MassHealth helps smokers quit, but cuts threaten program

Jeremy C. Fox | 11/25/2009, 4:48 a.m.

A benefit offered through MassHealth to help smokers kick the habit has produced a dramatic drop in smoking rates and a corresponding reduction in smoking-related health problems, the Massachusetts Department of Public Health (DPH) announced last week. But public health advocates worry that budget cuts will hamper its long-term success.

In a presentation before the DPH’s Public Health Council on Nov. 18, representatives from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) said the benefit had reduced smoking rates among MassHealth recipients by 26 percent. More than 75,000 people — 40 percent of all smokers covered by MassHealth, the state’s Medicaid program — have attempted to quit since the benefit became available, and more than 33,000 have succeeded.

Lois Keithly, Ph.D., director of the MTCP, said she was pleasantly surprised by the program’s popularity and attributed its success to its ease of use, low cost and wide promotion. The agency had hoped to see only about 5 percent of MassHealth smokers use the benefit each year.

According to the MTCP, among benefit participants tracked for a year after beginning treatment, there was a 38 percent drop in hospitalizations due to heart attacks, a 17 percent drop in the number of emergency room visits for asthma and another 17 percent drop in pregnancy complications, including ectopic pregnancies, hemorrhages and pre-term labor.

Because smoking is both a physical addiction and a social and psychological habit, treating it often requires a two-pronged approach. Robert Sokolove, Ph.D., director of smoking cessation programs at Boston Medical Center, said, “Whether one can maintain abstinence from cigarettes in part has to do with what behavioral skills they’ve been taught to replace nicotine as a way of coping with stress and physiologically how much they are genetically addicted to the nicotine molecule.”

That’s why the benefit covers both behavioral counseling to help smokers change their habits and all medications approved by the federal Food and Drug Administration, with only a $1 co-pay for generics and a $3 co-pay for brand-name medications. The low cost is essential to making the program work for low-income smokers.

“The way that they’ve set up the program really makes it so that folks are accessing the combination of counseling to quit and also medication, which is shown to double people’s chances to be able to quit and stay quit,” said Courtney Chelo, Oral Health Campaign Organizer at Health Care for All.

Massachusetts is one of only six states to offer a comprehensive smoking cessation benefit to Medicaid recipients, a group that has been shown to be more likely to smoke. A 2008 survey by the Centers for Disease Control and Prevention showed that nationwide 36.6 percent of Medicaid recipients between 18 and 65 were smokers versus just 22.6 percent of the general population.  

The smoking rate among MassHealth recipients was 38.3 percent for the 12 months prior to the benefit’s introduction. By calendar year 2008, it had dropped to 28.3 percent, well below the national average for Medicaid recipients.

Russet Breslau, executive director of the advocacy group Tobacco Free Mass, said the data confirms what she’s seen in her work, and that she believes further health benefits and cost savings will soon be evident. Breslau is concerned, though, that funding cuts for MTCP will hurt its ability to continue and expand the work. MTCP has lost 65 percent of its budget and no longer has any funding allocated for promoting the benefit.