WASHINGTON -- Responding to new medical concerns about the harmful effects of exposure to even low levels of lead, the federal government is requiring that virtually all young children on Medicaid be screened for lead poisoning. But the federal directive allows states to continue using a test known to be inaccurate in measuring small amounts of lead in the blood.
The new policy, in instructions to state Medicaid officials that take effect later this month, is intended to prod states to be more aggressive in testing children for lead poisoning. The policy reflects the conclusion of federal health officials that levels of lead once thought to be safe can cause mental retardation, learning disabilities, stunted growth, hearing loss and behavior problems.
"All children ages 6 months to 72 months are considered at risk and must be screened for lead poisoning," say the instructions from the federal Health Care Financing Administration, which supervises the Medicaid program for low-income families. "Complete lead screening consists of both a verbal risk assessment and blood tests."
Lead poisoning is one of the most common child health problems in the United States. The government says it afflicts 3 million to 4 million young children -- one in six youngsters under 6 years old. The highest risk occurs among low-income children, the very ones entitled to screening under Medicaid. Many of them live in dilapidated inner-city housing with peeling lead-based paint. But the government emphasizes that "no socio-economic group, geographic area or racial or ethnic population" is exempt from the risk of lead poisoning.
The new directive will affect hundreds of thousands and eventually millions of children. More than 6 million children under 6 are on Medicaid. Specialists say that fewer than half have been screened for lead poisoning.
Medicaid is jointly financed by the federal government and the states. If Medicaid recipients suffer lead poisoning, Medicaid usually pays for treatment and may pay for efforts to identify the source. Private insurance also pays for some lead screening. But Medicaid and private insurance usually do not pay for removing paint and other sources of lead, and it is often unclear who is responsible for cleaning up contaminated sites.
Until now, criteria for screening, like many details of the Medicaid program, varied from state to state. A recent report by the U.S. Public Health Service said, "Many states do not conduct much screening."
Last October, the Public Health Service said there was "overwhelming and compelling" evidence that children had been harmed by lead in concentrations as low as 10 micrograms per deciliter of blood. The test widely used for the last 15 years is not sensitive enough to detect levels that low.
"The more that is learned about lead's effects on children and fetuses, the lower the blood lead level at which adverse effects can be documented," the Public Health Service said. It noted that lead does not break down but builds up over months and years in human blood, bones and organs.
The new rules acknowledge that "it will take some time for states to make a transition" to a more accurate, more expensive test for lead poisoning, known as a blood lead test. This is clearly "the screening test of choice," the government said.
But "states continue to have the option" of using the cheaper, less accurate test, which is "not sensitive for blood lead levels TTC below 25 micrograms per deciliter," the government said.
Federal officials said they wanted to give state officials some flexibility. They noted that the more accurate test costs more: $15 to $60, depending on how and where the test is performed, as against $1 to $5 for the less accurate test.