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Court cuts short bid to stop MassHealth payments for circumcision
By adamg on Fri, 07/22/2022 - 11:11am
The Massachusetts Appeals Court today upheld the way MassHealth reimburses doctors for infant circumcisions, tossing a lawsuit by anti-circumcision activists who called that a waste of taxpayer money on a procedure they claim is "not medically necessary."
The court concluded that the 27 plaintiffs in the 2020 lawsuit, led by anti-circumcision activist Ronald Goldman, didn't have "standing" to bring the case in part because none could meet a legal requirement that they be directly harmed by whatever they were complaining about.
But the court also noted that the Supreme Court has ruled that individuals can't sue over Medicaid reimbursement rates set by states and ruled that while a Massachusetts law allows taxpayers to sue state agencies over spending that exceeds their "legal and constitutional right and power to expend money," circumcision doesn't fall under that criterion.
The court said the only cases decided by courts under that state law involved "flawed bidding procedure," not allocation of government benefits, such as the distribution of money to doctors who perform circumcisions - and by people who were directly affected by the errant bidding processes.
The court also snipped away at the plaintiffs' argument that MassHealth violated state law by not considering every single circumcision beforehand to determine whether it is is medically necessary:
No statute or regulation requires MassHealth to conduct prepayment review of all claims, nor would this be feasible given the sheer number of claims that MassHealth receives each year. Rather, it is within MassHealth's discretion to decide which services will require more individualized review for medical necessity and which services will be excluded from coverage. ... With regard to neonatal circumcision, the record reflects that MassHealth designated it as a covered service based on the recommendations of professional medical societies -- including the American Academy of Pediatrics and the American Urological Association -- with the approval of [the federal Centers for Medicare and Medicaid Services]. ...
While the plaintiffs may disagree with that choice, their disagreement does not give rise to a viable claim under § 63 because it cannot reasonably be said to go to MassHealth's "legal and constitutional right and power to expend money." See Brennan v. Governor, 405 Mass. 390, 396 (1989) ("plaintiffs can only state a cause of action [under § 63] if they can show that the defendants violated a specific provision of State law and, thus, rendered the proposed [expenditure] an unlawful exercise of power").
The court added that it considered the consequences were it to rule in favor of the anti-circumcisionists and that it did not like where that would lead:
Were we to hold otherwise, the ramifications could be vast. Among other things we would be opening the door for taxpayer groups to challenge in court any procedure or treatment covered by MassHealth that they happen to disfavor. See, e.g., Donovan v. Cuomo, 126 A.D.2d 305, 306, 309 (N.Y. App. Div. 1987) (rejecting purported taxpayer challenge to Medicaid agency's coverage of abortion services). This would cast the courts in the role of deciding generalized grievances, even though it has long been settled that standing to challenge agency action "usually is not present unless the . . . agency can be found to owe a duty directly to the plaintiffs." Enos, 432 Mass. at 136.
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Comments
Bris inside a Royal Deluxe II
SNL c. 1978? https://vimeo.com/312218800 (because I never learned how to embed a video)
And let us not forget Shakey
And let us not forget Shakey the mohel; https://www.youtube.com/watch?v=Zy-URspwUGA
This barbaric court is not considering mass heath …..
…. for MassHeath users. Why not allow funding for female circumcision while they’re at it?
Are you on the council of
Are you on the council of false equivalency or something?
this is
Taxpayer funded sexual assaults on helpless infants, with lifetime consequences
If people want to mutilate their own children they should pay for it themselves
And no, I am not anti-Semitic, I just don’t think it’s fair to do this to helpless little boys
If people want to practice circumcision they can do it ethically, at an age when the young person can legally give consent
anything else is child abuse
I know, because I am circumcised
Nobody had the right to take away part of my body
yeah, the lifetime
yeah, the lifetime consequence is that you don't have a weird looking jim-dog. that matter when you are of age when you actual want others to hang out with it, and not just ghost you after one jam session.
there are literally no downsides anyone can claim that aren't either rooted in anti semitism, or are personal battles with your parents.
that’s nonsense
The foreskin protects the head of the penis. Instead of having that natural protection the head of my penis has been scraping I guess my underwear for years.
The accusation of anti-Semitism is bullshit
newsflash
the Jewish people are not the only people who practice circumcision
So lube a condom..
Place on penis, pull your underpants up and have a good day
This is nonsense
If you're of age and you think the shape of your penis is causing you trouble, you're old enough to get a snip. Also, hardly anyone actually gives a shit whether someone else has a foreskin in the first place.
People care about what their own bodies look like, and like having control over their bodies. Saying it's all parental battles and anti-Semitism is just silly.
Quite the news snippet!
Cutting edge reporting! However, I think this is just the tip of the iceberg...
I'm actually glad to be circumcised...
My junk just wouldn't look good if I was uncut... and trust me, I've played with with the little guy enough over the years to know exactly what it would look like with foreskin....
And you could make that choice as an adult.
The main question isn't whether circumcision is immoral or undesirable or any of those things -- it's whether consent should be required.
(The question in the lawsuit is a little different, about whether it should be taxpayer funded.)
We don’t ask minors for
We don’t ask minors for consent for any other procedures.
We don't ask for *necessary* ones.
And we should definitely ask for cosmetic ones, such as circumcision.
