Tobacco treatment billing and tobacco use disorder diagnosis in healthcare settings in the United States: an analysis of South Carolina medicaid claims.

Background: Tobacco use, particularly smoking, remains the leading cause of preventable death in the United States. While Medicaid in all states provides some coverage of tobacco cessation treatments, rates of tobacco use remain much higher among Medicaid beneficiaries (30.0%) compared to those with private insurance (18.0%). The extent to which Medicaid beneficiaries receive cessation counseling services remains unclear. The current study assessed tobacco counseling occurrence among individuals who use tobacco among South Carolina Medicaid fee-for-service beneficiaries from 2019 to 2022.

Methods: Individuals with a tobacco use disorder diagnosis were identified (N = 49,401) and the differences in the number of patients counseled between demographic groups and the types of providers delivering counseling were assessed. Between-group differences in receiving counseling were assessed using Chi-squared tests.

Results: Fewer Black (χ2 = 34.54, 23.51, 8.54, 12.02, p < 0.5) and younger (χ2 = 81.43, 117.45, 83.25, 78.98, p < 0.0001) beneficiaries received counseling across all four years compared to their White and older counterparts, respectively. Additionally, fewer individuals in rural areas (χ2 = 12.44, 4.05, 5.07, p < 0.05) received counseling compared to those in urban areas in years 2019-2021. There were additional sex and regional differences in some years.

Conclusions: To improve cessation rates, focusing on increasing availability of cessation counseling services to Medicaid beneficiaries is critical.