Location:
SMOKING; WELFARE - MEDICAL ASSISTANCE (MEDICAID);

OLR Research Report


December 15, 2009

 

2009-R-0468

TOBACCO DEPENDENCE TREATMENT PROGRAMS

 

By: John Kasprak, Senior Attorney

You asked for information about tobacco dependence treatment programs in Connecticut, specifically those targeted at Medicaid recipients. You are also interested in other states' activities on this.

SUMMARY

While most states' Medicaid programs cover some tobacco dependence treatment, Connecticut's Medicaid program does not. The state does fund several tobacco cessation activities, particularly through the Tobacco and Health Trust Fund and Department of Public Health initiatives.

MEDICAID

According to the federal Centers for Disease Control and Prevention (CDC), of the 51 state Medicaid programs (including the District of Columbia), 43 offered coverage for some form of tobacco dependence treatment to Medicaid enrollees in traditional fee-for-service (FFS) Medicaid. Connecticut, along with Georgia, Missouri, Nebraska, and Tennessee do not provide any coverage under Medicaid for tobacco dependence treatment.

Of the 43 state Medicaid programs offering tobacco dependence treatment, 41 placed some form of limitation on the coverage in the form of copayments (32 states), treatment duration (25), prior authorization (21), and requiring enrollment in behavioral modification programs as a precondition for receiving pharmacotherapy (13).Only two states, New Mexico and New Jersey, provide access to tobacco-dependence treatments without any limitations or restrictions.

The following table provides information on each state's Medicaid program coverage for various tobacco dependence treatments.

State Medicaid Program Coverage of Tobacco Dependence Treatments by Type of Coverage, 2009

 

Medicaid Covers Any Tobacco-Dependence Treatment?

NRT Gum

NRT Patch

NRT Nasal Spray

NRT Inhaler

NRT Lozenge

Varenicline (Chantix)

Bupropion (Zyban)

Group Counseling

Individual Counseling

 

United States

44+DC Yes

42+DC Yes

43+DC Yes

34 Yes

32 Yes

33+DC Yes

43+DC Yes

43+DC Yes

20+DC Yes

24+DC Yes

 

