Medicaid Tobacco Cessation Coverage in Oklahoma: 

A Case Study in Leveraging Systems and Partnerships



Introduction 

Comprehensive Tobacco 

Cessation Benefit: 

■■ Nicotine patch 

■■ Nicotine gum 

■■ Nicotine lozenge 

■■ Nicotine nasal spray 

■■ Nicotine inhaler 

■■ Bupropion 

■■ Varenicline 

■■ Individual counseling 

■■ Group counseling 

■■ Phone counseling 

Oklahoma’s adult smoking rate has historically been 

among the highest in the nation at 23.7 percent 

(the national rate is 19.0 percent).1 However, major 

progress was announced in January 2013: the smoking 

rate for members of SoonerCare (Oklahoma’s Medicaid 

program) saw a five percent drop from 48 percent in 

2008 to 43 percent in 2013. In addition, the Oklahoma 

Tobacco Helpline has seen an 82 percent increase 

in the number of SoonerCare callers from 2009 to 

2012, and nearly a doubling of calls in the last year 

alone.2 These successes indicate that tobacco users 

on SoonerCare are interested in quitting, interested in 

using evidence-based treatments to do so, and can, in 

fact, be successful. 

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Barriers to Accessing

Cessation Benefits: 

■■ Copays 

■■ Prior authorization 

requirements 

■■ Limits on length of treatment 

■■ Limits on quit attempts per 

year or lifetime 

■■ Requirements to try one 

treatment before another 

■■ Requirements to enroll in 

counseling before receiving 

medication 

These are all reasons for Oklahoma to continue to work to ensure all Medicaid 

enrollees have easy access to a comprehensive tobacco cessation benefit. 

However, despite 2010 Patient Protection and Affordable Care Act (ACA) 

provisions that encourage coverage of evidence-based cessation treatments 

for Medicaid enrollees,3 not all states have fully embraced this type of effort,4 

signifying a critical missed opportunity to reduce smoking-related death and 

disease among the nation’s most vulnerable population, and to reduce evermounting smoking-attributed healthcare costs. A 2014 study showed that while 

many states are increasing coverage of cessation treatments, they are also 

increasing barriers to that coverage.5 

The improved health and wellbeing of tobacco users on SoonerCare as a result 

of near-comprehensive6 and almost barrier-free tobacco cessation coverage is a 

reflection of a solid foundation of long-term relationships across state agencies. 

Oklahoma’s recipe for success is a collective commitment among partners to 

improve the health of the state, and the leveraging of institutional strengths to 

make continued improvements to cessation coverage. 

GUIDE TO THE READER 

Purpose 

This case study explores Oklahoma’s “real world” experience of designing and 

implementing near-comprehensive tobacco cessation coverage in SoonerCare 

(the Oklahoma Medicaid program) that has resulted in the successes noted above, 

as well as other promising outcomes. The roles of partners, the environmental 

and infrastructure support leveraged to bolster success, challenges faced and 

lessons learned are highlighted to guide and encourage those working toward 

comprehensive, barrier-free tobacco cessation coverage in Medicaid in other states. 

Key Agencies and Acronyms 

Oklahoma Health Care Authority (OHCA) 

OHCA is the primary entity in the state of Oklahoma charged with administering 

and controlling costs of Oklahoma’s Medicaid system, called SoonerCare, and 

ensuring that those who rely on state-purchased healthcare are served in a 

“progressive and positive system.”7 In this report OHCA is sometimes referred to 

as “the Medicaid Department.” 

Oklahoma Tobacco Settlement Endowment Trust (TSET) 

In 2000, the Oklahoma Constitution was amended by a vote of the people to 

place a portion of each year’s Master Settlement Agreement (MSA) payments 

into an endowment trust fund. The protection of MSA funds through TSET is 

unique among most states and has kept Oklahoma’s tobacco control priorities 

safe from drastic state budget cuts being faced by tobacco control programs in 

many other states. In this report, TSET is sometimes referred to as “the Trust.” 

