A publication of the Kentucky Center for Public Service Journalism

Poor adults on Medicaid more likely to quit smoking but only 15% of KY smokers use cessation benefit

By Melissa Patrick
Kentucky Health News

Low-income adults who gained health insurance under the expansion of Medicaid like Kentucky and most other states were more likely to quit smoking than those in states that didn’t expand the program.

So says a study by the University of Pittsburgh Graduate School of Public Health, published in the journal Medical Care. Researchers examined smoking-related responses from more than 36,000 low-income adults without dependent children using data from the federal Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance Survey for the years 2011 to 2015.

It found that in the 31 states that expanded Medicaid, 8.1 percent of those newly covered said they had quit smoking in the past year, compared with 6 percent of low-income adults in states that did not expand Medicaid. (This was after the researchers factored in the effects of smoking rates from demographics, differences in cigarette taxes and states’ indoor-air smoking policies.)

“Smoking cessation is notoriously difficult to achieve,” Marian Jarlenski, senior author and assistant professor in Pitt’s Department of Health Policy and Management, said in a news release. “The sizable increase we found in smoking cessation might lead to significant reductions in death and diseases caused by smoking, and the taxpayer-funded health care expenditures that come with treating them.”

The report notes that smoking is responsible for 9 percent of annual health-care spending in the U.S. The annual cost of smoking related health care costs to Kentucky is estimated to be $1.92 billion.

J. Wyatt Koma, a lead author of the study, said there are many ways that engaging with health-care services could motivate new Medicaid enrollees to stop smoking.

“During the Medicaid enrollment process, people are asked whether they smoke, so it’s possible that this question might prompt them to start contemplating smoking cessation,” he said in the release. “After enrollment, they have access to primary-care visits, where their clinician is likely to counsel them about quitting. And studies have shown that people in states with Medicaid expansion are much more likely to get prescriptions for smoking-cessation medications, which are covered by Medicaid.”

The researchers say the study provides evidence that Medicaid coverage can help people stop smoking. Koma said the quit rate of 8.1 percent is low, especially compared to the almost 70 percent of adults who say they want to quit.

What about Kentucky?

About 30 percent of low-income adults in the United States are smokers, which is double the national average. That rate is even higher among Kentucky’s Medicaid population — almost 44 percent, according to a survey conducted by the federal Center for Medicare and Medicaid Services.

That means 616,000 of the approximately 1.4 million Kentuckians on Medicaid are smokers. In the 2016-17 fiscal year, 90,013 of them used the smoking-cessation benefit — about 15 percent of the smokers.

Of those, 49,319 were on Medicaid due to the expansion, which covers about 480,000 people, and 40,694 were on traditional Medicaid, according to the state Department of Medicaid Services. The expansion took effect in 2014.

The figures shows only how many Medicaid beneficiaries used the smoking-cessation benefit and not how many of them were successful at quitting.

A similar look at Medicaid claims data from 2015 found that only 17.2 percent of Medicaid smokers used a smoking-cessation medication and a mere 1.4 percent received smoking-cessation counseling. The 2015 Cabinet for Health and Family Services report cited a much smaller number of Kentuckians on Medicaid dependent on tobacco, only 10 percent, but that data was based partly on records that were likely incomplete.

New law and advocacy could lead to higher participation

When the numbers for the current fiscal year are compiled, they could show increased use of the smoking-cessation benefit, because Kentucky passed a law in the 2017 legislative session to require all health insurers, including Medicaid managed-care companies, to remove barriers to coverage for all federally approved tobacco-cessation medications and programs. The law took effect June 29, the day before the fiscal year ended.

Why was the law needed, if the Patient Protection and Affordable Care Act requires all insurance policies to cover smoking-cessation treatments? Insurers erected several barriers to treatment, such as co-payments, prior-authorization requirements and limits on length of treatment.

One of the goals of the newly formed Coalition for a Smoke-Free Tomorrow, staffed by the Foundation for a Healthy Kentucky, is to educate the public and health-care providers about the new law.

“We are all working to educate physicians, community health workers and residents to ensure they know that counseling and nicotine-replacement therapies are available free of charge,” said Ben Chandler, president and CEO of the foundation. “The starting points for smokers vary; it may be a talk with their doctor, or seeing one of the ads for the Kentucky QuitLine campaign. Our goal is to make sure that every Kentuckian who is addicted to nicotine knows where they can get the help they need to successfully kick the habit.”

Resources to help Kentuckians quit smoking can be found at www.quitnowkentucky.org and www.smokefreetomorrow.org. Kentucky’s Tobacco Quitline is 1-800-QUIT-NOW (1-800-784-8669). Also, many local health departments offer smoking cessation classes.

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