DHHS to cut Medicaid coverage for anti-smoking medications

AUGUSTA, Maine — Maine appears to be the only state in the country this year to eliminate Medicaid coverage for prescription drugs that help smokers quit, a budget-balancing move critics say will ultimately cost more and leave many Mainers hooked on nicotine.

The Maine Department of Health and Human Services plans to cut about $430,000 for anti-smoking medications under Medicaid, known in the state as MaineCare. The cut also will spell the loss of $750,000 in federal matching funds, amounting to a $1.2 million cut over the 2012 and 2013 fiscal years.

Pregnant women covered by MaineCare will not be affected by the cuts.

The reduction takes effect Sept. 1, according to Stefanie Nadeau, director of MaineCare Services at DHHS. Smokers trying to quit still can get help through the Maine Center for Disease Control and Prevention, another office within DHHS, she said.

“There is still over $2 million in CDC funding for the quit help line, for tobacco-cessation products and nicotine-replacement therapy,” she said. “We really felt this was one [savings opportunity] we could propose to the Legislature as there are still funds available when individuals are ready to access the help to quit.”

The toll-free Maine Tobacco Helpline has about $600,000 to help callers pay for over-the-counter therapies such as nicotine gum and the patch. Some individuals, including the uninsured and underinsured, can apply for a voucher to purchase a supply of the products at their local pharmacy.

The state CDC money does not, however, cover anti-smoking prescription drugs, such as Chantix.

While Georgia and Alabama already don’t pay for the medications through their Medicaid programs, Maine appears to be the sole state this year backsliding on its coverage, according to the American Lung Association.

The state CDC’s programs are no substitute because the tobacco help line can’t absorb the extra demand from smokers who will need help quitting, said Ed Miller, vice president of health promotion and public policy for the American Lung Association in Maine.

“There’s no question that the absence of the medications is going to reduce the number of people who make attempts to quit, and it’s going to reduce the number of people who are successful in quitting,” he said.

The smoking rate among people covered by Medicaid is much higher than the general population. While smoking among adults in Maine plateaued at about 18 percent in 2010, the rate among adults covered by MaineCare was more than twice that, at 40 percent.

A recent report in Massachusetts dispelled the myth that poor people, which Medicaid covers, don’t want to quit smoking, Miller said. After the Massachusetts Medicaid program beefed up coverage for smoking cessation in 2006, the smoking rate among recipients fell from 38 percent to 28 percent in 2½ years, according to a January study by George Washington University.

Researchers also found that Massachusetts saved $3.12 for every $1 invested in the anti-smoking program by preventing hospitalizations for heart problems related to tobacco use. On average, the savings were recouped within just over a year after the recipients used the benefits.

“We have taken one of the most cost-effective services that Medicaid offers and have eliminated it from the program,” Miller said. “That’s the wrong direction to be going in, particularly in tough economic and budget times.”

In 2010, 15,000 MaineCare recipients, or about 4 percent, took advantage of tobacco-cessation products and medications.

The cut could be fairly short-lived, depending on the fate of President Barack Obama’s health reform law. That law, which was recently largely upheld by the U.S. Supreme Court, requires all states to cover anti-smoking prescription drugs by 2014.

DHHS has applied to the federal Centers for Medicare and Medicaid Services to cut the funding for anti-smoking drugs, but the state budget’s language allows the department to implement the reduction now as it waits for approval, Nadeau said.

“Downstream we will need federal approval, and we have submitted and asked for that, but we don’t have to wait for the approval to take action,” she said.

The cut, made through an amendment to Maine’s Medicaid state plan, is separate from another amendment to the plan that DHHS is seeking to tighten eligibility requirements for MaineCare, Nadeau said. DHHS hopes to get word on that change, which ignited a standoff between the LePage administration and the federal government, by Sept. 1.