Utah Medicaid officials to reassess coverage of male circumcision

SALT LAKE CITY — Utah Medicaid policymakers intend to readdress inclusion of circumcision following Monday's endorsement of the procedure by the American Academy of Pediatrics.

State lawmakers nixed the procedure from the Medicaid formulary in 2003, as removal of a male infant's penile foreskin was then seen as elective and therefore cosmetic surgery. The state stood to save more than $350,000 annually by making the cut.

The academy now states, with further evaluation, "the health benefits of newborn male circumcision outweigh the risks," and such benefits "justify access to this procedure for families who choose it."

The issue will definitely "make its way onto their agenda," Utah Department of Health spokesman Tom Hudachko said regarding the state's Medicaid Policy Committee. Any recommendation to change current policy would have to pass the Legislature and receive a funding nod from the state's top lawmakers.

"The new report will certainly generate that discussion," Hudachko said, adding that officials will carefully review the presumed benefits and costs of circumcision before making a recommendation.

Utah Department of Health data indicates that Medicaid spent $730,000 for circumcisions in the 2003 fiscal year. Last year, when only medically necessary circumcisions were covered by the program, expenditures reached $260,000.

Hudachko said eliminating all but necessary procedures saved about $470,000 per year.

The circumcision rate dropped significantly in the year following the legislative move, from 60.3 percent to 52 percent statewide, according to inpatient hospital discharge data compiled by the state health department.

According to a 2010 Medicaid report, circumcision is one of the most common procedures submitted for prior authorization. That year, the statewide rate of circumcisions was 38.8 percent, Utah's lowest ever reported rate.

The rates are under-reported, Hudachko said, adding that numbers only include inpatient hospital procedures. Some infants are circumcised at various pediatric clinics within their first weeks of life.

The American Academy of Pediatrics' about-face on the matter came after a five years of research, involving a multidisciplinary work group of doctors, nurses and other stakeholders who analyzed health data and reviewed available literature regarding known risks and benefits of circumcision.

Data was inconclusive in the 1970s and again in 1999, when the academy first introduced its neutral opinion on circumcision and then reiterated it.

In the most recent study, the organization was able to quantify the specific benefits of circumcision — including prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections and penile cancer.

In addition, it found that male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction, according to a 31-page report released Monday.

The report mentions an overall national decline in male circumcision rates, settling around 50 percent to 55 percent in 2010. Rates are highest in the Midwestern states (74 percent), followed by the Northeastern (67 percent) and Southern states (61 percent). The lowest circumcision rates were found in the Western states, where 30 percent of infant males are circumcised, according to the report.

The academy cites cost as a major factor in the choice to circumcise newborn males. It recommends that third-party insurers, including Medicaid programs nationwide, provide reimbursement for the procedure, which ranges from $216 to $601 across the country.

"Hospitals in states where Medicaid covers routine newborn male circumcision have circumcision rates that are 24 percent higher than hospitals in states without such coverage," the report states.

The U.S. Centers for Disease Control and Prevention claims circumcision is a "societal cost-saving HIV prevention intervention," according to a recent cost-effectiveness analysis. "Financial barriers that prevent parents from having the choice to circumcise their male newborns should be reduced or eliminated."

Utah Medicaid officials meet weekly to discuss policy updates.

E-mail: wleonard@desnews.com

Twitter: wendyleonards