Oklahoma State Department of Health (OSDH) 

OSDH is the primary public health agency in Oklahoma. OSDH’s Center for 

the Advancement of Wellness works to reduce obesity and tobacco use in 

Oklahoma by working with communities, workplaces, schools and other groups 

to enact policy, environmental and social norm changes.8 In this report, OSDH is 

sometimes referred to as “the Health Department.” 
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Oklahoma Tobacco Helpline (OTH) 

Launched in September 2003, the OTH is primarily funded by TSET, in 

partnership with OSDH, OHCA, Oklahoma Employees Group Insurance Division, 

and the Centers for Disease Control and Prevention.9 In this report, OTH is 

sometimes referred to as “the Helpline.” 

Methodology 

This case study is built upon extensive review of key documents, reports and 

articles appearing in online publications. Sources for data on Medicaid include 

American Lung Association data, the Kaiser Family Foundation website and key 

published articles related to the Medicaid population and tobacco use. Keyinformant interviews were conducted with representatives from the OHCA, 

TSET, OSDH and the University of Oklahoma Health Sciences Center. 

Audience 

The primary audience for this case study is state tobacco prevention and control 

and state Medicaid agency staff. Secondary audiences include the greater public 

health community, healthcare systems and decision makers. 

BACKGROUND 

According to the Centers for Disease Control and Prevention (CDC), Oklahoma 

ranks 45th in the United States for adult smoking prevalence,10 meaning the 

state has one of the highest smoking rates in the nation. Approximately 

6,200 Oklahomans die each year from tobacco related causes.11 Oklahoma’s 

adult smoking rate in 2012, while lower than the 26.1 percent in 2011, was 

23.7 percent compared to 19.0 percent nationally.12 For Oklahoma Medicaid 

enrollees, the adult smoking prevalence rate jumps to 43 percent.13 

The importance of supporting Medicaid smokers specifically in quitting is well 

documented. Not only are rates of smoking much higher among Medicaid 

enrollees than those of the general population (30.1 percent versus 18.1 

percent),14 Medicaid enrollees are by definition low-income, and therefore less 

able to pay for tobacco cessation treatments themselves. There are also critical 

cost-savings to be realized by covering evidence-based treatments for this 

population of smokers. Medicaid expenditures attributable to smoking total 

nearly $40 billion annually, representing about 15 percent of all expenditures.15 

Smoking-related diseases cost Medicaid programs an average of $833 million per 

state in 2013.16 

Surprisingly, despite these and other compelling data, most state Medicaid 

plans do not cover all treatments proven effective in helping smokers quit, and 

all states have at least one policy in place that makes it harder for a Medicaid 

enrollee trying to quit to access treatments that are covered.17 Only two states, 

Indiana and Massachusetts, provide comprehensive coverage for all Medicaid 

enrollees.18 An additional seven states cover all cessation treatments except 

phone counseling for all Medicaid enrollees: Connecticut, Maine, Minnesota, 

North Dakota, Ohio, Pennsylvania, and Vermont.19 Clearly, an exploration of state 

efforts to successfully expand coverage and decrease barriers to accessing that 

coverage is necessary. 
 ̵ Medicaid Tobacco Cessation Coverage in Oklahoma: A Case Study in Leveraging Systems and Partnerships

Oklahoma’s Medicaid tobacco cessation benefit went into effect in 2006 and 

began as coverage of specific cessation medications, eventually expanding 

to the full range of FDA-approved cessation medications, including over-thecounter nicotine replacement therapies, and individual and quitline counseling. 

It was soon after the benefit started that the Medicaid Department first sat 

down with the Trust and the Health Department to be more deliberate about 

applying evidence-based practices to coverage. Nearly nine years and many 

iterations of coverage later, Oklahoma’s Medicaid population has access to nearcomprehensive and almost barrier-free tobacco cessation coverage, and tobacco 

use rates in this population are decreasing. 

