One-quarter to one-half of
all pregnant women receives their health insurance coverage through
Medicaid. It is estimated that 38.5% of women who receive services
funded by Medicaid smoke during pregnancy. By extending services to
pregnant smokers, states can significantly reduce the number of
pregnant smokers. State Medicaid programs have been encouraged to
provide smoking cessation counseling and prevention treatment
services to pregnant smokers and to urge health care providers to
screen all pregnant women for tobacco use. In addition, states
should ensure that Medicaid managed care contracts with health
plans include tobacco treatment coverage.
Currently, only 13 states
provide coverage under their general Medicaid program for
counseling services that are most effective for pregnant smokers,
while 33 states and the District of Columbia provided some type of
tobacco treatment. Just eight states provided counseling to
pregnant women either through a special program for pregnant women
or a home visiting program.
These states cover group
and individual counseling services for pregnant
Indiana and Wisconsin
provide individual counseling services for pregnant
Center for Medicare and Medicaid Services (CMS) issued a letter to
State Medicaid Directors in January 2001 with policy guidelines for
coverage. The National Partnership is seeking clarification of
these guidelines to determine recommended coverage and mandatory
2001 letter to State Medicaid Directors
( link for this document
is in development)
Early Periodic Screening,
Diagnostic and Treatment (EPSDT)
EPSDT component of Medicaid can provide treatment services for
pregnant women and girls aged 21 and under. For Medicaid-eligible
individuals, screening for tobacco use and counseling for smoking
cessation may be part of available services. Screening for tobacco
use is considered part of anticipatory guidance, as referred to in"
Bright Futures: Guidelines for Health Supervision of Infants,
Children and Adolescents", which is sponsored by CMS and the Health
Resources and Services Administration, which many states have
adopted as principles of practice.
more information about EPDST, visit http://www.cms.hhs.gov/medicaid/epsdt/default.html
learn more about what your state covers or to contact your State
Medicaid Director, visit http://www.nasmd.org/members.htm.
During the 107th Congress,
bi-partisan bills were introduced in both the House and Senate that
provided counseling and pharmacotherapy cessation coverage for
pregnant smokers under Medicaid (S. 854 and H.R. 3676). Similar
legislation is expected to be introduced early in the 108th
Interagency Committee on
Smoking and Health
Department of Health and Human Services has convened a special
Interagency Committee on Smoking and Health to provide Secretary
Tommy Thompson with recommendation on addressing tobacco-related
health issues in the United States. A subcommittee on cessation was
created with representatives from public health and advocacy
organizations to provide specific recommendations in this area.
Three public hearings were held in the fall of 2002 where more than
100 organizations testified on the issue; many of which addressed
the need for cessation services for pregnant smokers.
View the Cessation
Subcommittee's recommendations, here.
full report will be submitted to Secretary Thompson by the end of