Sponsors (2)
The bill expands and removes barriers to tobacco‑cessation treatment for Medicaid/CHIP enrollees (especially pregnant people and children) with a five‑year federal match to encourage uptake, trading significant short‑term federal/state spending and increased program and administrative costs for improved population health and access to cessation services.
Low-income Medicaid and CHIP enrollees — including pregnant people and children — will gain coverage of counseling and FDA‑approved tobacco‑cessation medications, increasing access to treatment and likely improving quit rates and child health outcomes.
Medicaid and CHIP enrollees face fewer administrative and financial barriers because the bill prohibits prior authorization and most cost‑sharing for cessation counseling and medications, which should raise uptake of cessation services.
States receive a temporary enhanced federal match (90% FMAP) for five years to help cover cessation services and outreach, reducing near‑term state budget pressure and making it easier to implement expanded benefits.
The federal government and states will face higher short‑term expenditures: enhanced 90% FMAP increases federal outlays for five years, and eliminating cost‑sharing and prior authorization raises near‑term federal/state program spending compared with more restrictive coverage.
When the five‑year enhanced FMAP expires, states may confront a much larger share of ongoing costs to maintain cessation services and outreach, creating sustained budget pressure and the risk of future benefit reductions.
Managed care plans, providers, and pharmacies may experience higher utilization and pharmacy spending from expanded, less‑restricted coverage, increasing operational costs that can translate into higher premiums or budget strain for payers.
Based on analysis of 4 sections of legislative text.
Requires Medicaid and CHIP to cover counseling and FDA‑approved tobacco cessation pharmacotherapy, bars cost‑sharing, and gives a 90% federal match for five years for those services and outreach.
Official title: Amend title XIX and XXI of the Social Security Act to provide coverage of comprehensive tobacco cessation services under such titles, and for other purposes.
Introduced June 12, 2025 by Lisa Blunt Rochester · Last progress June 12, 2025
Requires Medicaid and CHIP to cover counseling and FDA‑approved pharmacotherapy for tobacco cessation, prohibits cost‑sharing for those services, and provides an enhanced 90% federal matching rate for those benefits and related outreach for up to five years. The law defines covered cessation services, limits state prior‑authorization and cost‑sharing for these services and drugs, requires states to monitor and promote use of cessation services to beneficiaries and clinicians, and protects coverage for minors.