Medicaid members will have greater access to more smoking cessation assistance, thanks to reforms of New Jersey’s program, which advocates say now spends $1 billion annually on smoking-related health conditions.
The state Department of Human Services announced yesterday that language changes in the recently adopted state budget would make it easier for Medicaid patients to obtain medications — like gums, lozenges, and skin patches — to help them quit. The revision removes the current managed-care requirements that a doctor provide prior approval for this treatment; nearly 95 percent of New Jersey Medicaid patients are now covered by managed-care contracts.
In addition, the DHS said that — starting in January — Medicaid patients would also have access to smoking cessation programs like federally approved group counseling sessions. There is currently no reimbursement for these types of services.
Tobacco’s death toll
“Tobacco use is the leading preventable cause of death and disease in New Jersey, leading to chronic lung disease, heart disease, stroke, and cancer,” said DHS Commissioner Carole Johnson. “The Murphy administration is committed to reducing tobacco use, which kills 11,800 New Jerseyans each year.”
Lawmakers have considered similar reforms in a bill the Assembly health committee adopted in May, but the measure did not advance further. During the hearing, supporters pointed to data from Massachusetts, which expanded cessation coverage 12 years ago, that showed 37 percent of tobacco users on Medicaid took advantage of the program, and smoking-related hospital admissions were cut nearly in half.
The DHS had previously made changes to the Medicaid program to expand access to diabetes prevention programs, which provide specific diet, exercise, and lifestyle advice in an effort to reduce the incidence of the devastating disease. New Jersey is now among just a handful of states that will pay nonclinical providers, like YMCAs, to provide federally approved programs to Medicaid members.
Tobacco use among Medicaid members
While smoking rates have declined in the Garden State — to less than 14 percent of adults, and nearly 12 percent of high school students — and continue to be below the national average, tobacco use is significantly higher among Medicaid members than the general public. Cigarette smoking has been definitively linked to lung cancer (87 percent of lung cancer is attributed to tobacco use), heart disease, stroke, asthma, diabetes, reproductive problems for women, and low birth-weight babies, among other conditions.
Research published in 2017 by scientists at the University of California indicated that between 1997 and 2013 nationwide smoking rates declined from 22.6 percent to 16.8 percent among patients with private insurance. But the rate among Medicaid members dropped from 33.8 percent to 31.8 percent, a decline they considered negligible. With the growth of Medicaid overall, the number of smokers insured by the program more than doubled during that time.
Michael Seilback, a national vice president and state public policy director for the American Lung Association, said the state’s change would make it easier for people to “quit this deadly addiction, once and for all.” The association had previously given New Jersey an “F” for its smoking cessation efforts.
“Expanding tobacco cessation coverage for Medicaid enrollees, who smoke at rates higher than the rest of the population, is not only an important opportunity to save lives and prevent tobacco-related disease, but it will also reduce the state’s healthcare costs,” he added.
At the Assembly hearing in May, officials with the American Heart Association said New Jersey spends more than $1 billion annually on treating smoking-related conditions among Medicaid patients. While there was no estimate available for what the expanded coverage would cost, federal data collected as part of the Massachusetts program showed the Bay State saved $3 for every $1 it invested in the expanded cessation programs.
“Expanding access to tobacco cessation treatment for Medicaid patients will save lives, improve health, and save the state money by reducing healthcare costs,” added Dr. Jacqueline Schwanwede, president of the Northern New Jersey Board of Directors of the American Heart Association/American Stroke Association, in praising the DHS’s decision to move forward on its own. “Smoking is a major risk factor for cardiovascular disease and stroke, but smokers often need help to quit this deadly habit.”
Kicking the habit
According to a Heart Association poll, three out of four smokers want to quit and 80 percent have tried; 45 percent have tried more than three times. (One lawmaker, Assemblywoman Holly Schepisi (R-Bergen), conceded it took her seven tries to kick the habit.)
Under the changes instituted by the DHS, the state will now cover all seven tobacco cessation medications approved by the federal Food and Drug Administration, as well as the three forms of counseling that have been shown to help smokers quit. The FDA also offers a free text-messaging service designed to help tobacco users give up the habit.
The New Jersey Department of Health has spent roughly $10 million annually in recent years on various efforts to reduce tobacco use and the impact of smoking. In November, the state raised to 21 the legal age to purchase cigarettes and, starting in January, started to divert additional tobacco tax revenue — as much as $7 million annually — to cessation-related efforts.