Quit Tobacco Series Fact Sheet #3: Medicaid / BadgerCare

Medicaid/BadgerCare coverage for tobacco-dependence treatment applies to treatment provided by any Medicaid-certified Wisconsin physician, nurse practitioner or physician assistant.

 

Did You Know?

The smoking rate among Wisconsin Medicaid adult members is almost double the general population.

Coaching on how to quit—combined with medication—can quadruple the chances of quitting smoking.

 

Covered Medications

Medicaid/BadgerCare covers the following FDA-approved medications:

Bupropion SR: Zyban, Wellbutrin or generic

Nicotine lozenge: Over-the-counter

Nicotine inhaler: Nicotrol

Nicotine nasal spray: Nicotrol

Nicotine patch: Over-the-counter or prescription

Nicotine gum: Over-the-counter

Varenicline: Chantix

Combination therapy: E.g., nicotine patch + lozenge

 

Repeated courses of treatment are allowed. All require a written prescription by a Medicaid-certified provider (includes a physician, nurse practitioner, physician assistant or dentist).

 

Co-Pays

None for tobacco cessation. Per the Affordable Care Act, essential health benefits are to be provided without cost to the patient.


Know the Codes

Covered Counseling

Evaluation & Management (E&M) visits for the sole purpose of tobacco-dependence treatment are covered and do not require prior authorization for reimbursement. Services may be provided by ancillary staff (e.g., staff nurse) if under direct supervision of a physician. Medicaid reimburses these services when billed by a supervising physician. Exclusions: Group therapy, telephone and web-based counseling are NOT covered. Counseling is NOT reimbursed for dentists or dental hygienists.


Quit Line
The Wisconsin Tobacco Quit Line is free and available to assist all Wisconsin residents who want to quit: 800-QUIT-NOW (800-784-8669); Available 24/7.
 

 

Medicaid Program Details

Medicaid Enrollment Information

Contact Information
 General Information  800-362-3002 
 HMO Ombudsperson & Contract Monitors  800-760-0001
 Provider Services  800-947-9627
 Member Services  800-362-3002
 Enrollment Specialists  800-291-2002
 Automated Voice Response System  800-947-3544
 Wisconsin Medicaid Senior Care Member Services  800-657-2038
   
Medicaid & Badgercare HMO Member Services  
 Blue Cross Blue Shield (formerly CommunityConnect)  800-362-3002 
 Compcare  888-203-7771
 Children's Community Health Plan  800-482-8010
 Dean Health Plan (Dane County)  800-279-1301
 Dean Health Plan (Milwaukee and surrounding counties)  800-482-8010
 Group Health Cooperative of Eau Claire  888-203-7770
 Group Health Cooperative of South Central Wisconsin  608-828-4853
 Gundersen Health Plan  866-537-1477
 Health Tradition Health Plan  800-545-8499
 iCare  414-223-4847
 Managed Health Services  888-713-6180
 MercyCare Insurance Company  800-895-2421
 Molina HealthCare  888-999-2404
 Network Health Plan  888-713-6180
 Physicians Plus Insurance Corporation  800-545-5015
 Security Health Plan  8007913044
 Trilogy Health Insurance  866-429-3241
 UnitedHealthcare of Wisconsin  800-504-9660
 Unity Health Plans  800-362-3310