Exploring Factors Associated With Full Implementation of the Affordable Care Act's Medicaid Tobacco Cessation Provisions

• Published date: 01 September 2021
• Author: Sara B. McMenamin,Sara W. Yoeun
• Date: 01 September 2021
• DOI: http://doi.org/10.1002/wmh3.384

462

doi: 10.1002/wmh3.384

© 2021 Policy Studies Organization

Exploring Factors Associated With Full Implementation

of the Affordable Care Act's Medicaid Tobacco Cessation

Provisions

Sara B. McMenamin and Sara W. Yoeun

Medicaid enrollees use tobacco at rates more than double that of the general population. To address

this disparity, the Affordable Care Act (ACA)contained provisions to increase access to tobacco

cessation treatments for Medicaid enrollees. There have been relatively low levels of implementation of

these provisions by Medicaid programs. This research aims to evaluate the potential political, eco-

nomic, and policy factors associated with implementation of each of the four tobacco‐cessation‐related

ACA provisions. In 2017, UC San Diego researchers collected survey data from 51 Medicaid pro-

grams on tobacco cessation treatment policies and state‐level variables from publicly available sources.

Implementation of these provisions was associated with state‐level variables such as having a budget

shortfall during the recession years, Democratic control of the Governorship or legislature, and higher

state cigarette taxes. Further guidance from the Centers for Medicare and Medicaid Services will be

necessary to achieve full implementation of these ACA provisions.

KEY WORDS: tobacco cessation, Affordable Care Act, Medicaid

Introduction

Although great strides have been made in reducing cigarette smoking in the

United States, tobacco use continues to be one of the largest contributors to adverse

health outcomes among low‐income populations (Centers for Medicare and

Medicaid Services, 2019). Adults on Medicaid have smoking rates more than twice

that of the general adult population (Ku et al., 2016). Guidelines developed by

the United States Preventive Services Taskforce (USPSTF)recommend health in-

surance coverage of seven Food and Drug Administration (FDA)‐approved drugs

and three counseling modalities, including individual, group, and proactive tele-

phone counseling, without cost‐sharing to aid in smoking cessation (Fiore

et al., 1996, 2000, 2008). Prior to the enactment of the Patient Protection and

Affordable Care Act (ACA)in 2010, only seven Medicaid programs covered all of

the USPSTF recommended treatments (McMenamin et al., 2010).

In 2010, four relevant provisions were introduced through the ACA to align

state Medicaid program smoking‐cessation treatment coverage with the USPSTF

guidelines. These two mandatory provisions (Sections 4107 and 2502)and two

voluntary provisions (Sections 4106 and 2001)are described below.