Recommendations for blood lead screening of young children enrolled in medicaid: targeting a group at high risk.

Children aged 1-5 years enrolled in Medicaid are at increased risk for having elevated blood lead levels (BLLs). According to estimates from the National Health and Nutrition Examination Survey (NHANES) (1991-1994), Medicaid enrollees accounted for 83% of U.S. children aged 1-5 years who had BLLs > or = 20 microg/dL. Despite longstanding requirements for blood lead screening in the Medicaid program, an estimated 81% of young children enrolled in Medicaid had not been screened with a blood lead test. As a result, most children with elevated BLLs are not identified and, therefore, do not receive appropriate treatment or environmental intervention. To ensure delivery of blood lead screening and follow-up services for young children enrolled in Medicaid, the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) recommends specific steps for health-care providers and states. Health-care providers and health plans should provide blood lead screening and diagnostic and treatment services for children enrolled in Medicaid, consistent with federal law, and refer children with elevated BLLs for environmental and public health follow-up services. States should change policies and programs to ensure that young children enrolled in Medicaid receive the screening and follow-up services to which they are legally entitled. Toward this end, states should a) ensure that their own Medicaid policies comply with federal requirements, b) support health-care providers and health plans in delivering screening and follow-up services, and c) ensure that children identified with elevated BLLs receive essential, yet often overlooked, environmental follow-up care. States should also monitor screening performance and BLLs among young children enrolled in Medicaid. Finally, states should implement innovative blood lead screening strategies in areas where conventional screening services have been insufficient. This report provides recommendations for improved screening strategies and relevant background information for health-care providers, state health officials, and other persons interested in improving the delivery of lead-related services to young children served by Medicaid.