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Tobacco use is the leading cause of preventable death and disease in the United States. Oregon's coordinated care model for Medicaid provides an opportunity to consider novel ways to reduce tobacco use. We sought to evaluate the changes in tobacco cessation benefits, patient access to cessation interventions, and cigarette smoking prevalence before and after introduction of the statewide Coordinated Care Organization (CCO) cigarette smoking incentive metric for Medicaid members. Medicaid and public health collaborated to develop a novel