This case study details North Dakota’s successful efforts to improve access to tobacco cessation treatment for Medicaid enrollees by recognizing Certified Tobacco Treatment Specialists (CTTS) as qualified providers for reimbursement. Through participation in the CDC’s 6|18 Initiative and collaboration between the Tobacco Prevention and Control Program and the Medicaid Program, North Dakota addressed systemic barriers that previously limited reimbursement for CTTS, particularly in outpatient settings. Despite challenges presented by the COVID-19 pandemic, which disrupted progress and strained healthcare resources, the initiative laid important groundwork and secured legislative support for ongoing recognition of CTTS. Key lessons learned include the necessity of leadership buy-in, strong partnerships, data-driven decision making, and flexibility in implementation, all crucial for other states seeking to expand access to tobacco cessation services through similar policy changes.