Connecticut is one of four states that do not pay for smoking cessation help under Medicaid, though the state has received more than $1 billion in tobacco settlement funds designed to build an anti-smoking war chest.
But Kevin Lembo, who pushed for the coverage as the state’s health care advocate, said that he expects the incoming administration of Gov.-elect Dan Malloy to make Medicaid funds available for cessation. Statistics show that cessation programs are far less expensive than disease treatment.
“I think we’re heading in the right direction now and at long last,” said Lembo, who is the state comptroller-elect. The Department of Social Services, at the direction of the governor, needs to make policy change to bring Connecticut in line with other states, he said. “I am feeling very good about it,” Lembo said.
The state’s overall smoking rate is below the national average at 15.9 percent, but about 40 percent of Medicaid recipients smoke, according to a study by the Connecticut Health Policy Institute.
Medicaid does cover a long list of smoking-related expenses, from emphysema treatments to lung transplants. Medicaid patients who are pregnant are offered smoking cessation services. That coverage began last Oct. 1, mandated by federal health care reform.
Other states found that paying for smoking cessation for Medicaid recipients prevented costly tobacco-related illnesses. Among Massachusetts Medicaid subscribers who used their cessation benefit, there was a 46 percent drop in hospital admissions for heart attacks and a 49 percent decline in admissions for other acute cardiac conditions, according to a state study released in November.
It costs approximately $60,000 to provide treatment after a heart attack, in contrast to about $500 to help a smoker quit, said Patricia Checko, chair of Mobilize Against Tobacco for Children’s Health, a non-profit grass roots organization.
“Connecticut’s Medicaid budget is funded 100 percent up-front in the DSS budget, before partial federal reimbursement later comes to the general fund as revenue. This means additional dollars (need) to be identified up-front even when long-term benefits may be realized later,” said DSS spokesperson David Dearborn. In other words, the budget agreed upon by the legislature and governor determines whether resources are available to fund specific Medicaid services such as smoking cessation. He added that the state has used anti-tobacco money to operate a free QuitLine, where smokers can get nicotine gum or patches on a first-come-first-served basis.
Advocates will likely push for full Medicaid coverage for smoking cessation, including prescription drugs, nicotine replacement and counseling when the General Assembly convenes this week.
“It’s been a lack of commitment to the concept, despite the bankroll,” said Checko.
In 1998, Connecticut joined 45 states in reaching a $246 billion settlement with tobacco companies to be paid out in perpetuity. The state’s take was estimated to come to $3.6 to $5 billion over the first 25 years, a sum that was expected to go toward preventing children from using tobacco and helping adults quit. The settlement did not explicitly require states to use the money for these purposes, though its architects insist that was the intention.
“As I have repeatedly advocated, Connecticut has a public health and financial duty to properly invest our tobacco settlement dollars—more than one hundred million annually—in smoking cessation and prevention programs,” Attorney General Richard Blumenthal said in a statement after the Massachusetts study was released. Blumenthal, a U.S. Senator-elect, represented Connecticut in the settlement.
Only $9.1 million of the $1.29 billion received has gone to tobacco control, according to a 2009 report by Connecticut’s Tobacco and Health Trust Fund Board of Trustees. The state also has a $3-a-pack tax on cigarettes, which raised more than $380 million in the last fiscal year, according to the state Office of Legislative Research. That’s another pot of money advocates, like Checko, would like to draw on for smoking cessation.
The state has been criticized nationally for the way it uses its settlement funds. The Campaign for Tobacco Free Kids recently rated Connecticut 45th out of 50 states in investment to control tobacco. The state has $400,000 in trust funds set aside for tobacco control in fiscal 2011, which is .9 percent of what the federal Centers for Disease Control recommends. Yearly health care costs directly attributable to smoking in Connecticut are $1.63 billion, according to the campaign’s report.
Checko is optimistic that anti-tobacco groups stand a better chance of reaching their goal in the legislative session. The struggle has been so long in part because of a general hesitancy by the state to invest in public health, Checko said.
“This isn’t our only example, if you look at the way we fund public health and prevention in general,” she said.
The Connecticut Health Policy Institute report was funded by Universal Health Care Foundation, which is a C-HIT funder.