“This is a story of years and years of taking baby steps. We 

started with return-on-investment data and showed Medicaid 

the results. They were then worried about how much coverage 

would cost, so we encouraged an incremental approach. Don’t 

be afraid to put stopgaps in if your partners are worried about 

the money. Or, open it wide up and put stopgaps in later. 

The OHCA is under tremendous pressure to save money, and 

thankfully the science has advanced to show how cessation 

works to do just this. The Massachusetts study helped. Don’t 

be afraid to find creative ways to make the system work for 

you. Oklahoma’s approach is a great marriage between the 

science of cessation and the science of Medicaid!” 

—OSDH (Health Department) 

BUILDING BLOCKS FOR SUCCESS 

Systems Thinking 

Since 2008, the Trust, the Medicaid Department and the Health Department 

have worked together on a “systems approach” to cessation, with the Trust 

playing a lead role as a primary funder of Medicaid systems-based improvement 

efforts. Taking a systems approach allows for quick identification of underlying 

causes of an issue needing change and where to work to most effectively 

address it. Solutions that address as many problems as possible are identified, 

and, once the underlying structure is understood, the most appropriate leverage 

points to effect change within the system are clear. 

Medicaid’s Maternal and Child Health Unit is where, in 2008, the first formal 

partnership between the key agencies began. During a meeting of the state’s 

Perinatal Advisory Task Force in which the Health Department was invited to 

give an overview of cessation activities in the state, Medicaid was made aware 

of the Trust’s mission to fund systems-change efforts. A subsequent Trust grant 

to Medicaid to work with prenatal care providers to implement evidencebased clinical systems-change strategies was the beginning of a strong working 

relationship that also resulted in the hiring of a full-time Medicaid employee 

dedicated to this work. Over time, the focus of this position has changed from 

prenatal provider systems change to state-level partner engagement on cessation. 

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“Systems level changes are the lesson here. If you do not force 

yourself to look at big picture changes that you must dedicate 

resources to, you will not change the health of your state.” 

—OSDH (Health Department) 

TACTIC 

The structure of state Medicaid agencies varies. However, all Medicaid 

agencies are required by federal law to cover a comprehensive set of 

benefits and services for children known as Early and Periodic Screening, 

Diagnosis, and Treatment (EPSDT) programs. All Medicaid agencies have an 

EPSDT coordinator, and this is a great person to start with when trying to 

identify potential champions. While EPSDT coordinators have a specific set 

of duties assigned to them, they are often public-health minded supporters, 

are linked to the medical division within the agency, and understand that 

addressing tobacco use is key to the health and wellbeing of children. 

Aside from historic, trusted and respected relationships among layers of leadership 

within the key agencies, strategy to craft Medicaid agency infrastructure that makes 

the focus on cessation permanent has been highly successful and methodically 

implemented in Oklahoma. By leveraging administrative matching rates (costs 

incurred by states in administering the Medicaid program that are matched by 

the federal government at a 50 percent rate), the Trust now funds four positions 

responsible for identifying and fostering internal Medicaid cessation champions, 

incorporating wellness and cessation efforts into existing opportunities within the 

Medicaid agency (“in-reach” vs. outreach), and working with Medicaid providers. 

This strategy to leverage administrative matching funds is also used to support 

the SoonerQuit for Women mass media campaign. This campaign, which is 

targeted to the Medicaid population, has played an important role in increasing 

the Helpline’s reach to Medicaid enrollees.20 Capitalizing on administrative 

matching funds has gone a long way, with not a single dollar coming from the 

state Medicaid budget, but from the Trust—funds intended for supporting 

tobacco users in quitting. 

“We made the decision that if we were focusing on systems-level change, it had 

to come from within...We knew we needed to stick our nose to the ground, learn 

the language of insurance, how they make decisions and where they decide to 

take risks...Partnerships get the door open, and you have to have partners who 

are willing to listen. However, you better come in that door with the business case 

to support your innovation. This is what sets us apart—someone has to know the 

mechanism to operationalize this, and that person is inside Medicaid.” 

