Washington not meeting lead testing requirements for kids, audit finds

Washington is failing to meet Medicaid lead testing requirements for kids, even for children most at risk for exposure to the dangerous neurotoxin.

That’s according to a recent state audit, which found that less than a third of children on Medicaid born from 2014 to 2016 were tested for lead before they turned 6 years old.

“We may think lead exposure is only an issue on the East Coast or in the Midwest – places with a history of industrial pollution and older homes,” the audit said. “However, this performance audit shows we can never be complacent about the risks our children face.”

Lead exposure is particularly harmful to young children and even low levels can cause lifelong health effects. It can cause brain and nervous system damage and problems with development, learning, hearing and speech. Kids are typically exposed to lead from sources like chipped paint in older homes or contaminated soil.

Only 26% of Washington children enrolled in Medicaid — known as Apple Health in the state — received at least one of the federally-required tests for lead exposure between 1 and 6 years old, according to the audit’s Department of Health data review. More than 240,000 of Washington’s Medicaid enrollees are kids under the age of 6.

Medicaid requirements call for children to receive blood lead screening tests at 12 and 24 months. Any child between 2 and 3 years old with no record of a previous test must also receive one. Only 3% of Washington’s childhood Medicaid enrollees received both tests.

“The state lacks an adequate process to ensure children enrolled in Medicaid receive required blood lead testing,” the audit authors wrote.

In the overall population, not just Medicaid enrollees, only 4% of the state’s children were tested in 2018, according to Centers for Disease Control and Prevention data. Compared to six other Western states, Washington had the highest percentage of children with elevated blood lead levels and the second-to-lowest rate of lead exposure testing.

Dr. Scott Phillips, head of the Washington Poison Center, said testing rates might be low because health care providers just don’t think of lead as a common problem anymore.

“They’re seeing bigger problems and it’s kind of fallen off of their radar,” Phillips said.

Phillips said that aside from identifying risks in the household and getting a blood screening, parents can prevent the more severe impacts of lead poisoning by monitoring their child’s nutrition, as low levels of iron and calcium can result in the body absorbing more lead.

The audit also found that while children in areas with a heightened risk were tested at higher rates, Washington still isn’t meeting the Medicaid requirement in those communities. “Some communities with higher numbers of elevated test results also test the fewest children,” the audit said.

Lead testing results varied widely by county. Walla Walla and Adams counties tested more than half of its Medicaid-enrolled children before age 3. Eight counties tested less than 11% of their Medicaid-enrolled children.

Testing rates were nearly twice as high for children of families who do not speak or write English. State officials suggested possible reasons for this include refugee screening requirements, health care provider awareness of lead exposure risks for agricultural workers and public health outreach by local governments and immigrant community groups.

Tribal members, however, were tested at the lowest rates by race and ethnicity, despite having a higher rate of elevated test results. The audit cautions that tribal labs are not required to report testing rates to the Department of Health.

The audit recommends increased monitoring of the state’s compliance with the Medicaid lead testing requirement and providing clearer expectations and guidance to health care providers.

“The results of our analyses suggest that much more could and should be done,” the audit concluded.