Notes from the Field, CDC's Morbidity and Mortality Weekly Report*, 2025.*
Among Americans with health insurance, tobacco use is most common among Medicaid members: in 2021, 28.1% of Medicaid members nationwide used tobacco, against 16.2% of people with private insurance. Medicaid members also have more tobacco-related disease and face gaps in getting effective help to quit, and Medicaid spends about $68 billion a year on smoking-related illness. Finding the members who use tobacco and offering them help to quit can improve their health and cut costs — but claims data on their own can undercount tobacco use.
What the study did
Washington is one of five states that ask about tobacco use on Medicaid eligibility forms; the others are Arkansas, Indiana, Missouri and Utah. Researchers combined two sources for King County Medicaid members aged 18 to 64:
- Enrollment answers from the Washington Health Benefit Exchange (HBE), the online insurance marketplace run as a public-private partnership. A person counted as a current user if they said they had used tobacco products (not counting e-cigarettes or vapes) more than four times a week over the previous 6 months.
- Reimbursement claims: a diagnosis of tobacco use, a diagnosis or procedure code for help quitting, or a pharmacy claim for nicotine replacement therapy or varenicline.
Members had to be enrolled for at least 7 months in a year, to allow time for other conditions to be diagnosed. Some groups — people eligible for both Medicaid and Medicare, those enrolled through the aged, blind and disabled pathway, and those in long-term care — enrol through a different system with no tobacco question, so they have no self-reported data.
What it found
Of 511,154 Medicaid members, 101,060 (19.8%) were identified as using tobacco by one source or both. Neither source found everyone:
| Identified by | Members | Share of tobacco users |
|---|---|---|
| Enrollment form only | 14,163 | 14.0% |
| Claims only | 51,534 | 51.0% |
| Both | 35,363 | 35.0% |
The two sources found different people.
| Characteristic | Enrollment form only | Claims only |
|---|---|---|
| Aged 25–34 | 35.5% | 29.3% |
| Male | 68.1% | 55.0% |
| Female | 32.2% | 45.6% |
| No chronic condition | 52.0% | 10.8% |
| Black or African American | 15.9% | 23.2% |
| Hispanic or Latino | 10.1% | 13.9% |
| A physical health condition | 15.9% | 55.7% |
| A behavioural health condition | 42.9% | 81.5% |
What it means
Claims catch people once they are already being treated for something. Asking about tobacco at enrollment reaches people earlier — especially men and people without a chronic condition yet — when help to quit might lower their risk of developing one. Using several data streams to find Medicaid members who use tobacco strengthens public health surveillance and could widen the reach of treatment to help them quit.
Sources
- Amber K. Sabbatini, Austin Craig, Eli Kern, Susan Hernandez, Caroline Brazeel, Alexandra Kearly, Madison Hluchan, Orobosa Idehen, Elizabeth Courtney-Long, Corinne Husten and Brian S. Armour, "Notes From the Field: Enhanced Identification of Tobacco Use Among Adult Medicaid Members — King County, Washington, 2016–2023", MMWR, vol. 74, no. 7, 2025. https://www.cdc.gov/mmwr/volumes/74/wr/mm7407a2.htm
- The authors are from the University of Washington; Public Health – Seattle & King County; the Association of State and Territorial Health Officials; and CDC's Office on Smoking and Health.
- Rewritten in hubnx's own words.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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