Frequently Asked Questions

Click here to see the middle column in this chart for partial requirements.

Questions about Partial Requirement

What is the most up-to-date source for what is required to go into effect for the Medicaid Tobacco-free policy on July 1, 2025?
  • Medicaid Bulletin: As announced on June 28, 2024, tobacco-related policy requirements outlined in the NC Medicaid Bulletin from March 21, 2024, have been delayed until July 1, 2025.
    • For specifics about the tobacco-related policy requirements, please see NC Medicaid Bulletin from March 21, 2024.
    • For information about the delay in implementation until July 1, 2025, please see the NC Medicaid Bulletin from June 28, 2024.
What can we do if our staff like spending time with clients by smoking together in the designated areas?
  • Talk with staff and clients about what other things they might enjoy doing together and consider what options are most feasible.  Get clients and staff to suggest ways to help foster these opportunities as appropriate for the facility, the clients and staff and as time and resources allow.  
  • Help them understand this policy is to protect the health and safety of both staff and residents. The Surgeon General has determined that there is no safe level of exposure to secondhand smoke. Secondhand smoke is an independent risk factor for heart attacks, heart disease, lung cancer and stroke.
  • Talk to staff and clients about the policy and the commitments to the health and wellbeing of both staff and clients.
What do we do if staff walk to the property line and smoke/vape on the property next door?
  • While smoking/vaping outside of the facility property line is not a violation of this policy, make a plan for clear communication of the policy with neighboring property owners to avoid potential conflicts, including exposing neighbors to secondhand smoke, risk of fire, or improper disposal of tobacco-related products. 
  • If employees need assistance to get through the day or a shift without using tobacco, contact your Regional Tobacco Control Manager who can assist staff by letting them know about the benefits of using nicotine replacement therapy (NRT).   This includes nicotine patches to ease the addiction to nicotine and nicotine gum or lozenge to help get past triggers or cravings.   Regional Managers can help staff understand how to access NRT through QuitlineNC or other source and how to use it properly.  We will do our best to accommodate this need via in-person or virtual and/or recorded sessions.
What help is available for people who may want to take this opportunity to quit smoking/using tobacco?
  • Most tobacco users WANT to quit. This policy gives tobacco users an opportunity to quit tobacco. QuitlineNC offers a broad array of services, including tailored coaching by talk or text or chat via the web, and combination nicotine replacement therapy (patches plus gum or lozenge). 
  • Many tobacco users want to quit but have done so without assistance and support.  People who use the full services of QuitlineNC are 2-3 times more likely to quit successfully than folks who try to quit on their own.
  • For staff and clients with Medicaid as their primary insurance, NC Medicaid is eliminating co-pays for nicotine replacement therapy as of August 2024.
  • Click here for a complete summary of the services and programs available from QuitlineNC.
The policy states that providers are prohibited to purchase, accept as donations, or distribute tobacco products to individuals we serve. Does this truly mean that we are no longer permitted to purchase tobacco products for our residents for whom we are representative payee?
  • If individuals have funds remaining, after ensuring their current needs are met, they are allowed to use those funds to purchase legal tobacco products. Medicaid providers are not permitted to directly purchase those products for them, however.
  • The acceptance of donated tobacco products to contracted providers and their staff is prohibited. No contracted provider staff shall receive tobacco product donations on behalf of residents.
We currently safeguard MANY of our resident’s tobacco products and give them to the residents during smoking times, will we no longer be able to do that? Will residents be required to manage and maintain their own cigarettes, etc.?
  • For safety reasons, LTSS staff may continue to safeguard tobacco products, matches, etc. that residents purchased for themselves or were provided by family/friends. LTSS staff may give them to residents to go to the designated outdoor smoking area during smoking times.  For more information, please refer to the SSA Representative Payee Program.
<br /> Does this Tobacco free policy apply to Medicaid Direct?
  • Not at this time. If the agency is under contract with a Medicaid Managed Care Plan, then the policy must be followed as per the Updated Medicaid Bulletin.
  • NC Medicaid Direct may consider adopting a tobacco-free policy in the future as an administrative policy. 

