Tobacco Treatment Access and Utilization in Kentucky's Medicaid Population Over Time

Tobacco Treatment Access and Utilization in Kentucky’s Medicaid Population Over Time In states like Kentucky, with high prevalence of tobacco use and low socioeconomic status, increasing availability of tobacco treatment by removing barriers may increase demand and utilization of these services. In the long run, increased availability of tobacco treatment services is expected to reduce rates of tobacco use, leading to improved health and chronic disease outcomes and healthcare cost savings. The 2010 Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility to include individuals at 138% of the federal poverty level. The ACA also subsidized the creation of state-based insurance exchanges wherein individuals and small businesses can purchase health insurance plans. Kentucky was the only southern state to both expand Medicaid and establish a state based Marketplace. Under the ACA, access to tobacco cessation prescription and over the counter products was enhanced. Health plans are now required to cover beneficiaries for two quit attempts per year, with each attempt consisting of four sessions of counseling and 90 day supplies of any FDA-approved cessation medication. Governor Matt Bevin has unveiled a 1115 Medicaid demonstration project proposal (Kentucky HEALTH) that includes monthly premiums and requires patients to earn "credits" to access dental care and over the counter medications. This has major implications for the provision of tobacco treatment, as healthcare access, including access to over the counter nicotine replacement therapy, may be jeopardized. In addition, dentists play a major role in delivery of tobacco treatment and early identification of tobacco-related oral cancers. The purpose of the project is to examine the impact of the ACA and Kentucky HEALTH on tobacco treatment access and utilization among Medicaid recipients. Specific Aim 1: Examine utilization of tobacco treatment medications and counseling services over time, from pre-ACA to post ACA using the Medicaid claims dataset. Specific Aim 2: Determine differences in utilization of tobacco treatment medications and counseling services pre and post ACA implementation in Appalachian Kentucky versus non-Appalachian Kentucky using the Medicaid claims dataset. Specific Aim 3: Explore facilitators and barriers to and unintended consequences of tobacco treatment medications and services in Kentucky since implementation of the ACA and after the proposal of Kentucky HEALTH through semi-structured interviews with healthcare providers, Medicaid recipients, and representatives of managed care organizations. Key words: tobacco treatment, healthcare access, healthcare reform