S. 2064 — Helping Tobacco Users Quit Act

This section requires state Medicaid programs to cover counseling and pharmacotherapy, including FDA-approved prescription and nonprescription agents, for tobacco cessation by eligible individuals (per specified clinical guidelines) as a mandatory benefit (amending SSA §1905(a)(4)(D) and (bb)). It provides a temporary enhanced federal medical assistance percentage (FMAP) of 90% (increased from applicable state FMAP) for such expenditures during calendar quarters beginning on enactment and ending five years later (SSA §1905(bb)(2)). It prohibits cost-sharing for these services (amending SSA §§1916(a)(2)(B), (b)(2), 1916A(b)(3)(B)) and exempts nonprescription tobacco cessation agents from states' optional exclusion of such drugs from Medicaid coverage (amending SSA §1927(d)(2)(F)). It further requires states to monitor and promote use of these services, including through outreach to tobacco-using beneficiaries and their providers (adding SSA §1902(a)(88)), with 100% federal reimbursement for development, implementation, and evaluation of such outreach campaigns (adding SSA §1903(a)(8)).

This section requires State Children's Health Insurance Program (CHIP) plans—which provide health coverage to uninsured children in families whose incomes exceed Medicaid limits but are insufficient for private insurance—to cover counseling and pharmacotherapy for tobacco cessation (as defined to include physician-supervised diagnostic, therapy, counseling services, and FDA-approved prescription and nonprescription agents recommended by specified clinical guidelines). It (1) prohibits cost-sharing for such benefits and related prescription drugs; (2) prevents states from excluding or restricting FDA-approved nonprescription tobacco cessation agents for pregnant women and other eligible individuals when guideline-recommended; (3) requires state CHIP plans to describe procedures for monitoring and promoting these services, including outreach campaigns targeting tobacco-using enrollees and their providers; and (4) provides 90% federal reimbursement (in addition to regular CHIP payments) for such services and outreach for five years after enactment.