title: State-level Medicaid expenditures attributable to smoking.
abstract: BACKGROUND
  Medicaid recipients are disproportionately affected by tobacco-related disease because their smoking prevalence is approximately 53% greater than that of the overall US adult population. This study estimates state-level smoking-attributable Medicaid expenditures.
  
  
  METHODS
  We used state-level and national data and a 4-part econometric model to estimate the fraction of each state's Medicaid expenditures attributable to smoking. These fractions were multiplied by state-level Medicaid expenditure estimates obtained from the Centers for Medicare and Medicaid Services to estimate smoking-attributable expenditures.
  
  
  RESULTS
  The smoking-attributable fraction for all states was 11.0% (95% confidence interval, 0.4%-17.0%). Medicaid smoking-attributable expenditures ranged from $40 million (Wyoming) to $3.3 billion (New York) in 2004 and totaled $22 billion nationwide.
  
  
  CONCLUSIONS
  Cigarette smoking accounts for a sizeable share of annual state Medicaid expenditures. To reduce smoking prevalence among recipients and the growth rate in smoking-attributable Medicaid expenditures, state health departments and state health plans such as Medicaid are encouraged to provide free or low-cost access to smoking cessation counseling and medication.
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-88, Atlanta, GA 30329, USA. barmour@cdc.gov
authors.forename: Brian S
authors.initials: BS
authors.lastname: Armour
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.forename: Ian C
authors.initials: IC
authors.lastname: Fiebelkorn
mesh_terms: D000328:Adult; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D017059:Models, Econometric; D015995:Prevalence; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult