title: The impact of tobacco dependence treatment coverage and copayments in Medicaid.
abstract: BACKGROUND
  The Affordable Care Act (ACA) expands Medicaid's tobacco dependence treatment (TDT) coverage; however, these expansions differ in comprehensiveness based on Medicaid eligibility category.
  
  
  OBJECTIVE
  To examine whether more generous Medicaid TDT coverage (in terms of cost-sharing requirements and treatments covered) is associated with greater likelihood of quit attempts and successful quit rates.
  
  
  METHODS
  This study used repeated cross-sections from the Current Population Survey (2001-2011), linked to state-level survey data on Medicaid TDT coverage. The sample included 3,071 adult Medicaid recipients who reported smoking 12 months prior to the survey and resided in 28 states with consistent TDT coverage across Medicaid fee-for-service and managed care. Logistic regression models, conducted in October 2013, examined the relationship between state TDT coverage and Medicaid recipients' successful quits and attempted quit rates, controlling for individual and state characteristics.
  
  
  RESULTS
  Forty-one percent of Medicaid recipients attempted to quit smoking in the prior year and 7% quit successfully. Medicaid recipients in states with the most generous coverage (counseling without copayment and pharmacotherapy with copayment) had the highest predicted successful quit rates (8.3%). Those living in states with no TDT or pharmacotherapy-only coverage had lower predicted successful quit rates (range=4.0%-5.6%).
  
  
  CONCLUSIONS
  These findings suggest that the ACA will increase smoking quit rates among Medicaid recipients. Recipients who have more generous TDT coverage (such as the new Medicaid expansion population and pregnant women) will likely see greater increases in quit rates compared to existing adult Medicaid enrollees.
authors.affiliation: School of Nursing, George Washington University, Washington, District of Columbia. Electronic address: jessgreene@gwu.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Greene
authors.affiliation: Health Research Group, Institute for a Sustainable Environment, University of Oregon, Eugene, Oregon.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Sacks
authors.affiliation: Department of Family & Preventive Medicine, University of California San Diego Health Sciences, La Jolla, California.
authors.forename: Sara B
authors.initials: SB
authors.lastname: McMenamin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017047:Cost Sharing; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011247:Pregnancy; D012737:Sex Factors; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000628:therapy*; D014481:United States; D055815:Young Adult