Published: December 22, 2022
Updated: March 30, 2023
California Health & Wellness (CHS), a health insurance plan serving recipients of Medi-Cal, recently announced that effective January 1, coverage for newborn circumcisions would be extended from 28 days to 30 days after birth. [1] Intact America reacted by declaring that Medi-Cal was extending newborn circumcision coverage to 30 days. [2]
Medi-Cal is the name of the Medicaid program that serves low income individuals in the Golden State. Medi-Cal eliminated coverage for newborn circumcisions back in 1982. It would be big news if coverage were reinstated in California, the most populated state in the USA.
Readers trust Circumcision Choice to provide accurate information. Rather than make assumptions we decided to investigate this situation. We contacted the California Department of Health Care Services and the Alameda County Social Services Agency and learned the following.
Med-Cal has not changed its policy regarding newborn circumcision. The question of whether Medi-Cal recipients are eligible for circumcision coverage, however, requires some explanation.
Medi-Cal has two delivery systems. The Fee-for-Service (FFS) system covers about 13.3% of Medi-Cal beneficiaries. [3] Under the FFS delivery plan a circumcision is covered only if the provider deems it medically necessary. [4] CPT codes 54150 and 54160 are non-benefits, but may be available for medical necessity with prior authorization. [5]
The other delivery system is the managed care system. The vast majority of Medi-Cal beneficiaries - 86.7% - receive benefits under this system. [3] A managed care plan has the option to cover other services in addition to the required FFS benefits. [5] In other words, CHS administrators have chosen to cover neonatal circumcisions based on American Academy of Pediatrics recommendations. There are approximately 29 Medi-Cal Managed Care Health Plan options. Medi-Cal recipients covered by a managed care plan should check with their provider to ascertain the circumstances under which a circumcision procedure would be covered.
Based on the information above, we conclude that Medi-Cal does not cover elective newborn circumcision at this time.
UPDATE
On March 23, 2023 NO-HARMM founder Tim Hammond reached the same conclusion. Hammond cited and linked to this article, although he erroneously labeled us "pro-circumcision." Hammond also opined on the recent Massachusetts Medicaid case, which we discussed at these links:
[1] "22-985 Extended Benefit Coverage for Newborn Circumcision"; California Health & Wellness; December 2, 2022
[2] Intact America Facebook post; December 8, 2022. Intact America tweets; December 8, 2022 and December 11, 2022
[3] "Medi-Cal Monthly Eligible Fast Facts - October 2022 (Date Represented: July 2022)", 11th slide; California DHCS; October 2022
[4] Alameda County SSA Office Specialist [name redacted] email to Andrew Gross; December 19, 2022
[5] DHCS Medi-Cal Benefits email to Andrew Gross; December 21, 2022