—TSET (the Trust) 
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TACTIC 

Embed someone within the network you want to change! Hire a person who 

knows that system well and who can translate cessation into the system’s 

language and agenda. How can we make the most of a system on behalf of 

cessation when we don’t even know where the essential leverage points are? 

Cross-Agency Work Group 

After seeing data reported in the March 28, 2014 Morbidity and Mortality 

Weekly Report on tobacco cessation21 the Medicaid and Health Departments 

launched a joint work group with the aim to improve access to tobacco cessation 

treatments among Medicaid enrollees by December 31, 2014. Over the course 

of multiple planning sessions, the agencies identified and prioritized several 

potential approaches for achieving this objective. The two strategies chosen by 

the group were to: 

■■ Remove barriers to obtaining tobacco cessation medications and 

counseling. At this time, barriers to obtaining cessation treatments 

among Medicaid enrollees included prior authorization for medications, 

copayments, a requirement to enroll in counseling in order to receive 

cessation medications, duration limits, and annual limits on quit attempts. 

The work group decided to focus first on elimination of copayments and 

prior authorization for all cessation medications covered by Medicaid. Steps 

included: 

❍■ Identify the appropriate channels for internal policy change 

❍■ Collaborate with Medicaid’s Health Policy Unit 

❍■ Review and analyze available data to assess utilization and possible 

budget impacts 

❍■ Determine if cost savings would be sufficient to pursue an administrative 

policy change process 

❍■ Obtain leadership approval 

Medication copayments and prior authorization were officially eliminated 

on September 1, 2014, the date set by the Health Policy Unit. While it is 

too early to begin analyzing claims data to assess the impact of the change, 

the state’s work group will focus on this assessment in 2015. 

■■ Increase the number of referrals to the Oklahoma Tobacco Helpline 

and increase the rates of enrollment in quitline counseling resulting 

from referrals.22 The work group created an automated referral database 

to improve the referral process to the Helpline and trained Medicaid 

Population Care Management (PCM) staff to integrate the new referral 

system into daily work processes. In four months, referrals to the Helpline 

were only slightly increased, as clients tended to want to work directly 

with case managers on quitting. However, the referral process has been 

incorporated into PCM processes, outreach and training. 
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“It has been one of the most 

productive work groups I’ve 

been on. It was also a work 

group that was created by 

leadership from both agencies 

and put at the top of the 

priority list. If we had other 

projects going on, those were 

pushed aside temporarily in 

order to complete the work 

group’s objectives.” 

—OHCA (Medicaid) 

Cross-Agency Work Group Members 

Oklahoma State Department of Health 

Cessation Systems Program Consultant 

Project Manager, Center for Health Innovation and Effectiveness 

Tobacco Use Prevention Manager 

Oklahoma Health Care Authority (Medicaid) 

SoonerQuit Grant Manager 

Policy Development Coordinator 

Medical Director 

Senior Planning Coordinator 

Case Management Supervisor 

Planning Coordinator 

Health Promotion Manager 

Statistician 

Research Analyst 

Data, Data, Data 

Evaluation planning is about anticipating what you want to achieve by expanding 

coverage and engaging evaluators and data experts from the very beginning 

of a change initiative. For Oklahoma, it was critical to define why specific data, 

especially cost-related data, was being collected, who was collecting it, and how 

it would be reported to internal and external stakeholders. While the Medicaid 

Department wanted to support enrollees in quitting, it also did not want to 

break the bank by expanding and promoting a cessation benefit. It was the 

responsibility of the work group members and the Trust to show at every step 

how utilization of the benefit would actually stretch Medicaid’s financial capacity 

to support the benefit. In summary, data were needed early on to ease the 

concern that the state Medicaid program would go broke as a result of expanded 

coverage with reduced barriers. 

