana V No V Yes No Yes No Yes V Yes V Yes No No
Maine No No Yes Yes No No Yes Yes No No No No No No
Maryland No No Yes Yes No No Yes Yes Yes Yes No Yes No No
Massachusetts Yes No Yes No No No No No Yes Yes Yes Yes No No
Michigan No No No V No No No No V V No V No No
Minnesota No No V Yes No No No No V No No No No No
Mississippi V V Yes No No No No No No V Yes No No No
Missouri No No No No No No No No No No No No No No
Montana No No Yes Yes No No Yes No Yes Yes Yes No No No
Nebraska V V Yes V Yes No No No Yes Yes Yes Yes No No
Nevada No No V V No No No No Yes V V No No No
New Hampshire V No V V V No V V V V V V No No
New Jersey V No No No No No No No V No V NA No No
New Mexico V No V No V No No No V V Yes V No No
New York V V No V No No No No No No No No No No
North Carolina Yes Yes No No No No Yes Yes Yes Yes No Yes No No
North Dakota Yes No Yes No Yes No Yes Yes Yes Yes Yes Yes No No
Ohio No No V No No V V No V V V Yes No No
Oklahoma No No No No No No No No Yes Yes No Yes No No
Oregon No No Yes V No No No V Yes Yes Yes V No No
Pennsylvania V No V Yes No No V No V Yes V Yes No No
Rhode Island No No V V V No No V V V No V No No
South Carolina No No No No No No No No Yes Yes Yes Yes No No
South Dakota Yes Yes No No No No No No No Yes No No No No
Tennessee Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes V No
Texas No No Yes Yes No No Yes Yes V No V V No No
Utah Yes V V V V V V V V V Yes V No No
Vermont No No Yes Yes No No Yes Yes Yes Yes Yes No No No
Virginia V No V No No No V No No Yes No No No No
Washington No No V Yes V No V No V No V Yes V No
West Virginia No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No V
Wisconsin Yes No No No No No No No Yes No No No No No
Wyoming Yes V No No No No No No Yes Yes Yes Yes No No
Totals
Yes 10 6 17 17 9 5 11 10 26 26 25 22 0 0
No 28 39 16 21 36 40 30 34 7 12 14 15 49 50
V 13 6 18 13 6 6 10 7 18 13 12 13 2 1
NA 0 0 0 0 0 0 0 0 0 0 0 1 0 0

Abbreviations: NA = not available; V = varied coverage.
* Barriers apply to one or more cessation treatments.
“Yes” indicates a barrier applies to all standard Medicaid enrollees; “No” indicates a barrier does not apply to any standard Medicaid enrollee; and “V” indicates a barrier applies to some, but not all, standard Medicaid enrollees.
§ Includes the District of Columbia.
As of December 31, 2018.
** As of December 31, 2022.


Suggested citation for this article: DiGiulio A, Tynan MA, Schecter A, Williams KS, VanFrank B. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2018–2022. MMWR Morb Mortal Wkly Rep 2024;73:301–306. DOI: http://dx.doi.org/10.15585/mmwr.mm7314a2.

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