At a time when American adults living below the poverty line are over 50 percent more likely to smoke than other citizens, health care services provided through Medicaid may make a real difference. A new paper by researchers from the George Washington University Milken Institute School of Public Health (Milken Institute SPH) analyzed state Medicaid coverage policies to see which ones were most effective.
“While smoking declined substantially in the general population from 1997 to 2013, smoking rates among Medicaid beneficiaries remained essentially flat,” points out Erin J. Brantley, MPH, a PhD candidate in the Milken Institute SPH Department of Health Policy and Management. “Individuals with private insurance have a significantly higher rate of quitting smoking than Medicaid beneficiaries.”
The GW research team focused on Medicaid recipients because it is the source of insurance for more than 40 percent of poor working age adults, far more than any other source of insurance. They analyzed information from the U.S. Centers for Disease Control and Prevention’s National Health Interview Survey in 2010 and 2015, which included questions about how smokers attempt to quit.
“The Affordable Care Act’s expansion of Medicaid coverage has provided the opportunity for increased utilization of tobacco cessation services, but low utilization of Medicaid’s smoking cessation services has been a recognized problem for many years,” adds Leighton Ku, PhD, a professor in the Department of Health Policy and Management.
Brantley, Ku, and their colleagues found that in smokers are more likely to use counseling if their state Medicaid programs covers this service. Smokers are more likely to try to quit if they live in a state with higher use of cessation medications. The authors also found that Medicaid expansion was linked with lower smoking among Medicaid beneficiaries. Given mixed impacts of Medicaid policies on smoking outcomes, the authors conclude that states need to go beyond covering tobacco cessation services to move the needle on smoking among Medicaid beneficiaries.
“Incorporating tobacco cessation measures into pay-for-performance initiatives could encourage providers to counsel patients on cessation. States should also promote cessation counseling benefits to [Medicaid] beneficiaries and educate providers on how to bill for counseling,” Brantley, Ku and their colleagues write in “Policies Affecting Medicaid Beneficiaries Smoking Cessation Behaviors.” The new paper is published in Nicotine & Tobacco Research.