Paying People to Kick the Habit—Novel Anti-Smoking Effort to be Launched in Connecticut

An unorthodox anti-smoking effort that offers at-risk people financial incentives if they successfully quit tobacco—and smaller rewards for progress toward doing so—has been designed by researchers at the Yale School of Public Health and will be implemented statewide in coming months.

The iQuit program will encourage both smokers and medical providers to participate in counseling and training sessions, peer coaching and other smoking-cessation techniques. Financial incentives—up to a maximum of $350 per year—will be used to encourage smokers to attend these sessions and to achieve objective, verifiable goals in reducing and eliminating tobacco use.

The program will target the state’s Medicaid recipients—particularly pregnant women, mothers of newborn babies and individuals with mental illnesses—who continue to smoke. While approximately 17 percent of the state’s population currently smokes, between 25 percent and 30 percent of the state’s Medicaid recipients, approximately 125,000 people, are smokers. Other anti-smoking efforts, including tax increases, restricted smoking areas and public health campaigns, have had limited success with the Medicaid population.

“This vulnerable population continues to smoke. We think a new approach is needed,” said Jody L. Sindelar, professor in the division of Health Policy and Administration and one of the architects of the iQuit program. “There is solid evidence that such incentive payments can work. Small payments can be effective in providing effective, immediate and clear-cut gains.”

A five-year federal grant of up to $10 million funds the state program and seeks to improve health and lower taxpayer’s long-term costs by helping Medicaid patients to quit smoking. Smoking-related illnesses are a heavy burden, costing the national Medicaid program some $22 billion annually.

The program represents a new way to encourage people to quit smoking, said Susan Busch, associate professor at the school who helped design the program. If successful, it is likely to save money for the state’s Medicaid program over the long term by reducing smoking-related health care costs.

In October 2010, Connecticut began providing smoking cessation coverage for pregnant women in Medicaid, as required under federal health care reform, but smoking cessation services did not extend to other Medicaid recipients. Gov. Dannel Malloy’s February 2011 budget expanded smoking cessation beyond the Affordable Care Act requirement to include other Medicaid beneficiaries, and the measure was approved by the General Assembly.

“This innovative program is encouraging Connecticut and other states to try new approaches to fight chronic diseases that destroy people’s health and cost taxpayers millions of dollars,” said Lt. Gov. Nancy Wyman. “By using new methods to encourage Medicaid participants to quit smoking, we can make real improvements in their health and help the state’s fiscal bottom line.”

The state Department of Public Health and the Hartford-based Hispanic Health Council are partners in the programs. The state Department of Public Health is the primary recipient of the grant with a subcontract to Yale.