MMWR Morb Mortal Wkly Rep. 2014 Mar 28;63(12):264-9.
Medicaid enrollees have a higher smoking prevalence than the general population (30.1% of adult Medicaid enrollees aged <65 years smoke, compared with 18.1% of U.S. adults of all ages), and smoking-related disease is a major contributor to increasing Medicaid costs. Evidence-based cessation treatments exist, including individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications. A Healthy People 2020 objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments. However, most states do not provide such coverage. To monitor trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of all evidence-based cessation treatments except telephone counseling by state Medicaid programs (for a total of nine treatments), as well as data on barriers to accessing these treatments (such as charging copayments or limiting the number of covered quit attempts) from December 31, 2008, to January 31, 2014. As of 2014, all 50 states and the District of Columbia cover some cessation treatments for at least some Medicaid enrollees, but only seven states cover all nine treatments for all enrollees. Common barriers in 2014 include duration limits (40 states for at least some populations or plans), annual limits (37 states), prior authorization requirements (36 states), and copayments (35 states). Comparing 2008 with 2014, 33 states added treatments to coverage, and 22 states removed treatments from coverage; 26 states removed barriers to accessing treatments, and 29 states added new barriers. The evidence from previous analyses suggests that states could reduce smoking-related morbidity and health-care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use.
医疗补助计划的参保者吸烟率高于普通人群（<65 岁的成年医疗补助计划参保者中，有 30.1%吸烟，而所有年龄段的美国成年人中，这一比例为 18.1%），而与吸烟有关的疾病是导致医疗补助计划支出增加的一个主要因素。现已有基于证据的戒烟治疗方法，包括个人、团体和电话咨询以及七种获得美国食品和药物管理局（FDA）批准的药物。《2020 年健康人》（Healthy People 2020）的一个目标（TU-8）呼吁所有州的医疗补助计划采用这些治疗方法的综合覆盖。然而，大多数州并未提供这种覆盖。为了监测各州医疗补助计划戒烟覆盖范围的趋势，美国肺脏协会收集了各州医疗补助计划（总共涵盖九种治疗方法）对除电话咨询以外的所有基于证据的戒烟治疗方法的覆盖数据，以及自 2008 年 12 月 31 日至 2014 年 1 月 31 日各州获取这些治疗方法的障碍数据（如收取共付额或限制可报销的戒烟尝试次数）。截至 2014 年，所有 50 个州和哥伦比亚特区至少为某些医疗补助计划参保者覆盖了一些戒烟治疗方法，但只有 7 个州为所有参保者覆盖了所有九种治疗方法。2014 年的常见障碍包括期限限制（40 个州，至少针对某些人群或计划）、年度限制（37 个州）、事先授权要求（36 个州）和共付额（35 个州）。与 2008 年相比，2014 年有 33 个州增加了治疗方法的覆盖范围，22 个州取消了治疗方法的覆盖范围；26 个州取消了获取治疗方法的障碍，29 个州增加了新的障碍。之前的分析结果表明，各州通过为所有基于证据的戒烟治疗方法提供医疗补助计划覆盖、取消获取这些治疗方法的所有障碍、推广覆盖范围并监测其使用情况，可降低医疗补助计划参保者的与吸烟有关的发病率和医疗保健费用。
