Medicaid and CHIP Must Cover 100% of Quit-Smoking Costs, Eliminating All Copays and Prior Approvals

This legislation, dubbed the Helping Tobacco Users Quit Act, mandates a significant overhaul of how Medicaid and the Children’s Health Insurance Program (CHIP) cover tobacco cessation services. In short, if this passes, states must cover comprehensive services—meaning both counseling and prescription medications—to help people quit using tobacco products, and they can’t charge you a dime for it. Specifically, the bill requires coverage for treatments that align with established clinical guidelines, like those from the Public Health Service or treatments approved by the FDA (SEC. 2).

The biggest takeaway for anyone on Medicaid or CHIP is the elimination of cost-sharing. If you’re eligible, you won’t face any copayments, deductibles, or coinsurance for the counseling or the prescription drugs needed to quit, including nonprescription drugs if a doctor prescribes them for this purpose (SEC. 2 & SEC. 3). This is huge because often, even a small $5 or $10 copay can be the barrier that stops someone from getting the help they need. The bill also removes the administrative headache of prior authorization for these cessation drugs, meaning doctors can prescribe them without waiting for bureaucratic pre-approval from the state (SEC. 2 & SEC. 3).

The Federal Carrot: 90% Off for Five Years

To get states moving quickly, the federal government is offering a massive financial incentive. For the first five years, the feds will cover 90 percent of the cost for these new cessation services and the medications through an enhanced Federal Medical Assistance Percentage (FMAP) (SEC. 2). They’ll also cover 90 percent of the cost for states to run outreach campaigns, making sure that both patients and providers know these services are now available and free (SEC. 2 & SEC. 3). For states, this is a very sweet deal, essentially making the required coverage almost entirely federally funded for half a decade.

What This Means for Your Coverage

For a working parent covered by CHIP or a low-income adult on Medicaid, this bill makes quitting tobacco financially feasible. Imagine a construction worker trying to quit smoking: under this law, they could get counseling sessions and the necessary patches or prescription pills without worrying about the cost. Previously, states had flexibility on drug coverage and could charge copays, making the path to quitting unnecessarily expensive. This bill removes that financial friction entirely.

However, there is a catch in the funding structure. While the 90 percent federal match is great for the first five years, it drops back to the standard FMAP rate afterward. States will have to figure out how to maintain these expanded services and outreach programs once that enhanced federal funding disappears. If a state doesn't plan ahead, there's a risk that outreach efforts could slow down or that the burden on state budgets could increase significantly after the five-year clock runs out. The law also includes a safety net provision to ensure that the new rules don't accidentally limit any existing counseling or drug therapy already available to individuals under 18 years old (SEC. 4), protecting care for younger tobacco users.