Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment

J Behav Health Serv Res. 2020 Apr;47(2):264-274. doi: 10.1007/s11414-019-09669-1.


This study examined whether living in a Medicaid-expanded state or having health insurance was associated with receipt of smoking cessation services or smoking behaviors among substance use disorder (SUD) treatment clients. In 2015 and 2016, 1702 SUD clients in 14 states were surveyed for health insurance status, smoking cessation services received in their treatment program, and smoking behaviors. Services and behaviors were then compared by state Medicaid expansion and health insurance status independently. Clients in Medicaid-expanded states were more likely to be insured (89.9% vs. 54.4%, p < 0.001) and to have quit smoking during treatment (AOR = 3.77, 95% CI = 2.47, 5.76). Insured clients had higher odds of being screened for smoking status in their treatment program and making quit attempts in the past year. Medicaid expansion supports greater health insurance coverage of individuals in SUD treatment and may enhance smoking cessation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health
  • Male
  • Medicaid / statistics & numerical data*
  • Middle Aged
  • Patient Protection and Affordable Care Act
  • Smoking / epidemiology
  • Smoking Cessation / methods*
  • Smoking Cessation / statistics & numerical data*
  • Socioeconomic Factors
  • Substance-Related Disorders / therapy*
  • Tobacco Use Disorder / therapy
  • United States