“You feel like you are free,” she said. “It is such an addiction, your whole lifestyle changes because you are not trying to support the doggone habit.”
Bailey used the Freshstart smoking cessation program offered through University Hospital and for a time used the drug Chantix – although she dropped it because of side effects.
“It gave me a good start anyway,” she said. “It gave me an option for quitting.”
It is not an option, however, for most people on Georgia Medicaid. Today is the Great American Smokeout, when smokers are urged to take the day to consider quitting or plan ahead and quit today.
One of the biggest populations that has expressed the most desire to quit is Medicaid patients. According to a recent report from the Centers for Disease Control and Prevention, Medicaid patients expressed the highest desire to quit and the highest rate of attempting to quit among those who had insurance, but had the lowest success rate. Georgia is one of only two states that do not offer smoking cessation coverage to Medicaid patients who are not pregnant, said Jennifer Singleterry, the manager of cessation policy for the American Lung Association in Washington, D.C.
Medicaid smoking rates are “one of the highest rates if you break it down by insurance coverage,” she said.
But the Georgia Department of Community Health, which oversees Medicaid in Georgia, offers different reasons for not doing so. When first asked about it, department spokeswoman Pamela A. Keene said in an e-mail it was not offered “because there are no federal matching funds available” and the cost of products and counseling would be $13 million a year. Not so, Singleterry and the lung association said.
“It’s not true,” she said. “Tobacco cessation treatment is reimbursed just like any other health care expense that Medicaid could provide.” The state should know this because the Centers for Medicare and Medicaid Services sent a letter to state Medicaid directors on June 24 that included a number of ways state Medicaid programs could provide these services to all Medicaid patients.
Keene sent another e-mail Wednesday saying that the Social Security Act of 1927 “restricts the use of tobacco cessation drugs under the Medicaid program.” Also not true, Singleterry said. The law says that the drugs are on a list of drugs that “may be excluded from coverage or otherwise restricted” but does not require it.
The department’s e-mail goes on to say that “tobacco cessation success is directly related to the presence of both behavior modification therapy in addition to pharmacotherapy,” which the department says would mean providing “intensive face-to-face” counseling that is “much more costly.” State funding to cover both has not been provided, the department said. But Singleterry said she has never heard of the federal government not matching tobacco cessation spending by state Medicaid programs.
State Medicaid programs that have done it have seen marked success, according to the June 24 letter. Massachusetts’s Medicaid program, for example, provided comprehensive smoking cessation coverage and saw its Medicaid smoking rate drop from 38.3 percent to 28.3 percent, a decline of about 26 percent, according to CMS.
The lack of Georgia Medicaid coverage is an ongoing issue for health advocates, said June Deen, the state director for the American Lung Association.
“We intend to encourage state officials to re-examine this issue,” she said. “It just seems like a lost opportunity not to provide this benefit for the Medicaid population as well. Georgia can only win by providing this option.”
On a bright note, the State Health Benefit Plan will be providing coverage next year of one prescription per year to help state workers quit smoking.
“It’s not great but it’s a start,” Deen said.
As now a former smoker, Bailey said the important thing is to not stop trying.
“If you don’t quit one time, try it again because it is the most rewarding feeling,” she said.