State-Level Public Insurance Coverage and Neonatal Circumcision Rates

Area of Science:

• Public Health
• Pediatrics
• Health Policy

Background:

• Seventeen states lack Medicaid coverage for neonatal male circumcision, despite American Academy of Pediatrics recommendations.
• This study examines state-specific trends and the impact of Medicaid policy changes on neonatal circumcision rates.

Purpose of the Study:

• To compare state-specific neonatal circumcision trends with national estimates.
• To assess how changes in Medicaid coverage affect neonatal circumcision rates.

Main Methods:

• Analysis of State Inpatient Databases in four states (CO, FL, MI, NY) from 2001-2016.
• Multivariable logistic regression to identify factors associated with neonatal circumcision.
• Examination of circumcision rates before and after Medicaid defunding in Florida (2003) and Colorado (2011).

Main Results:

• Overall neonatal circumcision rate was 54.5%.
• Circumcision rates decreased significantly in Florida (16.0% reduction) and Colorado (20.9% reduction) after Medicaid defunding.
• Neonates with private insurance had higher odds of circumcision (aOR 2.23).
• Black neonates had higher odds with Medicaid coverage (aOR 1.44) but lower odds without (aOR 0.40).

Conclusions:

• State-specific neonatal circumcision trends mirror national estimates.
• Medicaid defunding led to substantial reductions in circumcision rates in Colorado and Florida.
• Changes in Medicaid coverage disproportionately affected Black neonates, highlighting disparities in access.