MIAMI HERALD, Miami, Florida, 3 July 2003.

Posted on Thu, Jul. 03, 2003

Medicaid won't cover elective procedures


Florida Medicaid patients who want their newborn boys circumcised will have to pay for it themselves unless it's done right after delivery and is billed as part of that process.

Medicaid will still pay for the procedure -- surgical removal of the foreskin -- at any time if a doctor deems it medically necessary, usually due to infection, injury or abnormality that impairs function.

The rule change went into effect Tuesday and was passed by the Legislature as a cost-cutting measure.

Out-of-pocket, an elective circumcision might cost between $400-$1,000, depending on the age of the child, according to an informal survey of South Florida pediatric surgeons, urologists and obstetricians.

Newborns don't need anesthesia; older children do, increasing the cost of the procedure.

The lower end of the scale is about what South Florida mohels -- practitioners, usually rabbis, who perform the procedure ritually on 8-day-old Jewish boys -- are paid.

Muslims also ritually circumcise, but later in a child's life.

Medicaid is a state program that pays some medical expenses for the poor. Florida is the 11th state to drop elective circumcision coverage.

The rule is designed to save the state $2.3 million a year.

That's what 14,420 circumcisions cost in 2001-2002, including $122,656 for 677 circumcisions in Broward County and $106,630 for 659 in Miami-Dade, according to state Medicaid records.

It's unclear how many procedures were done as part of the delivery or some time thereafter. Department records show that Medicaid covered 12,585 circumcisions of babies less than a year old and 384 for children 1-2 years old. The remainder were done on Medicaid recipients of all ages, up to 79.

The records also do not provide a breakdown of how many circumcisions were elective or medically necessary.

Circumcision, a procedure dating back about 4,000 years, became popular in the mid-1800s, when it was thought to promote better hygiene and deter masturbation.

It was once nearly universal in the United States but began to decrease in popularity after the American Academy of Pediatrics declared in 1971 that it held no health benefits.

Nationwide, according to the National Center for Health Statistics, about 60 percent of baby boys undergo the procedure, which some doctors consider unsafe and anti-circumcision activists consider an emotionally damaging mutilation.

Its advocates, however, say that it's a prudent hygiene measure that reduces the risk of urinary-tract infection.

Four years ago the American Academy of Pediatrics recommended against routine circumcision because the potential medical benefits, including a decreased risk of urinary-track infections and penile cancer, were not significant.

The American Jewish Congress, which monitors church/state matters, took no position on the Florida legislation.

''We don't think that per se this decision is something we'd oppose,'' said chief information officer David Twerksy, from his New York office. ``But there's no question there's a move among some in the medical community to outlaw it [so] if this budgetary decision would presage an anti-circumcision move, we'd express vigorous opposition.''

South Florida mohel Michael Andron says it takes him about 10 seconds to perform the procedure during a brit milah: circumcision ceremony. It takes doctors in hospitals 10 minutes, he says, because they use different tools.

Religious circumcisions were never covered under state Medicaid guidelines.

Ronald Goldman, who has written two books decrying the procedure, doesn't advocate outlawing circumcision but hopes it will die out as Americans become convinced there's no benefit to it.

Executive director of the Boston-based Circumcision Resource Center, Goldman notes that 80 percent of the world's population doesn't practice circumcision.

(File prepared 16 July 2003)