I oppose North Carolina Medicaid’s draft proposal to fund Routine Infant Circumcision (“RIC”), entitled “Necessary Circumcision Clinical Coverage Policy 1A-22.” For over ten years, North Carolina declined to cover RIC, citing it as cosmetic and unnecessary. RIC does not meet Medicaid’s definition for medical necessity.
State Medicaid has proposed to insert backdoor language into 1A-22 that would essentially allow circumcision payouts for almost any reason, in violation of the intent of state law. All healthcare providers would need to do in order to receive payment for RIC would be to note “HIV prophylaxis.” It’s a preposterous excuse because babies are not at risk for HIV, no western studies have shown a link between circumcision and HIV rates, and the State has not provided any in-state data on “female to male” HIV versus circumcision status.
Medical experts have stated, “CIRCUMCISION fails to meet the commonly accepted criteria for the justification of preventive medical procedures in children … Circumcision of underage boys … has no compelling health benefits, causes pain, can have serious long-term consequences, constitutes a violation of the U.N. Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm.”
Proposal 1A-22 will only serve to increase revenues for hospitals and doctors at the expense of the Medicaid program and the taxpayers of North Carolina. Furthermore it’s the baby boys that must suffer from needless traumatic pain, loss of choice for an intact body, and loss of anatomically important erogenous tissue. Circumcision payments were ended in 2009, but now medical industry advocates are attempting to relitigate the issue and revive this income stream once again.
The 1A-22 Proposal relies on the most positive assumptions about the claimed benefits of circumcision, assumptions that are disputed by medical experts around the world. The proposal does not consider the risk and complications that arise from RIC. More often than not, it’s Black, Brown, and Latino babies that suffer disproportionally from circumcision malpractice. Doctors will solicit or pressure Medicaid families into signing consent forms for circumcision on their sons, telling them it’s “free.” Hospitals and clinics are inclined to rush the procedure or use poorly trained personnel to maximize revenues. When malpractice or disfigurements happen, medical staff downplay the consequences and tell the parents not to worry, it will heal. These children must often endure the rest of their lives with physical disfigurements and psychological harm.
Furthermore, the State did not perform any cost benefit analysis on circumcision. No analysis was done on what financial impact Proposal 1A-22 would have on the State Medicaid program. In addition to the billing charge for the procedure, other cost factors that must be included are complication rates, botches, malpractice, and circumcision revision surgery expenses, including cosmetic repairs, by pediatric urologists. The complete costs are vital to know in an era of our overburden medical system and state budgets already impacted by COVID-19 costs. Yet the 1A-22 Proposal did not seem to consider these things at all.
North Carolina Medicaid should not be pay for unnecessary, cosmetic, life altering surgery on babies. The changes contained in the proposed 1A-22 Policy should be rejected.
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