North Carolina Standard & Tailored Plan Tobacco-Free Policy Requirement
Tobacco-related policy requirements go into effect on Dec. 1, 2022.

Tobacco-related policy requirements go into effect on Dec. 1, 2022.

This bulletin has been replaced by Update: North Carolina Standard Plan and Tailored Plan Tobacco-Free Policy Requirements published Nov. 4, 2022.

This replaces the bulletin published on Sept. 7, 2021, North Carolina Standard & Tailored Plan Tobacco-Free Policy Requirement

Tobacco-related policy requirements for Standard Plans and Tailored Plans contracted medical, behavioral health, intellectual/developmental disabilities (I/DD), and traumatic brain injury (TBI) service providers will be effective Dec. 1, 2022. These requirements will apply to both Medicaid and state-funded service providers. The Department will work with the Standard Plans and Tailored Plans to include these requirements, as appropriate, in advance of Dec. 1, 2022.

Secondhand smoke is a well-documented danger to health. No one should be exposed to secondhand smoke when they access care or on the job. Research shows that most people who use tobacco want to quit. An environment free from triggers to use tobacco products is necessary to support service recipients whose goal is to become tobacco free. People with behavioral health disorders die disproportionately from tobacco-related illness. Among people who try to become tobacco free, only a small minority receive evidence-based care to assist them.

Therefore, starting Dec. 1, 2022, NC Medicaid Managed Care Standard plans and Tailored Plans will require contracted providers, not including retail pharmacies, and with the exception of the residential provider facilities noted below, to implement a tobacco-free policy covering any portion of the property on which the participating provider operates that is under its control as owner or lessee, to include buildings, grounds, and vehicles.

A tobacco-free policy includes a prohibition on smoking combustible tobacco products and the use of non-combustible tobacco products, including electronic, heated, and smokeless tobacco products, and/or nicotine products that are not approved by the FDA as tobacco treatment medications, as well as, prohibiting participating providers from purchasing, accepting as donations, and/or distributing tobacco products to the individuals they serve. 

Intermediate care facilities for individuals with intellectual disabilities (ICF-IID) and I/DD residential services subject to the Home and Community Based Services (HCBS) Final Rule are exempt from this requirement. However, starting Dec. 1, 2022, the following policies shall be required in these settings: 

  1. Indoor use of tobacco products shall be prohibited in all provider owned/operated contracted settings. 
  2. For outdoor areas of campus, providers shall: 
    • Ensure access to common outdoor space(s) that are free from exposure to tobacco use; and 
    • Prohibit staff/employees from using tobacco products anywhere on campus.

As part of policy implementation, Standard Plan and Tailored Plan contracted service providers should integrate tobacco use treatment and support into all settings. Evidence-based tobacco use treatment is defined as a combination of FDA approved medications and counseling.

To support this policy change, the North Carolina Division of Public Health Tobacco Prevention and Control Branch partners with the Division of Mental Health/Developmental Disabilities/ Substance Abuse Services and the Division of Health Benefits to coordinate Breathe Easy NC: Becoming Tobacco Free

Breathe Easy NC: Becoming Tobacco Free is a statewide initiative to support people with behavioral health conditions and I/DD/TBI in becoming tobacco free, by working with service providers to integrate tobacco use treatment and make campuses tobacco free.

  • Standard Plan and Tailored plan contracted service providers should make use of this resource to ensure they have a transparent, well-organized, and evidence-based tobacco-free policy and tobacco use treatment implementation process.
  • Making an organization’s campus tobacco-free is a process that should involve all organization stakeholders: service recipients or clients, leadership, and staff. Implementing a tobacco-free policy can take 3-6 months, occasionally longer.
  • Providers should integrate tobacco use treatment or referrals to tobacco use treatment resources, such as QuitlineNC, prior to policy implementation.

Providers can visit for technical assistance and training on tobacco-free policy implementation and evidence-based tobacco use treatment or contact their county’s regional or local tobacco control staff directly. They can assist with every step of this process.

If you have any questions, check out these Frequently Asked Questions (FAQ) webpages from Breathe Easy NC:

For additional questions, please contact Stephanie Gans at

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