While substantial environmental improvements have been made to reduce exposure to lead, certain children remain at substantial risk for exposure to lead and disproportionately experience negative health consequences. The Centers for Disease Control and Prevention (CDC) projects that there are about half a million children between the ages of one and five in the United States who possess blood lead levels greater than 3.5 micrograms per deciliter (µg/dL), which is the threshold level at which CDC recommends public health actions are taken. It is essential that children enrolled in Medicaid receive appropriate blood lead screening tests. All children enrolled in Medicaid, regardless of whether coverage is funded through title XIX or XXI, are required to receive blood lead screening tests at ages 12 months and 24 months. In addition, any child between 24 and 72 months with no record of a previous blood lead screening test must receive one. Completion of a risk assessment questionnaire does not meet the Medicaid requirement. The Medicaid requirement is met only when the two blood lead screening tests identified above (or a catch-up blood lead screening test) are conducted.
In November 2016, the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin that reviewed the lead screening policy for Medicaid and CHIP, and outlined the actions states can take to increase blood lead screening rates.
In 2012, CMS expanded its lead screening policy to allow states to request approval from CMS to implement a targeted lead screening program. This policy change aligns with current recommendations of the CDC. For more information, see the June 2012 Informational Bulletin. In addition, CMS and CDC have developed a guidance and process document for states that want to request to move to a targeted screening approach. Interested states should send requests and supporting documentation to the EPSDT mailbox at EPSDT@cms.hhs.gov, with the subject line: "Request for Use of Targeted Lead Screening." The following chart identifies the states with approved targeted lead screening policies. All other states are expected to continue to require that children receive blood lead screenings at ages 1 and 2.