Adoption of system strategies for tobacco cessation by state Medicaid programs

Background: The Public Health Service's Clinical Practice Guideline for treating tobacco dependence recommends 6 system-wide strategies for health administrators, insurers, and purchasers to support tobacco cessation. Methods: A 24-question survey was sent to each state Medicaid program office in the fall of 2005, including questions to assess whether each state Medicaid program adopted 4 of the 6 system strategies most relevant to Medicaid contracting. Results: The number of system strategies adopted by state Medicaid programs in 2005 ranged from 0 to 4 of the 4 strategies examined. Oregon, Pennsylvania, and West Virginia adopted all 4 systems strategies for cessation in their Medicaid programs. Seven states adopted 3 strategies, and 14 states adopted 2. Seventeen states adopted only I of the system strategies, and 10 state Medicaid programs had not adopted any of the recommended system strategies for tobacco cessation. The most frequently adopted strategy was Medicaid coverage for tobacco dependence treatments, with 75% of the states covering at least I recommended treatment under their Medicaid program. Conclusions: Although most state Medicaid programs have made efforts to adopt at least one of the recommended system strategies to support tobacco cessation, there remains substantial room for improvement. More research is needed regarding the barriers to Medicaid program adoption of comprehensive system strategies to promote cessation among their enrolled populations.