Nebraska Plans to Stop Funding Erectile Dysfunction Treatment, Says Sex Is Not Medically Necessary

Poor Nebraskans seeking treatment for erectile dysfunction may soon be turned away by state government.

State officials are proposing state Medicaid rules be changed so that the insurance program does not pay for penile implants.

State Medicaid director Vivianne Chaumont said the change is consistent with a federal rule, approved in 2006, that barred the federal government from spending Medicaid dollars on erectile dysfunction drugs including Viagra. Nebraska followed suit a few months later and changed its rules to keep state Medicaid money from being spent on the drugs.

The federal government will still help pay for penile implants in states that choose to continue covering the procedure under their Medicaid plans.

"The decision was made not to cover the drugs, so it's ... a good idea to have particular procedures for prosthesis not covered as well," Chaumont said.

Medicaid is meant to pay for the medical necessities of needy people and "sex is not medically necessary," she said.

Unlike other, current proposals in the state to reduce coverage for dental services, eyeglasses and hearing aids, among others, removing erectile dysfunction from the Medicaid list is not meant as a cost-cutting measure.

Three Nebraskans have had penile implants paid for by Medicaid since 2003, with Medicaid picking up $11,705 of the costs, according to the state Department of Health and Human Services.

The exact cost to the state could not be figured, spokeswoman Marla Augustine said, but the state normally funds 40 percent of Medicaid. The federal government pays the rest.

Dr. Ira Sharlip with the American Urological Association said the proposed rule change is unfair to poor men who can't afford the treatments and raises issues of gender equity.

The condition, he said, can be "devastating psychologically," leading to depression and marital problems.

"It is not logical to me or seem fair to deny poor people from having access to safe and not very expensive treatments," said Sharlip, a professor of urology at the University of California in San Francisco.

A substantial percentage of men with erectile dysfunction have it as a result of prostate cancer. He compared that link to women who have their breasts removed as a treatment for breast cancer.

Federal law requires many insurers who pay for mastectomies to also pay for breast reconstruction, Sharlip said.

Nebraska is not required to cover breast reconstruction under its Medicaid program, but does so anyway.

"At the very least, to provide for gender parity, men who have ED as a result of prostate cancer should be provided treatment under Medicaid," Sharlip said.

Chaumont, who moved to Nebraska about a year ago to take her current position, said she didn't know why the decision was made to cover breast reconstruction under Nebraska Medicaid but added that it didn't strike her as unreasonable.

"I don't think breast cancer has anything to do with sexual dysfunction or sexual impotence," she said.

Asked why it is important to cover breast reconstruction, she said that doing so "is in line with other insurers."

A hearing on the proposed rule change is scheduled for July 10.