STATE ESTIMATES OF MEDICAID EXPENDITURES ATTRIBUTABLE TO CIGARETTE-SMOKING, FISCAL YEAR 1993

Objective. To develop estimates of state Medicaid expenditures attribu table to smoking for fiscal year 1993. Methods. The smoking-attributab le fractions (SAFs) of slate Medicaid expenditures were estimated usin g a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. Results. In fiscal year 1993, the SA F for all slates (all types of expenditures) was 14.40%, 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 expenditures to 21.7% for hospital expenditures. An estimated total of $12.9 billion of fiscal year 1993 Medicaid expenditures was attributable to smoking. The relat ive error of this estimate was 40.3%. Conclusions. Cigarette smoking a ccounts for a substantial portion of annual state Medicaid expenditure s, with considerable variation among states. The range in expenditures among the states is due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the level and scope of the Medicaid program.