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Author Notes:

Correspondence: E. Kathleen Adams, Ph.D., Rollins School of Public Health, Emory University, Health Policy and Management, 1518 Clifton Road NE, Atlanta, GA 30322. Email: eadam01@emory.edu. Telephone: 404-727-9370. Fax: 404-727-9198.

Acknowledgments: We gratefully acknowledge the collaboration of Sara McMenamin, PhD at University of California, Berkeley in sharing the data from the MMWR series in Excel format and for her able assistance in understanding its limitations.

The authors also acknowledge the input and hard work of the PRAMS working group.

See publication for full list of PRAMS working group.

Disclosures: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


Research Funding:

Funding for this research was provided by the Centers for Disease Control and Prevention, Division of Reproductive Health and the Robert Wood Johnson Foundation (RWJF), HCFO Initiative Health Care Financing Initiative (HCFO) Grant # 66104.


  • Medicaid
  • Maternal and Perinatal Care and Outcomes
  • Substance Abuse: Alcohol / Chemical Dependency / Tobacco
  • Observational Data / Quasi-Experiments

Expansion of Medicaid Covered Smoking Cessation Services: Maternal Smoking and Birth Outcomes


Journal Title:

Medicare & Medicaid Research Review


Volume 3, Number 3


, Pages mmrr.003.03.a02-mmrr.003.03.a02

Type of Work:

Article | Final Publisher PDF


Objective: To assess whether Medicaid coverage of smoking cessation services reduces maternal smoking and improves birth outcomes. Methods: Pooled, cross-sectional data for 178,937 women with live births from 1996 to 2008, who were insured by Medicaid in 34 states plus New York City, were used to analyze self-reported smoking before pregnancy (3 months), smoking during the last 3 months of pregnancy, smoking after delivery (3-4 months), infant birth weight, and gestational age at delivery. Maternal socio-demographic and behavior variables from survey data and birth outcomes from vital records were merged with annual state data on Medicaid coverage for nicotine replacement therapies (NRT), medications and cessation counseling. Probit and OLS regression models were used to test for effects of states' Medicaid cessation coverage on mother's smoking and infant outcomes relative to mothers in states without coverage. Results: Medicaid coverage of NRT and medications is associated with 1.6 percentage point reduction (p<.05) in smoking before pregnancy among Medicaid insured women relative to no coverage. Adding counseling coverage to NRT and medication coverage is associated with a 2.5 percentage point reduction in smoking before pregnancy (p<.10). Medicaid cessation coverage during pregnancy was associated with a small increase (<1 day) in infant gestation (p<.05). Conclusions: In this sample, Medicaid coverage of smoking cessation only affected women enrolled prior to pregnancy. Expansions of Medicaid eligibility to include more women prior to pregnancy in participating states, and mandated coverage of some cessation services without co-pays under the Affordable Care Act (ACA) should reduce the number of women smoking before pregnancy.

Copyright information:

All material in the Medicare & Medicaid Research Review is in the public domain and may be duplicated without permission. Citation to source is requested.

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