In addition to cost data and utilization data, the University of Oklahoma Health 

Sciences Center evaluates two key programmatic areas using Helpline data: the 

Medicaid media campaign and efforts to increase fax referrals to the Helpline 

from clinics serving a high volume of Medicaid enrollees. The number of Helpline 

calls from Medicaid enrollees is tracked and analyzed for increases in utilization 

and for trends to inform media buys and ad placement. These data have been 

especially helpful in garnering support for Medicaid-specific Helpline promotion 

and systems intervention by providing real-time results of Helpline utilization 

linked with internal Medicaid activities to promote the Helpline. 

The Medicaid Department has also been working to promote the Helpline 

through fax referrals from targeted clinics. The Helpline data are helpful in 

tracking clinics’ and providers’ referrals and, again, linking results with internal 

programmatic efforts. 

Helpline data are shared with Medicaid quarterly in a dashboard format and the 

evaluator, Oklahoma Tobacco Research Center, works with Medicaid on how 

to communicate findings back to their decision-makers and how to frame the 

results for their partners. 
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Medicaid staff realized fairly quickly that once the medications benefit was in 

place, they needed to ensure monthly monitoring of counseling enrollment and 

medication utilization rates in order to sustain success. They needed to promote 

the robust benefit so that enrollees would be aware of it and want to use it, but 

also have hard data to report to internal stakeholders showing that the benefit 

was not going to “break the bank.” The Medicaid Department’s medical director 

has been a key ally in connecting with internal players such as the pharmacy 

director and public information officers to share data, analyses and trends. 

TACTIC 

When building your evaluation plan, do not rely too heavily on helpline/ 

quitline data. Helpline data goes a long way toward informing program 

staff, but can result in staff being unable to look beyond what the quitline 

can provide. There are many other important indicators and outcomes to 

monitor. Working with evaluators outside of your program can help guide 

you toward these. 

CHALLENGES TO SUCCESS 

Knowing How to Speak “Insurance” 

The Health Department and the Trust struggled with figuring out the intricate 

details of how insurance works. They knew best practices for tobacco control, 

but were in a foreign land when it came to creating and implementing a cessation 

insurance benefit. One of their first lessons was learning just how influential a 

role actuaries play within insurance providers (whether public or private) and 

that, when it comes to cessation, actuaries routinely overestimate the number of 

people who will use cessation treatments to try to quit. For both agencies, this 

became a critical leverage point for education. 

Actuaries must determine how much a benefit will cost in order to establish the 

impact of increased coverage on the overall budget, as well as the degree to 

which the investment in the benefit will be returned. As Health Department and 

Trust staff worked to understand how return-on-investment (ROI) figures were 

being determined by Medicaid, they learned that a cessation benefit utilization 

rate of 20 percent was predicted—an unheard of utilization rate to tobacco 

control professionals, who know that it takes a comprehensive mass media 

campaign to drive 5 to 6 percent increases in call volume to quitlines. Information 

on the factors that drive people to make a quit attempt and the full story of 

behavior change were critical context for actuaries to have as they developed 

ROI information. The Health Department had a “warehouse of epi support” to 

assist Medicaid with projecting utilization and could draw on the experience of 

what it takes to drive calls to the quitline to support this education effort. 
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TACTIC 

While educating the actuaries to ensure proper calculation of return on 

investment, the critical role of partnerships was also in play. The Health 

Department was working with the Medicaid medical director, a person 

with the ear of leadership, to show why Health Department data was more 

relevant and useful to cessation benefit utilization than data from internal 

experts the medical director works with every day. 

“Get someone to help you understand insurance. It is a different world 

and a different language. Don’t wait to get them to the table! They 

know what drives decisions and the data that matters. I would like to 

have skipped the couple of years we took to learn this lesson.” 

—OSDH (Health Department) 

“Agency leadership— 

leadership that is visionary 

and interested in truly serving 

the public’s needs—that is the 

gold ticket.” 

—OSDH (Health Department) 

TACTIC 

Barriers to accessing cessation medications serve two primary functions 

for state Medicaid agencies: cost containment and reduction of misuse 

or overuse. Therefore, utilization data, the evidence base on effective 

cessation treatments, and everything else used to make the case for 

decreasing barriers to medications coverage MUST address the concern 

that opening up access to medications will “blow the budget.” 

