We are asking North Carolina in-state residents to be added to our letter to state Medicaid officials. The letter is an inquiry about state Medicaid policy over their  “Infant circumcision HIV prophylaxis” exception to state law 1A-22.

Your participation as a in-state resident will help to give us standing in the matter.

Please note this is only for North Carolina residents.

Please fill out the form below and we will add your name to our letter.

It’s imperative be get the “Infant circumcision HIV prophylaxis” exception rescinded.

We will be submitting our letter in the coming week.

Thank you for your participation.

Anthony Losquadro, Director, Intaction/HEC

Questions for state Medicaid officials:

1. We are wondering what is the basis the department is relying on to support the policy position that infant circumcision for HIV prophylaxis is reasonable and necessary?
2. Since North Carolina is the only state covering infant circumcision for HIV prophylaxis under state Medicaid, is it the Department’s position to say that it’s a generally accepted standard for medical practice? If so, why?
3. Which policy statements or sources is the department relying on when it comes to supporting coverage of infant circumcision for HIV prophylaxis?
4. Does the Department realize that the 2012 American Academy of Pediatrics (AAP) Circumcision Policy Statement, which was vague, contradictory, and criticized, expired in 2017, and has not been renewed, replaced, or reaffirmed?
5. Does the Department have any data or studies that shows infant circumcision reduces HIV infection rates in high risk groups such as MSM or PWID?
6. Under Medicaid law, a treatment or service must be cost effective. Do you know if the Department performed an analysis of the cost effectiveness of circumcision for HIV prophylaxis? If such an analysis was done, did it take into account generic antiretrovirals commonly available today like PreExposure Prophylaxis or Post Exposure prophylaxis, condoms, testing, or education? If any cost effectiveness analysis exists, did it take into account circumcision complication rates, which one study estimates at 11.5%? How do we know if infant circumcision is cost effective as HIV prophylaxis? (Source: Lau, K., et al. “Identification of Circumcision Complications Using a Regional Claims Database.” 66th Annual Meeting of the Societies for Pediatric Urology, May 2018. PubMed, pubmed.ncbi.nlm.nih.gov/15534340/. )
7. If such a cost analysis was done, would the Department be willing to make it available to us?
8. When the department added “circumcision for HIV prophylaxis” to policy 1A-22, then doubled the reimbursement rate for circumcisions, and then streamlined HCP payments for the same, was the intent to synergistically increase the rate of infant circumcisions, most of which previously would have been not allowed under Medicaid?
9. By broadening coverage and increasing payments, did the department consider there would be increased incentives for HCP’s to solicit parents for an unnecessary service?
10. Regarding the changes to 1A-22 for “circumcision for HIV prophylaxis”, the application of a 2x multiplier for reimbursement, and the streamlining of diagnosis codes, were any of these policy changes requested or initiated by HCP’s?
11. How does the Department ensure and safeguard that circumcisions claimed to be done under the “HIV prophylaxis” exception are not a disguise used by HCP’s to perform circumcisions for other disallowed reasons in violation of state law?