Working with Medicaid a Win-Win Partnership Tracey Strader, MSW, LCSW Oklahoma Tobacco Settlement Endowment Trust Terrie Fritz, MSW, LCSW Oklahoma Health Care Authority

Background Medicaid covered only Rx cessation products and required a prior authorization Public Health’s first steps – Started with Medical Director – Presented PHS Guidelines to HMO medical directors – Launched the Oklahoma Tobacco Helpline – Collaborated on Smoke-Free Families grant with the Oklahoma State Medical Association – Brought in Abby Rosenthal from the CDC for a strategic planning session on cessation systems

Background Medicaid’s first steps – Medical Director attended strategic planning session – Medical Director and other staff collaborated on the Smoke- Free Families grant – Changed administrative rules to allow coverage for all FDA approved Rx and OTC products without a prior authorization for the first attempt, and with a prior authorization for subsequent attempts.

Medicaid Claims FY 03 – FY 06 FY 2003FY 2004FY 2005 FY 2006 Clients ,5313,762 Claims1871,2974,7877,365 Cost$18,142.80$118,619.15$464,320.63$679, Per Diem$3.80$4.04$4.13$4.00

Partnering for Success Attempted to cover Helpline services Direct mail to 150,000 Medicaid beneficiaries announcing the cessation benefit in FY 06 and FY 07. – Each mailing resulted in 1,000 to 2,000 enrollments in 4 to 6 weeks Changed administrative rules to institute provider reimbursement for 5A’s – Same as Medicare rates

Many thanks to the State of Oregon for creating the initial concept and design - and sharing it with us!!

Next Steps Eliminate the prior authorization completely Continue to do the direct mailing each year Extensive outreach to health providers Pursue coverage for individual & group counseling

Its All About Relationships Look for Medical Director, MSW, MPH, or people in Behavioral Health Find out what Medicaid is already doing. Check the website. How can we help? vs. We want to fix you! Start by promoting the helpline and/or just meeting to orient to one another. Take it one step at a time. The momentum will build from previous success Remember we share the same goals.

Acknowledgements Lynn Mitchell, M.D., State Medicaid Director, Oklahoma Health Care Authority Sally Carter, MSW, LCSW, Director of Planning and Cessation Systems, Tobacco Use Prevention Service, Oklahoma State Department of Health Linda Wright-Eakers, MPH, Cessation Systems Coordinator, Tobacco Use Prevention Service, Oklahoma State Department of Health