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More Than One-Third of Medicaid-Enrolled Children in Five States Did Not Receive Required Blood Lead Screening Tests


There is no safe level of lead exposure; even low-level blood lead concentrations during childhood have been associated with behavioral and physical impairments. Children exposed to lead may suffer stunted cognitive development and delayed reproductive development. In the longer term, elevated blood lead levels have been linked to increased incidence of hypertension and coronary heart disease, as well as higher rates of violent crime and arrests in adulthood. Prevention is key to avoiding the permanent developmental effects of lead exposure on children. Scheduled blood lead screening tests can support early detection of elevated blood lead levels, timely followup, and improved outcomes for children.


We selected five States for which we reviewed Medicaid claims data and supplemental health department data for fiscal years (FYs) 2015-18. We examined the extent to which Medicaid enrolled children received required blood lead screening tests. We also interviewed stakeholders and surveyed practitioners to identify challenges in providing blood lead screening tests, followup services, and treatment for Medicaid-enrolled children.


Many Medicaid-enrolled children in five States did not receive required blood lead screening tests on schedule during FYs 2015-18. Specifically, more than one third of the 1 million children who were required to receive a 12-month and a 24-month blood lead screening test received neither test. Additionally, of the approximately 209,000 children who had been continuously enrolled in Medicaid from birth through age 3, 1 in 5 children in the selected States had never received a blood lead screening test by 3 years of age. Finally, stakeholders we interviewed called for consistent requirements for blood lead screening tests and practitioners reported challenges with providing blood lead screening tests for Medicaid-enrolled children.


To address challenges that contribute to low participation rates in the blood lead testing component of the EPSDT benefit, we recommend that CMS: (1) monitor national EPSDT performance data for blood lead screening tests and target efforts toward low-performing States to develop action plans for increasing the provision of blood lead screening tests according to Medicaid's schedule; (2) ensure consistency across CMS guidance related to actionable blood lead reference values and blood lead screening test definitions; and (3) coordinate with partners to develop and disseminate to State Medicaid agencies educational resources that reaffirm requirements and schedules for blood lead screening tests. CMS concurred with our recommendations.