Medicaid Targets Lead Poisoning in Children

Time to Get Proactive About Lead Screening

child drinking water
Jessica Byrum/Stocksy United

Flint, Michigan put lead screening on everyone's radar. The city had previously received its water supply from Lake Huron and the Detroit River. In 2014, however, the water supply was instead sourced from the Flint River. Unfortunately, the river had not been properly treated to prevent corrosion of pipes that could leach metals and other toxins into the water. The end result? Lead levels spiked in the water, and the city faced a public health crisis.

What is the government doing about it?

The tragedy in Flint is not the first of its kind. The dangers of lead poisoning have been known for decades, and yes, the United States government has taken steps to intervene. For one, the Environmental Protection Agency (EPA) has protocols in place to decrease the risk of lead exposure on a community scale. The Centers for Medicare and Medicaid, too, provides guidance to screen for possible lead exposure in children.

The overall goal is to prevent lead exposure in the first place, identify cases of exposure when they do happen, and provide early treatment to any children affected by elevated blood lead levels. Only in this way can we prevent, or at least minimize, the long-term health complications that can arise from the toxic metal.

The big question: Is it working?

What Happens When You Are Exposed to Lead

Exposure to lead can be harmful to anyone. In children, however, it can be especially dangerous, impacting on their neurological and cognitive development.

Lead toxicity in adults, on the other hand, tends to target the peripheral nervous system.

There is no classic presentation for lead poisoning. Symptoms vary and may include any of the following:

  • High blood pressure
  • Gastrointestinal disease including abdominal pain, anorexia, nausea, and/or vomiting
  • Kidney disease
  • Neurologic symptoms including ataxia, hallucinations, headache, muscle weakness, and/or seizures
  • Reproductive issues including infertility, low libido, and/or miscarriage

You and your healthcare provider need to be on the look out for unusual symptoms or exposures that could put you or your child at risk.

Where You Can Be Exposed to Lead

More people are exposed to lead than you may think. 

The Flint water crisis reminds us that lead can be leached into water through pipes and their fixtures. Pipes made prior to 1930 often contained lead, putting older homes or public water supplies at higher risk for exposing you to the metal.

Surprisingly, the EPA warns that buildings less than five years old are likely to have lead-contaminated water. This is because modern day plumbers often use lead solder to join copper pipes. The risk decreases after five years because the build-up of mineral deposits in the pipe eventually insulates the water from the lead in the solder.

Another common exposure is lead-based paint, which has not been sold in the United States since 1978. This does not put you in the clear if you own a newer home because lead may still be out there in other places you visit.

Any structure built before 1978 could have used lead-based paint, even public buildings, fences, playground equipment, and schools. Over time, the paint may chip and even break down into small fragments. Lead particles can float in the air or collect on surfaces like window sills. It can even contaminate the soil.

Concerns have also arisen about lead-tainted products imported from other countries. Think about lead when you purchase foreign candy, ceramics, medication, pottery, or toys. In the latter, lead has been found in both paint and plastic.

Lead Poisoning as a Public Health Issue

Lead poisoning was a problem in Flint, but could it be a problem for you?

The EPA states there are no safe levels of lead exposure. That being the case, it mandates that public water supplies be monitored for lead contamination. If lead concentrations exceed a level of 15 parts per billion in more than 10 percent of customer taps, then action must be taken. These actions must be taken by the water system and include:

  • Pursuing steps to optimize corrosion control treatment for water systems servicing 50,000 people or more
  • Notifying and educating the public about the issue and how it is being addressed
  • Replacing portions of lead service lines that are under the water system's control

Unfortunately, it is not always possible to eliminate all lead exposures. Treatment of water with anti-corrosion chemicals can reduce lead but may not eliminate from leaching into tap water.

Medicaid Screening for Lead Poisoning

The fact remains that avoidance of all lead exposures may not always be possible. To this end, it is important to screen for possible lead exposure in high-risk populations, namely children.

The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend screening for children with suspected exposures, i.e. those currently or previously living in older homes or those with who have siblings or playmates with elevated blood lead levels.

All children enrolled in Medicaid, however, are required to receive blood lead screening tests at 12 months and 24 months of age. If one of these children does not have any lead screening documented in the medical record and they are between 24 and 72 months of age, their health-care provider is required to get one.

Screening for lead is easily done. It requires a blood sample that may be collected either from a simple finger prick or from a traditional blood draw with a needle inserted into your vein. The sample may be collected in your doctor's office or at a laboratory.

Unfortunately, not all eligible children are being screened. Medicaid data in 2015 suggests that only about 38 percent of children between 12 and 24 months of age had been screened. The National Committee for Quality Assurance (NCQA), a non-profit organization, released data that estimating that only 66 percent of 2-year-old children enrolled in Medicaid were screened for lead levels over the past two years. Only 30 states that reported this measure to the NCQA, however, so this may not reflect the true national average.

Where Do We Go From Here?

As more lead screening is pursued, the number of children who will be found to have elevated blood lead levels will likely increase. That means we need to have resources in place to not only screen but also to treat those affected.

Medicaid continues to provide lead screening for all children, regardless of presumed risk, and recommends the following measures be taken across other health-care agencies:

  • Collaboration with state health agencies to screen children who have not been tested
  • Contacting health-care providers to ensure they screen children as required
  • Adding screening requirements into managed care contracts
  • Increase testing through Women, Infant and Children programs (WIC) and local health clinics

Medicaid hopes that these joint efforts will be able to keep the most vulnerable children safe from long-term health complications.

Sources:

Childhood Lead Poisoning Data, Statistics, and Surveillance. Centers for Disease Control and Prevention website. http://www.cdc.gov/nceh/lead/data/index.htm.

Coverage of Blood Lead Testing for Children Enrolled in Medicaid and the Children’s Health Insurance Program. Medicaid.gov website. https://www.medicaid.gov/federal-policy-guidance/downloads/cib113016.pdf.

Lead. U.S. Environmental Protection Agency website.https://www.epa.gov/lead.

Warniment C, Tsang K, Galazka S. Lead Poisoning in Children.  Am Fam Physician. 2010 Mar 15;81(6):751-757. http://www.aafp.org/afp/2010/0315/p751.html

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