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Medicaid & Medicare

Medicaid

A number of ACA provisions pertain to tobacco cessation, chief among them that states are now mandated to provide comprehensive cessation services to Medicaid pregnant women. Co-pays have been eliminated for preventive services and over-the-counter cessation medications cannot be excluded.

ACA Section 4106 is intended to improve access to Preventive Services for eligible adults in Medicaid. States are provided an Option to Cover USPTF Preventive Services A/B State Medicaid Agencies and receive a 1% FMTP.

The American Lung Association collects data on state Medicaid benefit coverage and this information is updated periodically and included in ALA’s State by State report cards. Through a May 2011 survey, the Collaborative identified 17 states working to improve Medicaid cessation benefits or promote benefits to increase utilization.

Medicare

Under the ACA, Medicare cessation benefits expanded to all beneficiaries. Cessation benefits were previously limited to Medicare recipients with tobacco-related disease. ACA Section 4104 eliminated co-pays for Preventive Services including tobacco cessation. ACA Section 4103 provides for coverage for an Annual Wellness Visit and a Personalized Prevention Plan that may include tobacco cessation services.

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