Updated Recommendations on Blood Lead Screening for Medicaid-Eligible Children Background

Since 1989, Medicaid-eligible children (MEC) have been identified as having an increased risk for lead exposure.1 Since then, the federal Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program has required blood lead screening on all MEC at ages 12 and 24 months, or at 36–72 months if the child has not previously been screened.2 In 1997, CDC endorsed universal screening of Medicaid-enrolled children unless dependable local data demonstrated the absence of lead exposure in this population.3 In 1997, the Alaska Section of Epidemiology (SOE) published the results of a population-based study involving 967 Medicaid-enrolled children throughout Alaska, which showed that the prevalence of elevated blood lead level (BLL) was very low (0.6%).4 The authors concluded that universal lead screening for Alaska’s Medicaid–enrolled children is not an effective use of public health resources, and recommended blood lead testing only in children with signs or symptoms of lead poisoning or in children who are suspected to be at high risk of having an elevated BLL.4 As a result of this study, Alaska Medicaid’s EPSDT regulations have not, until recently (see below), contained blood lead screening guidance. In 2008, the federal Administration for Children & Families issued a memorandum to their Head Start grantees, which stated that in order to meet the Head Start Program Performance Standards, Head Start programs must ensure that all enrolled children receive a lead toxicity screening as per the federal EPSDT requirements.5 If a child’s medical provider will not perform a lead screening test, then the Head Start program is required to assist the family in obtaining the test from other community resources. In 2009, CDC indicated that BLLs have decreased among MEC in some jurisdictions, and therefore called for a new national blood lead screening strategy to account for local variations in risk and disparities. State health officials were urged to recommend targeted lead screening criteria for MEC (Box).