LESSONS SHARED 

Strong Leadership at Every Level 

Mid-level to executive-level leadership with direct knowledge and understanding 

of cessation goals has been immensely helpful to the success of Oklahoma’s 

efforts to increase coverage and decrease barriers to access. Through Medicaid 

structural and reporting changes over time, the staff at the center of this 

successful effort have, at times, reported to the agency director and medical 

director. In fact, for the past several years they reported to the Director of 

Communication, Outreach and Reporting, who now serves as the Medicaid CEO, 

and who was already an ally. In addition, the entire structure of Medicaid is very 

flat, or non-hierarchical, which facilitates access to executive staff and a less 

formal approach to working with other state agencies. 

There have also been long-standing relationships between the Trust’s 

Executive Director, and executive level leadership within Medicaid and the 

Health Department. Many of these leaders share social work backgrounds and 

understand the importance of addressing tobacco-related health disparities 

among low socio-economic-status communities, including persons enrolled in 

Medicaid. As noted by multiple key informants, while these partnerships, which 

have spanned over 15 years, have been essential to moving cessation forward, 

they are not the only essential piece of the puzzle. 
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“You simply can’t ride on the coattails of “partnerships” 

until the very end. You MUST be able to make the 

business case. Unfortunately for public health, this is a 

skill set we lack.” 

—OSDH (Health Department) 

A Less-Specific Policy 

There is some specificity to the Oklahoma Medicaid cessation coverage policy. 

For example, for counseling to be covered, a provider must use the 5 A’s 

protocol,23 and only cessation medications approved by the FDA are covered. 

However, the official policy does not specify all aspects of the benefit, and that 

has been an advantage. As a result of less specificity around existing barriers 

to treatment, there has not been a need for formal policy changes to decrease 

coverage barriers. The latter work has all been done administratively, including 

the removal of prior authorizations and copayments for medications. 

Don’t Forget Promotion and Tracking 

Anytime you are working to improve coverage, it is important to remember that 

outreach and promotion related to the improved or new coverage is an essential 

step that should follow on the heels of implementation. After all, the enhanced 

benefit will not be a success unless those who need it are aware of it and use it. 

In addition, be sure to promote the benefit, not only to Medicaid enrollees, but 

also to healthcare providers who serve the Medicaid population. These two very 

different audiences will require different messages and different messengers. 

“It doesn’t mean you have anything just because you have the 

benefit in place! It needs to be used to be meaningful. There 

was a lot of work focused on promotion and utilization right 

after our “win” that I didn’t anticipate.” 

—OHCA (Medicaid) 

Take Time to Strategize 

The Trust and Health Department carefully considered the right message to 

convince Medicaid of the need for improved coverage of and access to cessation 

treatments. Their message called attention to all of the costs associated with 

smoking by Oklahoma Medicaid enrollees and focused on convincing the Medicaid 

Department that, with a few changes that were in their full control, healthcare 

costs could be significantly reduced. As one partner expressed it, “We gave them 

the steering wheel to their car, and let them determine how fast and where to go.” 

The next step was to secure and support an internal champion. For Oklahoma, 

this was the Medicaid medical director—an ambassador who spoke both 

the language of Medicaid and the language of the cessation evidence base. 

Identifying the right champion within a Medicaid agency requires homework and 

getting to the root of formal and informal power within the institution. It is about 

so much more than the organizational chart! 
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WHAT COMES NEXT? 

