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Requires Medicaid and the Children’s Health Insurance Program (CHIP) to cover tobacco cessation counseling and FDA‑approved medicines, and it bars cost‑sharing and prior authorization for those treatments. The law funds outreach and monitoring, and it provides an enhanced 90% federal matching rate for those services and outreach for five years, with changes taking effect at the start of the first fiscal year after enactment. A final clause preserves or expands—not reduces—access to counseling and medicines for people under age 18.
Defines "counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan" to include diagnostic, therapy, and counseling services and pharmacotherapy (including prescription and nonprescription FDA-approved tobacco cessation agents) furnished by or under physician supervision or by other health care professionals who are legally authorized under State law and authorized to receive payment under the title or designated by the Secretary.
Amends section 1905(a)(4)(D) to require Medicaid coverage of counseling and pharmacotherapy for tobacco cessation for individuals eligible under the State plan (as defined in new 1905(bb)).
Provides a temporary enhanced Federal medical assistance percentage (FMAP) of 90 percent for amounts a State spends on counseling and pharmacotherapy for tobacco cessation for calendar quarters beginning on the date of enactment and ending 5 years after that date.
Adds counseling and pharmacotherapy for tobacco cessation and covered outpatient drugs prescribed for tobacco cessation (per the guideline in section 1905(bb)) to the list of services that cannot be subject to Medicaid cost-sharing under section 1916 (and to alternative cost-sharing rules under section 1916A).
Changes section 1927(d)(2)(F) to address nonprescription drugs by stating: 'Nonprescription drugs, except, when recommended in accordance with the guideline referred to in section 1905(bb), agents approved by the Food and Drug Administration for purposes of promoting tobacco cessation.'
Directly affected groups include Medicaid and CHIP enrollees (adults, children, and pregnant people). Medicaid/CHIP programs must update benefits and remove administrative barriers, which will increase claims for counseling and cessation medications and require state administrative work to implement outreach and monitoring. Health care providers, pharmacies, and behavioral counselors are likely to see higher demand for cessation services. State budgets will receive substantial federal support (90% FMAP) for five years, reducing state costs for these services during that period; federal spending will increase to cover the enhanced match and outreach. Public health outcomes are expected to improve over time through higher quit rates and lower tobacco‑related disease, while near‑term operational impacts include plan amendments, provider education, and outreach campaigns. The clause protecting minors preserves or expands access to treatment for youth and prevents coverage rollbacks for people under 18.
Last progress June 12, 2025 (8 months ago)
Introduced on June 12, 2025 by Lisa Blunt Rochester
Read twice and referred to the Committee on Finance.