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An estimated 20 percent of pregnant women enrolled in Medicaid smoke during pregnancy. The prevalence is even higher in certain geographic areas and among some groups such as women younger than 24 years. Smoking during pregnancy and the reproductive years is harmful for women and infants (For the most recent data, see the 2014 Surgeon General's Report: The Health Consequences of Smoking-50 Years of ProgressChapter 9, "Reproductive Health.").

The Affordable Care Act requires states to expand Medicaid coverage of cessation services for pregnant women, which can save lives and save money.

Tobacco dependence interventions for pregnant women are particularly cost-effective because they can:

  • Reduce perinatal deaths;
  • Reduce the number of premature and low birth-weight babies; and
  • Reduce use of newborn intensive care units, shorten lengths of stay, and decrease service intensity. 

Based on 2002 birth certificate data, at least 5% of preterm-related deaths and at least 23% of sudden infant deaths would be avoided if prenatal smoking was eliminated.

2006 analysis indicated that implementing a smoking cessation intervention among pregnant women could cost from $24 to $34 per pregnant smoker counseled and may save $881 per pregnant smoker in averted neonatal costs, potentially resulting in net savings of from $400,000 to $8 million. The Congressional Budget Office estimated that the savings derived from Medicaid coverage of comprehensive tobacco cessation services for pregnant women more than offset their costs, resulting in reduced costs for states and the Federal government.

Action Steps for States

  • States must add counseling and pharmacotherapy benefits for pregnant women, which under Section 4107 of the Affordable Care Act are now mandatory benefits under Medicaid. This coverage is defined as diagnostic, therapy, counseling services, and pharmacotherapy for cessation of tobacco use by pregnant women. For more information, please see State Medicaid Director Letter #11-007 (PDF, 273.85 KB) and contact your regional CMS office.
  • Promote cessation benefits to pregnant women and all women of reproductive age.
  • Make use of the many resources available to the public and to health care providers to help women quit smoking. See this Resource Guide for a list of highlighted resources.

For technical assistance and additional resources, contact MedicaidCHIPPrevention@cms.hhs.gov.