 

Where can residents smoke/vape/use tobacco products in an Adult Care Home?
  • Residents are prohibited to smoke indoors in Adult Care Homes pursuant to NC General Statute 131D-4.4 (2007).  Residents in an Adult Care Home are no longer permitted to use e-cigarettes/vapes or any other tobacco product indoors after July 1, 2024.
  • A designated outdoor smoking/vaping/tobacco use area can be set up if it has not been already, so long as it keeps common areas free from tobacco exposure.
Can contractors and visitors smoke on the Adult Care Home property?
  • Staff, contractors, and visitors are not allowed to use tobacco on the property.  
  • Residents who choose to use tobacco products can have a designated smoking area outdoors and away from places that would expose others to tobacco.
How can we best gain compliance from visitors and staff on our new tobacco-free requirement?
  • The first step is to develop a comprehensive tobacco-free policy that clearly outlines the rules and expectations regarding tobacco use on company premises.
  • Involve employees in the development process to gain their input and support. This can help foster a sense of ownership and increase compliance.
  • Clearly communicate the policy to all employees through multiple channels, such as email, company meetings, posters, and employee handbooks.
  • Establish clear enforcement procedures and consequences for violating the tobacco-free policy. Consistently enforce these procedures to demonstrate the organization’s commitment to maintaining a safe and healthy tobacco-free environment.
  • Many companies have successfully worked to promote normative change by placing positively worded tobacco-free signage on the grounds in key visible locations for visitors. This is likely all that is needed to reach compliance, especially if communicated respectfully with an understanding of why this is important in a health facility.
In some Adult care facilities, staff live on-site. Are they allowed to smoke/use tobacco on the property?
  • There is no exception for staff who live on the property, as this is a healthcare setting policy and smoking/using tobacco products around clients is not appropriate for healthcare staff.
How does the grievance/complaint process work? How will non-compliance be documented?
  • Provider monitoring for compliance with the tobacco-free policy requirement will occur through a grievance/complaint process. 
  • Patients, family or staff may file grievance with the appropriate health plan following their standard filing process. The health plan then forwards the tobacco related grievance to the NCDHHS Tobacco Prevention and Control Branch via email.
  • NCDHHS will monitor for any complaints related to noncompliance with this policy. Our goal is to support facilities with training and technical assistance as needed.  More information is described in the March 21, 2024 Medicaid Bulletin.
Will there be penalties and/or fines associated with non-compliance?<br /> Can the Medicaid Managed Care Plans take punitive action for repeated non-compliance?<br />
  • While Medicaid does not prohibit MCOs from taking punitive action, NCDHHS preferred approach is to provide and encourage training and technical assistance to assist providers with compliance to this policy.
Where can I find assistance with implementing a tobacco-free policy?
  • Every county in NC has an assigned tobacco prevention manager who is experienced in helping organizations implement a tobacco-free policy and integrate tobacco use treatment. Your regional tobacco prevention manager is available to provide one on one assistance to implement the tobacco-free policy on your campus. Find yours here.