Alabama

No

No

No

No

No

No

No

No

No

No1

Alaska

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

No

Yes

Arizona

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Arkansas

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

California

Yes

Yes2

Yes

Yes2

Yes2

Yes2

Yes2

Yes

Yes2

Yes

Colorado

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Connecticut

No

No

No

No

No

No

No

No

No

No

Delaware

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

District of Columbia

Yes

Yes2

Yes2

No

No

Yes2

Yes2

Yes2

Yes2

Yes2

Florida

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

Yes

Georgia

No

No

No

No

No

No

No

No

No

No

Hawaii

Yes

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

No

Idaho

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

No

Illinois

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Indiana

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Iowa

Yes

Yes

Yes

No

No

No

Yes

Yes

No

Yes

Kansas

Yes

No

Yes

No

No

No

Yes

Yes

No

No

Kentucky

No

No

No

No

No

No

No

No

No

No1

Louisiana

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

No

No

Maine

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Maryland

Yes

Yes2

Yes

No

No

Yes2

Yes2

Yes2

Yes

Yes2

Massachusetts

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Michigan

Yes

Yes2

Yes

Yes2

Yes2

Yes2

Yes2

Yes2

No

No

Minnesota

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Mississippi

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No1

No1

Missouri

No

No

No

No

No

No

No

No

No

No

Montana

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Nebraska

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Nevada

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes3

Yes3

New Hampshire

Yes

Yes3

Yes3

Yes3

Yes3

Yes3

Yes3

Yes3

No1

Yes

New Jersey

Yes

Yes2

Yes

No

No

No

Yes2

Yes2

Yes

Yes

New Mexico

Yes

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

No

New York

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

No

No1

North Carolina

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

North Dakota

Yes

Yes

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Ohio

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Oklahoma

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Oregon

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Pennsylvania

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Rhode Island

Yes

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

Yes2

Yes

Yes

South Carolina

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

South Dakota

Yes

No

No

No

No

No

Yes

Yes

No

No

Tennessee

No

No

No

No

No

No

No

No

No

No

Texas

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes2

Yes2

Utah

Yes

Yes3

Yes3

Yes3

Yes3

Yes3

Yes

Yes

No1

No1

Vermont

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

Virginia

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No1

No

Washington

Yes

Yes

Yes

No

No

No

Yes

Yes

No

Yes

West Virginia

Yes

Yes2

Yes2

Yes2

Yes2

Yes2

No

Yes2

Yes2

No

Wisconsin

Yes

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes3

Yes

Wyoming

Yes

Yes

Yes

No

No

Yes

Yes

Yes

No

Yes

 

Notes: 

Data as of April 2009.

Sources: 

Kaiser State Health Facts; American Lung Association's State Cessation Coverage Database. Available at http://lungusa2.org/cessation2/.

Definitions: 

NRT: Nicotine replacement therapy.

Footnotes: 

1. Coverage only for pregnant women.

2. Coverage varies by health plan.

3. Coverage provided only under certain conditions.

OTHER CONNECTICUT PROGRAMS

Background

In 1999, the legislature established a Tobacco and Health Trust Fund with the purpose of creating a significant source of funds to (1) support and encourage development of programs to reduce tobacco abuse through prevention, education, and cessation programs; (2) support and encourage development of programs to reduce substance abuse; and (3) develop and implement programs to meet the unmet physical and mental health needs in the state.

The Trust Fund is a separate, non-lapsing fund that accepts transfers from the Tobacco Settlement Fund and may apply for and accept gifts, grants, or donations from public or private sources. A board of trustees was established in 2000 to administer the fund. The board's statutory purpose is to select programs to receive money from the trust fund. Following are some highlights on smoking cessation initiatives from the “Fiscal Year 2010 Report of the Tobacco and Health Trust Fund Board of Trustees,” published in December 2009.

Quitline

“Connecticut Quitline” is a smoking cessation telephone service available to state residents that provides information and counseling about tobacco use. Callers can phone 866-363-4224 (866-END-HABIT) or 1-800-784-8669 (1-800-QUIT-NOW) seven days a week from 8 a.m. to 3 a.m. Written materials are also sent to callers, based on their readiness to quit. Separate materials are available for pregnant women who wish to quit smoking. Callers who are ready to quit smoking and are interested in further telephone-based service will receive up to five telephone counseling sessions and a “Quit Kit” containing informational and supportive materials.

Connecticut Quitline is funded by the Department of Public Health (DPH) and administered by Free and Clear, Inc., a commercial tobacco treatment provider based in Seattle, Washington. More information is available at http://www.freeclear.com/. As a result of RFP #2009-0916, issued on October 7, 2008, a contract was awarded to Free and Clear for an additional $1.5 million during the period of August 2009 through June 2010 for basic services, nicotine replacement therapy and pharmacotherapies, customer satisfaction and quit rate surveys, and marketing materials replacement.

Community-Based Cessation Programs

DPH developed and released an RFP on January 19, 2009 for community-based cessation programs. On May 29, 2009, it awarded contracts totaling $412,456 for the period of September 1, 2009 to December 31, 2011 to: AIDS Project New Haven ($70,290); Community Health Center, Inc. ($42,450); Fair Haven Community Health Center, Inc. ($66,712); Generations Family Health center, Inc. ($43,700); Hartford Gay and Lesbian Health Collective, Inc. ($94,230); Hospital of St. Raphael ($51,248); and Ledge Light Health District (443,826).

(Other tobacco use cessation programs operate throughout the state—see attached list.)

Cessation Programs for People with Serious Mental Illness

An RFP on smoking cessation programs for persons with serious mental illness was released in February 2009. In May 2009, a contract for $1,199,687 was awarded to CommuniCare, Inc. of Ansonia.

Counter Marketing Campaign

A contract was awarded in May 2009 to Cronin and Company of Glastonbury for $1,999,820 for the September 1, 2009 to August 31, 2011 period for a smoking counter marketing campaign. Generally, such a campaign involves television, radio, print, billboard and other media and venues.

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