ST. PETERSBURG TIMES, St. Petersburg, Florida,
July 1, 2003.

State limits circumcision coverage

Medicaid will no longer cover most of the surgeries in Florida as state officials seek to reduce costs.

By ALISA ULFERTS, Times Staff Writer
© St. Petersburg Times
published July 1, 2003

TALLAHASSEE - Florida has taken sides in the long-running debate over the medical necessity of circumcision. It has joined the opposition.

Beginning today, the procedure is no longer covered by Medicaid in Florida except in limited cases.

That means a Medicaid mom who wants her newborn circumcised will have to find some other way to pay for it, while those with private health insurance will generally find the procedure is covered.

It's a cost-saving step, lawmakers say.

"You have to spend Medicaid dollars on medically necessary services," said Rep. Frank Farkas, a St. Petersburg Republican and vice chairman of the House Subcommittee on Health Appropriations. Research suggests circumcision is done more often for cultural or religious reasons, Farkas said. "It really was a no-brainer."

The change is expected to save the state $2.3-million a year.

In the past four years, Medicaid paid $5.8-million for almost 45,000 circumcisions in Florida.

Medicaid will continue to cover the procedure in the case of injury or other problems.

But what was once routine procedure performed within days of a boy's birth won't be for the poor.

Circumcision involves the removal of all or part of the foreskin of a penis. It is religious ritual in Judaism and Islam. Proponents say it helps prevent disease, but opponents say the risks are high for little return.

Medicaid has paid between $151.19 and $222.79 per circumcision, depending on the type of procedure used and whether there are complications.

Eliminating circumcision was one of several cost-saving changes lawmakers made in Medicaid this year. Eyeglasses, hearing aids and dentures for the poor were among the services deemed nonessential, as were some transportation costs.

Anti-circumcision groups, many of whom equate the procedure with genital mutilation, have pushed for this change for years, even when the state's coffers were flush with cash.

"This is taxpayer money, and circumcision is a procedure with no medical benefit," said Ronald Goldman, executive director for the Circumcision Resource Center, a Boston-based anti-circumcision group. Unless needed to correct a defect, the only justification for circumcision is cultural, religious or aesthetic, Goldman said.

"We wouldn't use taxpayer dollars to pay for other cosmetic surgery," Goldman said.

But social services advocate Karen Woodall said the change is unfair to poor parents who want to have their newborn circumcised for religious or cultural reasons. She also objects to the other changes done for cost-saving reasons.

Florida joins 10 other states, including Arizona, California and North Carolina, that won't pay for circumcision under Medicaid, which is funded with state and federal money.

"It's understandable that they would want to cut this because the American Academy of Pediatrics has said for many years that circumcisions are cosmetic," said Catherine Lynch, a professor of obstetrics and gynecology at the University of South Florida. Yet the procedure is widely performed in the United States, she noted.

For Ed Rose, a University of West Florida student and head of the Pensacola chapter of the Circumcision Resource Center, the issue is simple: "Being born male is not a disorder requiring surgical correction." Rose has been lobbying lawmakers for years to stop paying for circumcisions and testified before Farkas' committee.

Pediatricians once recommended circumcision as a way to reduce urinary tract and other infections in infants and toddlers. The practice is far more common in the United States, with about 65 percent of males undergoing the procedure. In the rest of the world, 20 percent of males are circumcised.

(File prepared 1 July 2003)