Further Decreasing Barriers 

Creating sustainable cessation coverage through administrative policy changes 

has been an extremely successful strategy, though the work is not yet complete, 

according to the Medicaid Department. Using the March, 2014 MMWR report, 

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to 

Coverage—United States, 2008–2014, to guide priorities, two barriers to 

“Board meetings, medical and drug utilization review meetings— 

you should be at all meetings that are open to the public. Listen 

and learn! You have to care about what they are doing—not just 

what you want them to do! You need to invest time in learning 

Medicaid 101. There isn’t a single Medicaid agency out there that 

isn’t under pressure to save money. Cessation is it!” 

treatment were removed in 2014. In 2015, efforts will continue the commitment 

to improve coverage of and access to cessation treatments. Specifically, the 

Medicaid team will work to remove the copayment currently required to receive 

counseling, even though most Medicaid enrollees are exempt from having to 

pay this copayment under the current billing system. This change can be made 

through an administrative mechanism due to its small budgetary impact. 

Additionally, Medicaid will review the possibility of removing duration limits 

on all cessation medications with the exception of varenicline (an exception 

resulting from the Director of Pharmacy’s concerns about the side effects of this 

medication). It has set a goal of having limits removed by the end of the fiscal 

year. Currently, all medications are available to Oklahoma Medicaid members for 

180 days. 

Further Exploring Data 

With seven years of tobacco cessation treatment coverage and seven years of 

data compiled, it is critical to review these data to learn more about successes, 

challenges, and opportunities for improvement. A complete evaluation of the 

cessation benefit that links Helpline data and Medicaid benefit utilization data 

to tell a fuller story of cost savings, utilization, and outcomes is on the horizon, 

though systematic review of claims data is not in place just yet. 

Increasing Access Points to Cessation 

While Oklahoma Medicaid cessation coverage has included medications and 

counseling since 2006, it was not until just a few years ago that Medicaid began 

trying to expand this benefit. Over time, the list of approved counseling provider 

types has expanded, first by adding public health nurses/RNs who work in tribal 

facilities, and most recently by adding licensed clinical social workers who are 

Mayo-certified tobacco treatment specialists. Creating as many access points to 

cessation counseling as possible remains a key goal. 
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CLOSING REFLECTIONS 

Over the past five years, Oklahoma has made significant progress in improving 

the health and well-being of tobacco users enrolled in Medicaid as a result of 

near-comprehensive and near barrier-free tobacco cessation coverage. This 

success reflects a solid foundation of long-term relationships across state 

agencies and a collaborative commitment among Medicaid, the Trust and the 

Health Department to address high smoking prevalence rates and mounting 

healthcare costs through improved coverage, reduced barriers to treatment, and 

targeted and tailored promotion of the Medicaid cessation benefit. 

Oklahoma’s success stands as an inspiration to other state Medicaid programs 

and Health Departments to make a commitment to (1) implementing systemsand policy-based interventions to decrease prevalence; (2) making the business 

case for expanding coverage using data that “speaks” specifically to the needs 

and challenges of individual state Medicaid agencies; and (3) creatively leveraging 

all possible funding sources to build and sustain cessation infrastructure within 

state Medicaid agencies. 

References 

1. Centers for Disease Control and Prevention (2013). Behavior Risk Factor Survey [data file and codebook]. 

National Center for Chronic Disease Prevention and Health Promotion: Division of Population Health 

[distributor].



2. Oklahoma Health Care Authority. OHCA Sees Drop In Smoking Rates Among SoonerCare Members. News 

Release. January 15, 2014. Retrieved from https://www.okhca.org/about.aspx?id=15554.



3. Patient Protection and Affordable Care Act of 2010. Pub. L. No. 114–48 (March 23, 2010), as amended through 

May 1, 2010. Retrieved December 5, 2014 from http://docs.house.gov/energycommerce/ppacacon.pdf. 

4. For state-level information on Medicaid coverage of tobacco cessation treatments, please visit www.lung.org/ 

cessationcoverage 

5. Jennifer Singleterry, MA, Zach Jump, MA, Elizabeth Lancet, MPH, Stephen Babb, MPH, Allison MacNeil, MPH, 

Lei Zhang, PhD. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United 

States, 2008–2014. March 28, 2014 / 63(12);264-269. Retrieved December 18, 2014 from http://www.cdc. 

gov/mmwr/preview/mmwrhtml/mm6312a3.htm. 

