The following is the summary of “Impact of Florida Medicaid guidelines on frequency and cost of delayed circumcision at Nemours Children’s hospital” published in the December 2022 issue of Pediatric urology by Soto, et al.

There was a rise in neonatal circumcisions (NC) after Medicaid in Florida stopped covering regular visits in 2003. Medicaid in Florida is one of 16 state programs that do not include coverage for North Carolina. If a child is ≥3 years old and has a medical condition that requires circumcision, or if he has persistent phimosis that has not responded to topical steroid therapy (TST), then Medicaid in Florida will pay for the procedure. Researchers want to calculate how much it costs to diagnose and circumcise young guys on Florida’s Medicaid who present with phimosis at Nemours Children’s Hospital. For September 2016 through September 2019, all male Medicaid patients  ≥3 years from the state of Florida who were seen at NCH for phimosis or circumcision were included in a retrospective chart study approved by the Institutional Review Board. Factors such as age at presentation, previous TST treatment, response to TST, and surgical procedures were also recorded. 

There were 3 treatment groups formed from the patients. Estimated reimbursement rates from Medicaid were used to determine total expenses for each cohort. Using SPSS, investigators performed a descriptive analysis of the collected data. They tested 763 guys. Patients’ ages at the presentation ranged from 3 to 17, with those between the ages of 6 and 12 making up 59% of the total. Around 340 people were circumcised. Care for all patients was predicted to cost a total of $1,345,533.90. Considering the expected cost of $171,675 if everyone had NC in 2020, this is a significant saving. However, the total estimated cost associated with the evaluation and management of 763 patients ≥3 years for phimosis/circumcision was 7.8 times the estimated cost of NC for all these patients and likely is an underestimation of the true difference in cost as we did not account for additional visits outside of the initial consultation and follow-up, post-operative visits outside of the global period, emergency room visits, and returns to the operating room.

Only 18.5% of the circumcisions were for medically acceptable reasons, as defined by Florida Medicaid. TST success rates reported in the literature range from 53.8% to 95.5%; ours was 34.3%. Caretakers who want to perform a circumcision may be less compliant with TST use, which may explain why our response rate is lower than that reported in the literature. TST failure was documented before presentation in only 6.6% of patients. The number of unnecessary office visits, healthcare expenses, and family burdens might be reduced if PCPs adopted TST and were educated on the current Medicaid/MCG recommendations for evaluating and managing phimosis.