Medicaid to drop practice

•   Missouri coverage will no longer include routine circumcisions.

By STEVIE ST. JOHN, Missourian staff
July 25, 2002

Beginning next month, Missouri Medicaid will no longer pay for male infant circumcisions. The decision to no longer fund the procedure will save state coffers about $260,000 a year.

Missouri Medicaid officials were looking for ways to reduce costs and considered professional recommendations regarding routine circumcision, said Greg Vadner, director of the Missouri Division of Medical Services.

Beginning Thursday, Missouri Medicaid will no longer cover routine male infant circumcisions, he said. Circumcisions that are medically necessary, such as in case of infection, will still be covered. By not covering routine circumcisions, in which the foreskin is removed from the penis, Missouri Medicaid expects to save $262,103 a year, he said.

“We think this is a change that is reasonable . . . that follows established medical guidelines,” Vadner said.

Missouri Medicaid listened to input from Doctors Opposing Circumcision, the American Academy of Pediatrics and individual doctors before making the decision, he said.

Vickie Greenlaw, reimbursement assistant for the division of urology at MU Health Care, said there is a $210 doctor’s fee and a small instrument use fee for each circumcision procedure.

Dr. Lynn Teague, a pediatric urologist with MU Health Care, performs one or two circumcisions per week. However, he said, the circumcisions he performs are mostly procedures that are necessary because of congenital problems. Teague said he does not believe routine circumcisions are medically necessary and counsels parents against it.

“I think (Missouri) Medicaid did the right thing,” he said.

Circumcision was thought to be a treatment for ailments including epilepsy and alcoholism around 1900, he said, and became the norm. He said babies are circumcised “to look like dad.”

“I think it’s a cultural thing rather than a medical thing,” he said.

Circumcision does decrease the risk of infections for the first few months of life, he said, but does not seem to make much difference later. He said that studies suggest an uncircumcised man who practiced proper hygiene would not be at an increased risk for penile cancer.

Dr. George Denniston, president of the Seattle, Wash.-based international organization Doctors Opposing Circumcision, said circumcision is harmful. Foreskin protects glands, covers the shaft of the penis when it is erect and has nerve endings related to sexual pleasure, he said in a phone interview from the Seattle Doctors Opposing Circumcision office.

Dr. Jack Swanson, a pediatrician in Ames, Iowa, served on the American Academy of Pediatrics task force on circumcision in 1999, when the academy’s statement on circumcision was last revised. In a phone interview, he said uncircumcised men have a slightly increased risk of infection in the first year of life and a slightly increased lifetime risk for penile cancer.

But he said these occurrences are not frequent enough to justify every male being circumcised as a preventative medical measure.

He said that he tells his patients it is OK to have their baby circumcised but that they should understand that they do not need to.

“It’s got to be a personal choice about what the parents think is right,” he said.