Benson, Lampitt, Pinkin & Mukherji Bill to Expand Medicaid Coverage for Comprehensive Tobacco Cessation Services Clears Assembly Panel

(TRENTON) – Legislation sponsored by Assembly Democrats Dan Benson, Pamela Lampitt, Nancy Pinkin and Raj Mukherji to expand Medicaid coverage for comprehensive tobacco cessation services was approved Thursday by the Assembly Health and Senior Services Committee.

Recent studies sponsored by the Centers for Disease Control and Prevention found that comprehensive Medicaid tobacco cessation services in Massachusetts were associated with substantial decreases in smoking prevalence and decreases in hospital admissions for cardiovascular conditions.

Moreover, researchers from the George Washington University School of Public Health and Health Services found that over the first 2 ½ years of Massachusetts’s comprehensive Medicaid cessation coverage, every $1 spent on tobacco cessation services was associated with $3.12 in Medicaid savings, on average.

“We know how deadly cigarettes can be, and we know how hard it is for smokers to quit,” said Benson (D-Mercer/Middlesex). “By expanding coverage, we can help more people beat this terrible addiction while saving tax dollars through reduced Medicaid expenditures on hospitalizations and other services.”

The bill (A-2444-2656) would provide for the expansion of the State Medicaid program to include coverage for comprehensive tobacco cessation benefits, for individuals who are 18 years of age or older or who are pregnant.

Presently, New Jersey provides only partial coverage for medications used for tobacco cessation, and does not cover any form of counseling specifically for tobacco cessation.

“Many people want to quit but can’t do it alone,” said Lampitt (D-Camden/Burlington). “The longer they smoke, the bigger the health risks. If we can provide more people with services to help them quit, we can spare them the health consequences and the state the associated expenses.”

“Quitting smoking is not easy. Without the proper support, it’s even harder,” said Pinkin (D-Middlesex). “If we can get people on a healthier path and save money in the process, that’s a win.”

“Expanding Medicaid coverage to help low income New Jerseyans quit smoking and avoid the associated long-term health problems will save taxpayers additional costs for care down the road,” said Mukherji.

The covered benefits required under the bill include: brief and high intensity individual and group counseling, and phone counseling; all medications approved for tobacco cessation by the U.S. Food and Drug Administration; and other tobacco cessation counseling recommended by the Treating Tobacco Use and Dependence Clinical Practice Guideline issued by the U.S. Public Health Service.

The bill prohibits the following conditions from being imposed on the Medicaid tobacco cessation services: copayments or any other forms of cost-sharing, including deductibles; counseling requirements for medication stepped care therapy or similar restrictions requiring the use of one service prior to another; limits on the duration of services; or annual or lifetime limits on the amount, frequency, or cost of services, including, but not limited to, annual or lifetime limits on the number of covered attempts to quit.

The bill would also prohibit prior authorization requirements from being imposed on these services, except for: treatments that exceed the duration recommended by the U.S. Public Health Service clinical practice guidelines; or services associated with more than two attempts to quit within a 12-month period.

The bill would also require that information regarding the availability of the Medicaid tobacco cessation services be provided to all individuals authorized to receive these services at the following times: no later than 30 days after the bill’s effective date; upon the establishment of an individual’s eligibility for Medicaid; and upon the redetermination of an individual’s eligibility for Medicaid.

Lastly, the bill would require the Commissioner of Human Services to apply for any necessary Medicaid state plan amendments or waivers to provide coverage for the tobacco cessation services and to secure federal financial participation for associated state Medicaid expenditures under the federal Medicaid program.