Most procedures that one
Most procedures that one would have reason to put a minor through confer much stronger medical benefits, e.g. repairing any congenital issues that affect cardiovascular, musculoskeletal, gastroenterological, or neurological systems. Maybe your appendix or tonsils need to come out. Maybe your wisdom teeth need to come out so they don't screw with your adult teeth. As far as the putative medical benefits of RIC are concerned, the AAP and AUA stand pretty much alone in their views.
All procedures are not the same, and the benefits they confer can range from "medically necessary intervention to prevent death or disfigurement" to "perhaps not strictly required for survival, but will lead to improved quality of life in adulthood". On this score, neonatal circumcision ranks much closer to cosmetic surgery than to, say, removing a lung tumor, and I'd wager that requesting cosmetic surgery for a minor---especially a minor under a year old---would be greeted with a lot of skepticism absent a compelling reason (e.g. reconstructive surgery after an accident). RIC is the removal of healthy tissue serving a unique biological function, and it is intellectually lazy to draw an equivalence between that and any number of more serious surgical procedures.
Parents do have the legal authority to make medical decisions on behalf of their minor children, but said authority must be wielded with responsibility and restraint.
Consent
Circumcision is actually an outlier in terms of completely elective procedures that don't require the child's consent to some degree.
The AAP's position on things like rhinoplasty for minors (for purely cosmetic reasons on something that wouldn't be clinically considered a facial deformity) is that the adolescent has to be initiating it and has to understand the cost/benefit analysis: https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/...
Even with things like wisdom teeth and tonsils, when the problem is minor enough that it isn't going to cause severe problems without the procedure, providers typically go with the adolescent's wishes, provided they understand the risks and benefits. Providers typically approach verbal kids in a similar fashion to an adult -- explaining, say, what problems the tonsils are causing, what will happen if not removed, what will improve if removed, what the risks are. If a youth understands the risks and benefits and is flat-out refusing, it stays an ongoing conversation. They aren't forced to get treatment for something that isn't going to kill them.
I've had adolescent clients who flat-out said they wouldn't get recommended vaccines, and providers aren't generally going to strap them down and do it against their will. They continue to talk about the issue and state what their recommendation is. In one case I saw a PCP who said they would write the exemption letter for a required vaccine for one year, but the teen was expected to spend the year dealing with their needle phobia since they weren't writing it again.
(FWIW, I'm a religious Jew who doesn't think we should be circumcising infants against their consent in 20fucking22. We also don't engage in stonings or yeeting people off mountains or many of the other things that happened in biblical times, because times change.)
Excellent addition to the
Excellent addition to the conversation. Verbal adolescents who can be engaged in medical discussion much like adults are worlds away from infants who do not even have the thoughts, let alone the words, to understand what circumcision is or to be able to express an opinion about what they want done (or not done) to their own bodies.
Hello HR? I need short term disability to get my...
I get the consent argument but don't really buy it and sure, I'm gonna get blistered here but ...
I didn't consent to vaccinations as a child,
I didn't consent to being baptized,
I didn't consent to the way mom cut my hair
I didn't consent to going to bed without supper because I was being an obnoxious a-hole
I could go on....
and btw, comparing male circumcision to female circumcision, as if...
it’s a fair comparison
both practices are genital mutilation, usually practiced on helpless children
I can’t believe we still allow it
Your comparisons are rediculous
Vaccinations don't remove a part of your body.
Baptism only counts if you have faith in it; if you don't believe, then it's moot.
Your hair grew back.
Sorry your mother was abusive.
Etc.
Oh, I apologize
This seemed to a consent issue depending on who is proselytizing...
So there's the consent crowd
AND the crowd who is sensitive to the look (and more likely size of their peen) ...
Oh then there's the restoration crowd, those are the angry ones... so many devices and contraptions to choose from...
So what you're saying is you
So what you're saying is you're knowingly making lazy comparisons and using them to prop up a refusal to consider the actual issue.
But, for the sake of being a little less lazy about it:
Vaccinations: medically necessary for both your health and the health of the public, supported by decades of medical evidence. Routine infant circumcision (RIC): little to no medical evidence showing unequivocal benefits. There's a strong argument to be made that your legal guardians' power to make medical decisions on your behalf when you're a minor/otherwise unable to make your own medical decisions is not limitless; a medical decision should confer a medical benefit.
Baptism: involves no physical alterations to your body whatsoever. Presuming you don't come from a fundamentalist or otherwise religiously oppressive background, you can choose to leave behind any beliefs at whatever age you decide to reject them. Again, though, the "no material impacts to your physical being" part is pretty key here.
The haircut: your hair grows back. Excised tissue, not so much. If you have emotional scarring from years of bad haircuts...well, I guess there's therapy for that.
Going to bed without supper: what even is this comparison.
The judicial opinion does at least point to the possible unintended consequences if they had sided with the plaintiffs, and that's surely to the good, but it does highlight the way in which our system of legal jurisprudence isn't that great at producing narrow outcomes that recognize nuance and distinction between different things/cases. Someone's always going to try to use the "this does not set precedent for any other case" case to get what they want, *especially* if they're acting in bad faith. (Remember Bush v. Gore and how that wasn't supposed to be precedent for anything? Guess what.)
Neonatal circumcision for non-therapeutic reasons is a topic that too many people would rather joke about than talk about with any seriousness or sincerity, and that's no way to treat public discourse.
No reimbursement?
So they should work for tips?
thats genious
thanks, we needed that
At Medicaid’s paltry reimbursement rates
It’s a real rip-off.
I’ll be here all week!