Learning Objectives: Become aware of the magnitude of smoking costs paid by Medicaid programs
Abstract: PROBLEM/OBJECTIVE-A 2010 Healthy People goal is to increase smoking cessation among pregnant women from 14% (baseline) to 30%. The effectiveness of brief cessation counseling of 5-15 minutes delivered by a trained provider with the provision of pregnancy-specific, self-help materials has been shown. Yet, while Medicaid now insures 27% to 53% of states’ live births, little is known about the magnitude of costs attributable to prenatal smoking among those publicly insured that could be potentially averted.
METHODS-The Centers for Disease Control and Prevention’s (CDC) Maternal and Child Health (MCH) Smoking-Attributable Mortality Morbidity and Economic Costs (MCH-SAMMEC) software was used to derive national and state-specific estimates of prevalence, smoking-attributable neonatal costs and costs per Medicaid birth for 1997.
RESULTS-Approximately 13% of all women giving birth in 1997 report smoking during pregnancy. Consistent with knowledge that lower-income groups smoke more, the prevalence for mothers on Medicaid from MCH-SAMMEC is 20%, ranging across states from 10% to almost 39%. Nationally, smoking-attributable neonatal expenditures for all births are estimated at $366 million with Medicaid infants accounting for almost two-thirds of this, or $228 million. Smoking-attributable neonatal costs per birth to Medicaid-covered mothers averaged $738, with state estimates ranging from $532 to $946.
DISCUSSION-Many state Medicaid programs do not provide reimbursement for non-medication-counseling services appropriate for pregnant smokers. States could use the data in MCH-SAMMEC with estimates of women served and quit rates based on the literature to simulate the cost-effectiveness of reimbursing for this and/or alternative interventions for women whose delivery is insured by Medicaid.
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