title: Medicaid Coverage of Smoking Cessation Counseling and Medication Is Underutilized for Pregnant Women.
abstract: BACKGROUND
  Policies to promote smoking cessation among Medicaid-insured pregnant women have the potential to assist a significant proportion of pregnant smokers. In 2010, Kansas Medicaid began covering smoking cessation counseling for pregnant smokers. Our aim was to evaluate the use of smoking cessation benefits provided to pregnant women as a result of the Kansas Medicaid policy change that provided reimbursement for physician-provided smoking cessation counseling.
  
  
  METHODS
  We examined Kansas Medicaid claims data to estimate rates of delivery of smoking cessation treatment to Medicaid-insured pregnant women in Kansas from fiscal year 2010 through 2013. We analyzed the number of pregnant women who received physician-provided smoking cessation counseling indicated by procedure billing codes (ie, G0436 and G0437) and medication (ie, nicotine replacement therapy, bupropion, or varenicline) located in outpatient managed care encounter and fee-for-service claims data. We estimated the number of Medicaid-insured pregnant smokers using the national smoking prevalence (14%) in this population and the number of live births reported in Kansas.
  
  
  RESULTS
  Annually from 2010 to 2013, approximately 27.2%-31.6% of pregnant smokers had claims for nicotine replacement therapy, bupropion, or varenicline. Excluding claims for bupropion, a medication commonly prescribed to treat depression, claims ranged from 9.3% to 11.1%. Following implementation of Medicaid coverage for smoking cessation counseling, less than 1% of estimated smokers had claims for counseling.
  
  
  CONCLUSIONS
  This low claims rate suggests that simply changing policy is not sufficient to ensure use of newly implemented benefits, and that there probably remain critical gaps in smoking cessation treatment.
  
  
  CONCLUSIONS
  This study evaluates the use of Medicaid reimbursement for smoking cessation counseling among low-income pregnant women in Kansas. We describe the Medicaid claims rates of physician-provided smoking cessation counseling for pregnant women, an evidence-based and universally recommended treatment approach for smoking cessation in this population. Our findings show that claims rates for smoking cessation benefits in this population are very low, even after policy changes to support provision of cessation assistance were implemented. Additional studies are needed to determine whether reimbursement is functioning as intended and identify potential gaps between policy and implementation of evidence-based smoking cessation treatment.
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Taneisha S
authors.initials: TS
authors.lastname: Scheuermann
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Kimber P
authors.initials: KP
authors.lastname: Richter
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Wichita, KS.
authors.forename: Lisette T
authors.initials: LT
authors.lastname: Jacobson
authors.affiliation: Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
mesh_terms: D000328:Adult; D016642:Bupropion / Q000627:therapeutic use*; D003376:Counseling / Q000706:statistics & numerical data*; D016208:Databases, Factual; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007615:Kansas; D008484:Medicaid; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D011203:Poverty; D011247:Pregnancy; D037841:Pregnant People; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D014481:United States; D000068580:Varenicline / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D000068580:Varenicline