Medicaid funding impacts circumcision utilization
A report examines the impact of Medicaid funding on how many neonates undergo circumcision.
Public opinion on neonatal circumcision has shifted over the years and a number of states do not offer Medicaid coverage for the procedure, in spite of the recommendation from the American Academy of Pediatrics that supports access to neonatal circumcision for families that choose to have their child get the procedure. A report in Pediatrics examines the trends for circumcision and the impact of changes in Medicaid coverage for the procedure.1
The researchers used the State Inpatient Databases to determine the rates of neonatal male circumcision in Colorado, Florida, Michigan, and New York during 4 different years: 2001, 2006, 2011, and 2016. During the study period, the procedure was defunded by Medicaid in Florida in 2003 and Colorado in 2011.
The researchers found that during the study period 54.5% of male neonates received a circumcision. They found that the rate of circumcision decreased in the years following the defunding of neonatal circumcision by Medicaid, 47.4% to 37.5% in Florida; 61.9% to 52.0% in Colorado. When compared to neonates who were covered by public insurance, neonates who were privately insured had higher odds of undergoing circumcision (adjusted odds ratio [aOR] 2.23; 95% CI 2.21–2.25). If Medicaid covered neonatal circumcision, Black neonates were found to have higher odds of circumcision than white neonates (aOR 1.44; 95% CI 1.42–1.46). However, when Medicaid did not cover the procedure, Black neonates were found to have lower odds of getting the procedure than white neonates (aOR 0.40; 95% CI 0.39–0.41).
The investigators concluded that overall the state-specific data indicate that the neonatal circumcision rates remain at levels similar to previous national estimates. However, defunding by Medicaid does lead to a reduction in the procedure, with Colorado seeing a 20.9% reduction and a 16.0% reduction in Florida. Additionally, Black neonates are the infants most likely to be impacted by a lack of Medicaid funding because they were overly affected by changes in Medicaid coverage of neonatal circumcision.
Reference
1. Zambrano Navia M, Jacobson D, Balmert L, et al. State-level public insurance coverage and neonatal circumcision rates. Pediatrics. October 14, 2020. Epub ahead of print. doi:10.1542/peds.2020-1475
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