circumcision health equality



north Carolina Medicaid circumcision

North Carolina Medicaid Proposes To Enrich Hospitals With Profits From
Routine Infant Circumcision

After more than a decade, North Carolina is proposing to alter their regulatory policy to have their Medicaid program, once again, pay hospitals and doctors to perform infant circumcision.  State officials want to insert clever language into Regulation 1A-22 so routine infant circumcision under State Medicaid can resume for almost any reason. This is in violation of the intent of State law and unauthorized Medicaid expansion. North Carolina hospitals and clinics are in line to start profiting again from cutting baby boy’s genitals.

Please watch this video for more information about this issue.

This is how State Medicaid officials and their hospital/doctor allies intend to get around the prohibition on Medicaid payments for routine infant circumcision.


3.2.2 Medicaid Additional Criteria Covered

a. Medically Necessary Circumcision for Newborns

Medicaid covers medically necessary circumcision for newborns. The conditions justifying medical necessity are extremely rare (i.e., certain congenital obstructive urinary tract anomalies, neurogenic bladder, spina bifida, or urinary tract infections) and are subject to individual review.

Note: “Newborn” is interpreted as the first 28 days of life.

4.2.2 Medicaid Additional Criteria Not Covered

Medicaid program does not cover routine or elective newborn circumcision. N.C. state law prohibits the Medicaid program from reimbursing for ritualistic, religious, and routine newborn circumcision.

Specific diagnosis codes do not indicate medical necessity for newborn circumcision and are, therefore, not covered under Medicaid.

Refer to Attachment A, Section B for specific newborn non-covered diagnosis codes.


3.2 Specific Criteria Covered
3.2.1 Specific criteria covered by both Medicaid and NCHC
a. Medically Necessary Circumcision for Newborns
Medicaid shall cover a circumcision for a healthy newborn (28 days or less)
while the baby is in the hospital or in an office setting for: the following
    1. Congenital obstructive urinary tract anomalies;
    2. Neurogenic bladder;
    3. Spina bifida;
    4. Urinary tract infections; and

Under the proposal, a doctor would be able to provide Medicaid circumcision for infants. The parents just have to express a need for “HIV prophylaxis,” or be coached to say that.

So this is what could happen. A baby boy is born, doctor solicits the parents for circumcision for any reason, parents sign consent, hospital coder/biller enters HIV prophylaxis on the chart. Doctor/hospital gets paid by Medicaid.

By citing HIV prophylaxis it basically covers any excuse by parents or doctors to get Medicaid paid circumcisions in violation of the intent of State Medicaid law.

The whole thing is preposterous because babies are not at risk for sexually transmitted HIV.

For those that wish to read the entire public notice

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