Abstract
We investigated California’s 1982 decision to stop funding Medicaid neonatal circumcision. We examined male neonatal circumcision rates for those born 1977–1981 and 1983–1987 by region, race, and insurance status. Overall, West-Medicaid circumcision rates decreased from 56.5% in 1979-81 to 26.7% in 1983-85. California’s 1982 decision to defund Medicaid circumcision coverage was associated with a 25.0-30.8% point decrease in West-Medicaid circumcision rates compared other groups, p < 0.01. This provides the earliest data to support that funding coverage for neonatal circumcision affects circumcision rates and magnifies healthcare disparities. Other states have since defunded Medicaid male neonatal circumcision. Circumcision have been associated with lower rates of sexually transmitted infections including HIV, and urinary tract infections. Lawmakers should consider re-funding Medicaid male neonatal circumcision.
Resumen
La cesación de financiamiento por Medicaid en 1982 para la circuncisión y el impacto de su tasa en California.
Aquí investigamos la decisión del gobierno de California en 1982 de dejar de financiar la circuncisión neonatal por Medicaid. Examinamos las tasas de circuncisión neonatal masculina para los nacidos entre 1977 a 1981 y entre 1983 a 1987 por región, raza y estatus de seguro médico. En general, las tasas de circuncisión de West-Medicaid disminuyeron 56.5% en 1979-81 a 26.7% en 1983-85. La decisión de California en 1982 de desfinanciar la cobertura de circuncisión por Medicaid se asoció con una disminución de 25.0 a 30.8 puntos porcentuales en las tasas de circuncisión de West-Medicaid en comparación con otros grupos, p < 0.01. Esto provee los primeros datos que demuestra la cobertura de financiamiento para la circuncisión neonatal afecta las tasas de circuncisión y aumenta las disparidades en cuidado médico. Desde entonces, otros estados han desfinanciado la circuncisión neonatal masculina por Medicaid. La circuncisión se ha asociado con tasas más bajas de infecciones de transmisión sexual, incluyendo el VIH, e infecciones del tracto urinario. Los legisladores deberían considerar refinanciar la circuncisión neonatal masculina por Medicaid.
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Acknowledgements
We thank Amanda Bowes, Lindsay Dawson, Angela Hernandez, Joseph Prejean, and Anna Satcher Johnson for their help with this project. We thank Dean Winslow, Donna Zulman, and Ezra Golberstein for their review of the manuscript.
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RYL contributed to the data sourcing and interpretation. RW contributed to the statistical analysis and interpretation. DS oversaw the project, including statistical analysis and interpretation.
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Linfield, R.Y., Wendling, R. & Slusky, D.J. The 1982 Medicaid Funding Cessation for Circumcision in California and Circumcision Rates. AIDS Behav 27, 1647–1652 (2023). https://doi.org/10.1007/s10461-022-03896-y
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DOI: https://doi.org/10.1007/s10461-022-03896-y