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State Immunization and Lead Level Screening Requirements

posted on Wed, May 9 2018 4:40 pm by Mathew Swinburne

School immunizations and blood lead screening are important safeguards in children’s health. A requester recently contacted the Network for information regarding which states allow religious exemptions to school immunization requirements and which states have blood lead level screening requirements. 

The Network provided the requester with a link to a survey of immunization exemptions from the National Council of State Legislators along with a survey of immunization exemptions in the 11 states of the Network’s Western Region Office and an overview of state school immunization requirements and vaccine exemption laws from the Centers for Disease Control and Prevention.

Medicaid has a lead testing requirement as part of the Early Periodic Screening Diagnostic and Treatment benefit. Section 5123.2.D.1 of the Centers for Medicare & Medicaid Services’ (CMS) Medicaid Manual requires children in the program receive testing at 12 and 24 months, as well as between the ages of 24 and 72 months if there is no record of previous blood tests. Originally, this requirement applied to all children in Medicaid. However, the Center for Medicare and Medicaid Services now allows states to request approval to perform targeted testing programs that focus on high-risk populations within Medicaid.  Currently, Arizona is the only state that has been granted this authority.

States have adopted a variety of approaches to lead level testing for non-Medicaid children. Currently, 19 jurisdictions have mandatory lead testing laws for children outside of the Medicaid program. There are three major categories of testing requirements: universal testing, targeted testing, and hybrid testing.  This survey by the Network outlines state lead testing policies for children not enrolled in Medicaid.


Network attorneys are available to answer questions on this and other public health topics at no cost to you, and can assist you in using law to advance your public health initiatives. Contact a Network Attorney in your area for more information.

The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.