References

  1. North Carolina Tobacco Prevention and Control Branch. Vision 2020 North Carolina’s Strategic Plan to Reduce the Health and Economic Burdens of Tobacco Use [Internet]. 2016 [cited 2021 May 18]. Available from: www.tobaccopreventionandcontrol.ncdhhs.gov
  2. Centers for Disease Control and Prevention. Tobacco Use [Internet]. 2020 [cited 2021 May 18]. Available from: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm
  3. U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General [Internet]. 2014 [cited 2021 May 18]. Available from: www.cdc.gov/tobacco
  4. Centers for Disease Control and Prevention. Smokefree Policies Reduce Smoking [Internet]. 2020 [cited 2021 May 18]. Available from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/protection/reduce_smoking/index.htm
  5. Centers for Disease Control and Prevention (US), U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General [Internet]. Publications and Reports of the Surgeon General. Centers for Disease Control and Prevention (US); 2006 [cited 2021 May 18]. 727. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44324/
  6. National Core Indicators. Does this person use nicotine or tobacco products? North Carolina [Internet]. 2018 [cited 2021 May 25]. Available from: https://www.nationalcoreindicators.org/charts/2017-18/?i=77&st=NC
  7. Steinberg ML, Heimlich L, Williams JM. Tobacco use among individuals with intellectual or developmental disabilities: A brief review [Internet]. Vol. 47, Intellectual and Developmental Disabilities. NIH Public Access; 2009 [cited 2021 May 25]. p. 197–207. Available from: /pmc/articles/PMC4451812/
  8. Bogner J, Corrigan JD, Yi H, Singichetti B, Manchester K, Huang L, et al. Lifetime history of traumatic brain injury and behavioral health problems in a population-based sample. Journal of Head Trauma Rehabilitation [Internet]. 2020 Jan 1 [cited 2021 May 25];35(1):E43–50. Available from: https://pubmed.ncbi.nlm.nih.gov/31033748/
  9. Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public Health. Annual Review of Public Health [Internet]. 2017 Mar 20 [cited 2021 May 18];38:165–85. Available from: https://pubmed.ncbi.nlm.nih.gov/27992725/
  10. Sivandzade F, Alqahtani F, Cucullo L. Traumatic brain injury and blood–brain barrier (BBB): Underlying pathophysiological mechanisms and the influence of cigarette smoking as a premorbid condition. International Journal of Molecular Sciences [Internet]. 2020 Apr 1 [cited 2021 May 25];21(8). Available from: https://pubmed.ncbi.nlm.nih.gov/32295258/
  11. Rong L, Frontera AT, Benbadis SR. Tobacco smoking, epilepsy, and seizures [Internet]. Vol. 31, Epilepsy and Behavior. Epilepsy Behav; 2014 [cited 2021 May 25]. p. 210–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24441294/
  12. North Carolina Department of Health and Human Services. Report on the Pilot to Establish a Tobacco Free Environent in State Operated Healthcare Facilities: Broughton Hospital and Walter B. Jones ADATC. 2011.
  13. National Native Network. Commercial Tobacco | Keep It Sacred [Internet]. 2015 [cited 2021 May 18]. Available from: https://keepitsacred.itcmi.org/tobacco-and-tradition/commercial-tobacco/
  14. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA; 2016.
  15. National Native Network. Traditional Tobacco | Keep It Sacred [Internet]. 2015 [cited 2021 May 18]. Available from: https://keepitsacred.itcmi.org/tobacco-and-tradition/traditional-tobacco-use/
  16. US Department of Health and Human Services. Treating Tobacco Use and Dependence: 2008 Update [Internet]. Rockville, MD: US Department of Health and Human Services; 2008 [cited 2021 Jun 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK63952/
  17. Siddiqi K, Shah S, Abbas SM, Vidyasagaran A, Jawad M, Dogar O, et al. Global burden of disease due to smokeless tobacco consumption in adults: Analysis of data from 113 countries. BMC Medicine [Internet]. 2015 Aug 17 [cited 2021 May 18];13(1):1–22. Available from: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0424-2
  18. Gaunkar RB, Nagarsekar A, Carvalho KM, Jodalli PS, Mascarenhas K. COVID-19 in Smokeless Tobacco Habitués: Increased Susceptibility and Transmission. Cureus [Internet]. 2020 Jun 25 [cited 2021 May 18];12(6). Available from: /pmc/articles/PMC7384704/
  19. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta, GA; 2020.
  20. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: An overview and network meta-analysis [Internet]. Vol. 2013, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2013 [cited 2021 Jun 15]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009329.pub2/full
  21. National Association of State Mental Health Program Directors. Tobacco-Free Living in Psychiatric Settings A best-practices toolkit promoting wellness and recovery [Internet]. 2007 [cited 2021 May 19]. Available from: www.nasmhpd.org
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  23. Greenberg MR, Greco NM, Batchelor TJ, Miller AHF, Doherty T, Aziz AS, et al. Physician‐directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program. Journal of the American College of Emergency Physicians Open [Internet]. 2020 Oct [cited 2021 May 19];1(5):782–9. Available from: https://pubmed.ncbi.nlm.nih.gov/33145519/