The funding landscape for quitlines continues to be uncertain at the federal level. As we previously laid out, funding for the National and State Tobacco Control Program (NTCP) is in limbo with limited available information about whether it will continue past April 28, 2025.  

In the absence of information, we understand making decisions about the future of your quitline program is extraordinarily difficult. At the same time, planning for a range of scenarios during periods of uncertainty can help you make informed decisions as more information becomes available. NAQC has a variety of resources that can guide your planning while ensuring the effectiveness, quality, and sustainability of quitline services. 

These resources focus on: 

• Identifying triggers for contingency plan implementation. 
• Prioritizing evidence-based practices, including technology-mediated services.
• Budget-based decision-making for Quitline services. 
• Enhancing service delivery through innovative and sustainable approaches. 

Quitline Contingency Planning
Quitline funders and providers continuously navigate shifting budgets, promotional campaigns, and partnerships while maintaining quality services. Effective contingency planning supports decision-making during funding cuts or demand surges, benefiting all stakeholders. Based on NAQC guidance and evidence-based practices, this document provides practical strategies for contingency planning.

Contingency plans help quitlines stay responsive and resilient. In times of limited funding, plans enable strategic service adjustments—such as reducing proactive calls or limiting NRT—while preserving core best practices. During high-demand periods, they support quick expansion through staffing, technology, and service enhancements.

Planning is always important and critical when resources are tight. Evidence-based practices serve as a guide to prioritize high-impact services and maintain effective support. The following elements outline key considerations for creating a strong, adaptable contingency plan.

Key NAQC Resources for Quitline Administrators
• Contingency Planning for Quitlines: Guiding Principles, Considerations and Questions to Strengthen Impact; 2014. This NAQC Guidance Brief outlines the essential elements to guide contingency planning for quitline programs.
• Adoption of Recommended Best Practices among State Quitlines; 2018. This document outlines the best practices for quitlines, including guidance on supplementing single-call services with other evidence-based practices.
• Identifying Priority Best Practices for State Quitlines; 2019. The priority best practices document provides additional information about budget-based decisions for quit medications.
• Recommended Best and Promising Practices on Technology-Mediated Services for Quitlines; 2021. This document makes the case for using technology-mediated services to support quitline impact.
• Report on Priority Practices for State Quitlines to Implement by June 2023; 2023. This priority practices report highlights the core components for impactful quitline programs.

Essential Elements to Guide Quitline Contingency Planning
• Review quitline goals and priorities.
Clearly articulate quitline values and priorities to guide contingency planning, especially during challenging periods. Ensure evidence-based best practices remain central to decision-making.
• Review your data to forecast future resource needs.
Evaluate historical performance data to set realistic and manageable goals during times of limited resources or increased service demand.
• Prioritize evidence-based best practices.
Commit to using proven, effective best practices as described above as the basis for adjustments during periods of resource fluctuation. NAQC’s best practice guidance provides practices to consider based on available budget.
• Define specific triggers for activating the plan.
Establish and agree upon clear triggers—such as funding reductions, national campaigns, or spikes in call volume—that initiate contingency plan implementation.
• Maintain open communication between providers and funders.
Ensure clear, transparent dialogue throughout the planning and implementation phases to facilitate collaborative decision-making.
• Base decisions on evidence and evaluation.
Use research and past evaluation outcomes to inform decisions regarding service adjustments when resources are constrained.

Managing Decreased Budgets & Limited Resources
When budgets are reduced and services need to be adjusted or managed, quitlines can still implement best practices by adopting strategies that maximize cost-efficiency while maintaining effective service delivery. Below are some recommendations to adjust best practices within your contingency plan.

Goals: 
• Prioritize essential services. 
Identify and protect the core evidence-based interventions most critical to impact smoking cessation outcomes, such as counseling, nicotine replacement therapy (NRT), text messaging and web-based interventions.
• Maximize the impact of limited resources.  
Public health impact is defined as Reach X Effectiveness. Delivering the most effective intervention to the greatest number of individuals will ensure maximum impact. Consider the relative cost-effectiveness of different service modalities for different populations.

Strategies to Maintain Quitline Best Practices Under Budget Constraints 
Check here for more detailed information about best and promising practices.

Phone counseling 
Adjust Service Delivery Models. 

• Reduce the number of counseling sessions. Supplement calls with alternative evidence-based supports e.g., one high-quality counseling call supplemented by follow-up texts or emails.
• Refine eligibility requirements, consider narrowing eligibility for some services (e.g., proactive calls, NRT) to those who are most in need or least likely to access other forms of support (e.g., uninsured, pregnant smokers).
• Enhance program efficiency. Develop triage protocols to efficiently direct callers to appropriate community-based resources. Expand the use of IVR technology to handle tasks such as intake, follow-up surveys, and reminders, reducing the need for live staff interactions during times of high demand.

Quit Medications
Limit or prioritize the provision of medications. 

• Offer shorter NRT courses, such as 2-week increments, and/or reserve for high-need groups. 
• Maximize use of your state’s Medicaid tobacco cessation medication coverage. Check the ALA Database.
• Check the ALA Financial Assistance Page for programs that cover the cost for tobacco cessation medications.
• Limit medications to un/underinsured populations. Educate insured participants about how to access medications.
• Limit the availability of different medications to one or two types rather than offering a full range of options like prescription medications, which may be more costly.
• Offer NRT starter kits (2-week supply) to ensure all participants have access to NRT.
• Offer participants the choice of quit medications in web only or text only plans to increase effectiveness.
  

Technology-based Services
Increase use of automated and digital solutions.

• Offer participants the choice of web only or text only plans and include quit medications in the plans when possible.
• Use web-based or texting services to complete intake.

Supplement reduced phone counseling services with text- and web-based services.

Evaluation
Conduct outcomes evaluation once every three years, in line with NAQC guidance on calculating quit rates.

Strategies to Promote Quitlines During Budget Constraints
• Use social media, email newsletters, and community e-bulletin boards to reduce promotional costs.
• Target key populations and messaging for high-risk or priority groups.
• Leverage partnerships such as healthcare and community organization referrals and information dissemination.
• Earn media coverage by sharing stories and expertise with local news to generate publicity without significant cost.
• Use available resources and update existing promotional materials.
• Promote positive client experiences and testimonials to encourage word-of-mouth referrals.

We will continue to share information with you and provide relevant resources as we learn more about the status of funding and program supports. Please let us know if there are particular topics you would like us to address.