Lawmakers Seek to Expand Medicaid Coverage for Smoking Cessation

Bill would deliver wide range of options to smokers, including counseling, group therapy, and full suite of medications

New Jersey lawmakers are considering a plan to expand insurance coverage of smoking cessation programs for Medicaid members — who are nearly twice as likely to smoke cigarettes as the population at large — in an effort to improve health, reduce deaths, and save money over time.

The Assembly Health and Senior Services Committee voted unanimously on Thursday to support legislation that would build on the current Medicaid program to ensure all members had access to a wide range of options to help end their tobacco addiction, including counseling, group therapy, and a full suite of medications. It also seeks to end prior approvals for those in managed-care Medicaid plans, which are run by insurance companies.

Lawmakers said Medicaid currently covers nicotine patches and gum; some Medicaid HMO plans also cover additional medications, but there is no benefit available for cessation programs. Anti-smoking advocates said more must be done to assist these tobacco users and stressed that any investment up front will generate two or even three times the savings down the road.

“Many people want to quit but can’t do it alone,” said Assemblywoman Pamela Lampitt (D-Camden), one of several Democratic sponsors of the plan. “The longer they smoke, the bigger the health risks. If we can provide more people with services to help them quit, we can spare them the health consequences and the state the associated expenses.”

Healthcare’s role in encouraging wellness

Interest in the legislation, which was first introduced in 2014, reflects a growing focus on healthcare’s role in encouraging wellness, not just treating disease. Providers are increasing the attention they pay to the underlying causes of conditions like heart disease and kidney failure, which are impacted by poor nutrition and lack of exercise, and investing in nonmedical prevention efforts like retrofitting homes to reduce asthma and limit accidents among the elderly.

State officials are also embracing prevention efforts, including initiatives to help individuals with high blood-sugar levels avoid being diagnosed with diabetes, a chronic condition that leads to amputations and even death. The Department of Human Services, which oversees Medicaid, is now seeking federal permission to tweak the state- and federally funded insurance plan to cover approved diabetes education programs run by healthcare providers and community groups like the YMCA.

DHS officials declined to comment on the pending legislation, but noted Democratic Gov. Phil Murphy’s $37.4 billion budget proposal for next fiscal year includes language to eliminate HMO prior authorizations for certain cessation benefits — something that has been a problem in the past, advocates note. “The administration is committed to increasing tobacco cessation and will continue to look for all available ways to reduce tobacco use,” DHS spokesman Tom Hester Jr. said.

Smoking on decline — selectively

Federal data shows smoking rates in the Garden State have continued to decline. Less than 14 percent of adults now smoke today, several points below the national average, and nearly 12 percent of high school students, according to the Campaign for Tobacco-Free Kids. But disparities abound, as tobacco use is more common among black and low-income residents, and among Medicaid members, more than 27 percent of whom smoke, advocates said.

In recent years, under former Gov. Chris Christie, the state has spent roughly $10 million annually on various anti-smoking efforts. Christie also signed a law last year to commit some $7 million more annually to this work, by diverting money from the state’s tobacco tax revenue, and he raised the legal smoking age to 21, starting in November.

Corrine Orlando, director of government relations for the American Heart Association, told the Assembly committee that smoking, which remains the leading cause of death in New Jersey and nationwide, cost the state’s Medicaid program more than $1 billion a year in treatments for related conditions. She said a recent poll showed three-out-of-four smokers wanted to quit and 80 percent of these had tried, while 45 percent had tried more than three times. Assemblywoman Holly Schepisi (R-Bergen) a committee member, said it took her seven times to kick the habit.

“We know how deadly cigarettes can be, and we know how hard it is for smokers to quit,” noted Assemblyman Dan Benson (D-Mercer), another lead sponsor. “By expanding coverage, we can help more people beat this terrible addiction while saving tax dollars through reduced Medicaid expenditures on hospitalizations and other services.”

Data from Massachusetts, which expanded Medicaid to cover a full suite of cessation benefits 12 years ago, suggests the investment pays off in a number of ways. Research by the American Lung Association showed that 37 percent of Bay State smokers with Medicaid took advantage of the program, and that it led to a nearly 50 percent reduction in smoking-related hospital admissions. Overall, Massachusetts received more than a $3 benefit for each $1 it spent.

The Garden State plan

The New Jersey proposal, which involved two bills (A-2444/A-2656) combined by the health committee, would amend the 1968 state law governing how Medicaid is administered to ensure all members have options for all medications, in addition to nicotine patches, gums, and nasal sprays, as well as cessation counseling and therapy programs approved by certain federal agencies. It also specifies that these services be available without any additional co-pay, deductible, or other out-of-pocket cost to the patient.

The bill — which received support from a wide range of anti-smoking groups, cancer advocates, and hospital representatives — would also prohibit HMO plans from requiring prior approval for these cessation services. And it would require state officials to distribute information about this new benefit to all Medicaid members within a month; evidence from other states, including Wisconsin and Iowa, underscores how public education is critical to the program’s success.

The measure was amended to ensure it applied to Medicaid members of all ages, not just those over 18 as originally proposed, and that telemedicine or online programs would be covered under the program. Other sponsors include Assemblywoman Nancy Pinkin (D-Middlesex) and Assemblyman Raj Mukherji (D-Hudson); Assemblyman Herb Conaway (D-Burlington), the committee chairman and a doctor, also added his name.

Assemblyman Erik Peterson (R-Hunterdon) questioned if the state had money to fund the expansion, but supported it based on Benson’s assurance the funds were available. The state’s nonpartisan Office of Legislative Services has not yet analyzed the cost of the proposal, but the federal government will cover 93 percent of the expenses, Benson noted.

“We need to be forward thinking enough,” Conaway said, “to move forward when all the evidence tells us we will save money and save lives, even if that savings is not immediate.” He also noted that, after the hearing, he was heading to the hospital to visit a patient who was admitted as a result of conditions linked to smoking.

A Senate version of the bill awaits a hearing.