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Tobacco Cessation: Quality Improvement Strategies

Expanding coverage of and access to medical assistance with tobacco cessation can greatly benefit Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries in their efforts to quit tobacco. Medical assistance with tobacco cessation includes counseling and pharmacotherapy and can be provided one-on-one, in groups, or over the telephone.

The Centers for Medicaid & CHIP Services Informational Bulletin, issued in February 2024, on Strategies to Improve Delivery of Tobacco Cessation Services provides an overview of evidence-based treatment opportunities, state tobacco cessation coverage requirements and authorities in Medicaid and CHIP, and highlights state strategies to improve delivery of cessation services. The Centers for Medicare & Medicaid Services (CMS) State Medicaid Director Letter, issued June 2011, also provides guidance on coverage of tobacco cessation services and shares various ways states can deliver these services and receive federal financial participation (FFP). It also discusses coverage of comprehensive tobacco cessation for pregnant people and quitline activities.

The tobacco cessation driver diagram and change idea table provides examples of evidence-based or evidence-informed quality improvement (QI) interventions for tobacco cessation. The change ideas were tailored for Medicaid and CHIP leaders. The tobacco cessation QI resources provide more information on how states can get started with QI.


Quitlines are a highly effective strategy to support tobacco cessation. All states offer quitline services via a single toll-free portal, 1-800-QUIT-NOW. Quitlines are a cost-effective way to make tobacco cessation support easily accessible, particularly for people whose mobility is limited, who live in rural or remote areas, or whose work schedules make obtaining tobacco cessation counseling more difficult. Quitlines can offer tailored resources to priority populations, such as pregnant people deliver services to multilingual groups; and make large-scale promotional campaigns more feasible and effective.

States may claim FFP for quitline expenditures as discussed in the State Medicaid Director Letter and under the Office of Management and Budget’s applicable cost principles, Circular A-87. States must also allocate allowable costs in accordance with the relative benefits received by the Medicaid program. States may claim FFP for the quitline only to the degree that the quitline serves Medicaid beneficiaries. For example, Maryland’s Medicaid agency collaborated with its state tobacco quitline to develop a cost allocation plan to reimburse the state’s quitline for services provided to Medicaid members using administrative matching.

For more information on these materials and other QI technical assistance, please email the mailbox at MedicaidCHIPQI@cms.hhs.gov. For questions about FFP, contact your regional CMS office.