The Centers for Medicare and Medicaid Services (CMS) has required universal screening of Medicaid-covered one- and two-year olds since the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Services benefit (EPSDT) was defined as part of the Omnibus Budget Reconciliation Act of 1989. The same act requires that children ages 36 to 72 months receive a blood-lead test if they have not been previously tested. However, the GAO estimates that nationally, only about 20 percent of Medicaid children are receiving the mandated tests.

The CDC is also expected to recommend screening pregnant women for elevated blood-lead levels. (New York State already has this requirement.) Lead is transferred freely through the placenta as early as the 12th week of gestation, and studies show that infants and toddlers exposed to relatively low levels of lead in utero score lower on tests measuring neurobehavioral development. Some states, including New York and New Jersey, require universal testing of all one- and two-year olds; Massachusetts also requires testing at age three. Legislation is pending elsewhere to expand mandated testing to more children. While funding availability varies from state to state, tests are typically reimbursable through Medicaid and through other public funding sources and private insurance. Many states also have initiatives to help fund lead-abatement in low-income housing.

However, regardless of how well-funded a state's lead-poisoning prevention program is, it remains extremely difficult to reach targeted populations with traditional blood-lead testing methods

Click for information on lead-poisoning programs by state

Traditional prescription-based & send-out methods of testing miss those children most at risk.

The traditional way of doing lead testing is for physicians to write a prescription for blood-lead testing and send children to an outside contracted lab. Parents want the best for their children, and usually have every intention of taking them for testing, but sometimes, life can get in the way. Socioeconomic and logistical barriers too often make it difficult, if not impossible, for families to follow through on written prescriptions for laboratory testing. Parents may be burdened with healthcare problems of their own, with transportation issues, or may have difficulty getting additional time off from work. For the general population there's typically a 20 percent no-show rate for outside laboratory testing prescriptions, but that rate can be more than double in segments of the Medicaid population. > Continue

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HOW ARE CHILDREN EXPOSED TO LEAD?

Lead sources may include: paint chips, dust, & soil in or around older (pre-1978) buildings older painted objects leaded glass, crystal, pewter, & ceramic dishes (more likely in painted china & in pottery from Latin America, the Middle East, & India) herbal/traditional remedies & cosmetics from other countries candy from Mexico toys & trinkets
Doctors and Public Health, click here to learn how the LeadCare II system can help you meet your state's blood-lead screening requirements.