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Smoking Cessation in California Medicaid Programs

Institution: University of California, San Diego
Investigator(s): Sara McMenamin, Ph.D.
Award Cycle: 2019 (Cycle 28) Grant #: 28IR-0056 Award: $587,017
Subject Area: State and Local Tobacco Control Policy Research
Award Type: High Impact Research Project Award

Initial Award Abstract

Prevalence of tobacco-use continues to remain higher among Medicaid enrollees with smoking rates more than double that of the general population. This tobacco use and related morbidity results in health disparities and lower health status for Medicaid enrollees, including vulnerable populations such as low income persons, pregnant women, people with disabilities, and people with mental illness. Despite Medicaid coverage for effective cessation medications, previous research has documented that these treatments are under-utilized -- with only 7% of Medicaid enrolled smokers in California using covered cessation medications. This signals a need to understand what California Medicaid programs are doing to encourage utilization of smoking cessation treatments, what barriers are being put into place to limit use, and what best practices can be taken and applied in the 25 MediCal managed care plans (MCPs) operating in California providing services to nearly 11 million enrollees.

The proposed research project will use a mixed methods approach to document smoking cessation policies in California MCPs and to link these practices with smoking and cessation-related outcomes. Information will be collected on MCP smoking cessation policies via in-depth interviews with key-informants at each MCP. These interviews will document current policies and allow for analysis of MCP characteristics associated with full implementation with federal and state policies. The second component of this research project will involve coding the responses from the MCPs into a quantitative dataset and combining this information with smoking and cessation outcome data from the California Smokers' Helpline, CHIS, and the California DHCS drug utilization database to allow us to explore the association between policies in place at each of the MCPs with specific smoking cessation outcomes.

This work would be of use to two different groups of stakeholders. First MCPs would benefit from receiving feedback on how their policies compare to the other MCPs in California. Second, policy makers, tobacco control advocates, and researchers will benefit from identification of MCP policies that enable Medicaid enrollee utilization of effective smoking cessation therapies to shrink the gap between medication utilization among MediCal enrollees compared to Medicaid enrollees nationwide.