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The Continuing Threat of Childhood Lead Poisoning

posted on Wed, Jul 31 2013 1:54 pm by Wayne Turner

In some ways the effort to combat elevated blood lead levels (EBLLs) in children has been hampered by its own success. Child lead poisoning rates have dropped significantly over the past two decades, due largely to improved screening and treatment, mitigation strategies, and the elimination of hazards such as lead paint and plumbing fixtures. For some, the issue of blood lead poisoning in children may seem like a public health priority for the last century.

However, the harmful effects of lead poisoning in children — lower IQ, long term behavioral health problems, and diminished school performance — continue to pose a threat, especially to children in low income households. According to a recent report by the U.S. Centers of Disease Control and Prevention (CDC), Medicaid-eligible children are twice as likely to have dangerously high blood lead levels as children from higher income families. In fact, more than 535,000 children in the U.S. currently have blood lead levels higher than 5 µg/dL, the CDC’s new “reference value” designed to trigger direct, clinical intervention.

The CDC adopted this “reference value” after recognizing  that “there is no safe level” of blood lead in children. The reference value replaced the “level of concern” — fixed at 10 µg/dL — which inadequately addressed the harmful effects of lower levels of blood lead poisoning.

In another major shift in childhood lead poisoning policy, the Centers for Medicare & Medicaid Services (CMS) recently announced  the end of required universal blood lead testing for Medicaid-eligible children. Under federal law and rules, states are required to screen all Medicaid-eligible children for EBLL. Instead, with approval from CMS and the CDC, states may choose to target screening efforts by testing only those children thought to be at high risk for lead poisoning. CMS outlined requirements that a state must meet, including rigorous mapping and survey data, evidence of statewide stakeholder collaboration, and an evaluation plan for targeted screening strategies. To date, no state has sought approval to end universal screening. The hope is that state officials will be motivated to improve their current lead screening efforts to win approval from CMS to end mandatory universal screening.

These two big changes in lead poisoning policy offer an opportunity for public health agencies and practitioners seeking to increase EBLL screening rates, which have been abysmally low for too long. According to the most recent data from CMS, in 2011 only eight percent of all Medicaid children received a blood lead screen, despite that screen being required.

With a slew of budget cuts targeting state and federal lead poisoning prevention programs, combined with a phase-out of the mandatory testing program, it’s more important now than ever for public health to fill the gaps. That may include primary prevention, remediation, and better coordination between public health advocates and Medicaid providers, including the managed care companies responsible for providing health services to many Medicaid-eligible children. Without action, the children, their families, and ultimately the community will pay the price for undetected blood lead poisoning for years to come.

This blog post was prepared by Wayne Turner, J.D., Staff Attorney at the National Health Law Program (NHeLP).

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.

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