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 smokers:


New Hampshire
Kansas New Mexico
Maine Oregon
Maryland Rhode Island
Massachusetts West Virginia
Minnesota Utah

Indiana and Wisconsin provide individual counseling services for pregnant smokers.

The 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 requirements.

January 5, 2001 letter to State Medicaid Directors

National Partnership Response
( link for this document is in development)

Early Periodic Screening, Diagnostic and Treatment (EPSDT)

The 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.

For more information about EPDST, visit http://www.cms.hhs.gov/medicaid/epsdt/default.html

To learn more about what your state covers or to contact your State Medicaid Director, visit http://www.nasmd.org/members.htm.

Federal Legislation
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 Congress.

Interagency Committee on Smoking and Health

The 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.

The full report will be submitted to Secretary Thompson by the end of February.

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