State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993

Objective. To develop estimates of state Medicaid expenditures attributable to smoking for fiscal year 1993. Methods. The smoking-attributable fractions (SAFs) of state Medicaid expend itures were estimated using a national model that describes the relationshi p between smoking and medical expenditures, controlling for a variety of so ciodemographic, economic, and behavioral factors. Results. In fiscal year 1993, the SAF for ail states (all types of expendit ures) was 14.4%, with a range from 8.6% in Washington DC to 19.2% in Nevada . On average, SAFs ranged from a low of 7.9% for home health services expen ditures to 21.7% for hospital expenditures. An estimated total of $12.9 bil lion of fiscal year 1993 Medicaid expenditures was attributable to smoking. The relative error of this estimate was 40.3%. Conclusions. Cigarette smoking accounts for a substantial portion of annual stale Medicaid expenditures, with considerable variation among states. The range in expenditures among the states is due to differences in smoking pr evalence, health status, other socioeconomic variables used in the model, a nd the level and scope of the Medicaid program.