6. According to the American Lung Association and for the purposes of this case study, comprehensive coverage 

means coverage of all 7 FDA-approved medications for smoking cessation and individual, group and phone 

counseling. The SoonerCare benefit does not include coverage of group counseling, therefore it is considered 

near-comprehensive. 

7. Oklahoma Health Care Authority. Retrieved on March 23, 2015 from http://www.okhca.org/about.aspx?id=32. 

8. Oklahoma Department of Health. Retrieved on March 23, 2015 from http://www.ok.gov/health/Wellness/. 

9. Bisbee, Julie. Oklahoma Helpline Celebrates 10 Years of Helping Oklahomans Quit Tobacco. June 8, 2014. 

Retrieved on March 23, 2015 from http://www.okhelpline.com/swilliams. 

10. Centers for Disease Control and Prevention (2013). Behavior Risk Factor Survey [data file and codebook]. 

National Center for Chronic Disease Prevention and Health Promotion: Division of Population Health 

[distributor]. 

11. Centers for Disease Control and Prevention (2013). Behavior Risk Factor Survey [data file and codebook]. 

National Center for Chronic Disease Prevention and Health Promotion: Division of Population Health 

[distributor]. 

12. Centers for Disease Control and Prevention (2013). Behavior Risk Factor Survey [data file and codebook]. 

National Center for Chronic Disease Prevention and Health Promotion: Division of Population Health 

[distributor]. 

13. Oklahoma Health Care Authority. OHCA Sees Drop In Smoking Rates Among SoonerCare Members. News 

Release. January 15, 2014. Retrieved from https://www.okhca.org/about.aspx?id=15554. 

14. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview 

Survey, 2012. Analysis by the American Lung Association, Research and Program Services Division. 

15. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual healthcare spending attributable to cigarette 

smoking: an update. Am J Prev Med 2015;48(3):326-333. 

16. Armour BS, Finkelstein EA, Fiebelkorn IC. State-level Medicaid expenditures attributable to smoking. Prev 

Chronic Dis 2009;6(3):A84. http://www.cdc.gov/pcd/issues/2009/jul/08_0153.htm. Accessed [May 19, 2014]. 

Smoking-attributable Medicaid costs are updated from 2004 to 2013 dollars, using the Medical Consumer Price 

Index. 

17. American Lung Association. Helping Smokers Quit. Tobacco Cessation Coverage, 2014. 

18. American Lung Association. Helping Smokers Quit. Tobacco Cessation Coverage, 2014. 
13 1-800-LUNGUSA ̵ LUNG.org Medicaid Tobacco Cessation Coverage in Oklahoma: A Case Study in Leveraging Systems and Partnerships

 

 

 

 

 

19. American Lung Association. “State Tobacco Cessation Coverage Database.” Accessed May 12, 2015. Available at: 

http://www.lungusa2.org/cessation2/. 

20. Advertisements from this campaign can be viewed here: http://www.okhelpline.com/media-room/soonerquit. 

21. Jennifer Singleterry, MA, Zach Jump, MA, Elizabeth Lancet, MPH, Stephen Babb, MPH, Allison MacNeil, MPH, 

Lei Zhang, PhD. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United 

States, 2008–2014. March 28, 2014 / 63(12);264-269. Retrieved December 18, 2014 from http://www.cdc. 

gov/mmwr/preview/mmwrhtml/mm6312a3.htm. 

22. Tobacco Work Group: Strengthening Collaborative Cessation Measures. 

23. For information about the 5 A’s of Tobacco Cessation, see the U.S. Public Health Service Guideline Treating 

Tobacco Use and Dependence. Available here: http://www.ahrq.gov/professionals/clinicians-providers/ 

guidelines-recommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf. 

This case study was supported by Grant Number 3U38OT000224-02, funded by the 

Centers for Disease Control and Prevention. Its contents are solely the responsibility 

of the authors and do not necessarily represent the official views of the Centers for 

Disease Control and Prevention or the Department of Health and Human Services.