South Carolina faced high smoking rates among Medicaid enrollees, leading to significant health and financial burdens. Before 2017, Medicaid tobacco cessation coverage was inconsistent, creating barriers to treatment. Through the CDC’s 6|18 Initiative, the South Carolina Department of Health and Human Services and the Department of Health and Environmental Control partnered to standardize cessation benefits, remove co-pays and prior authorization, and secure federal funding for the state’s Quitline. This collaboration led to comprehensive, cost-effective coverage and strengthened partnerships between agencies. The initiative serves as a model for other states seeking to implement similar health policy changes.