Lead Testing and Hazard Control

Budget Impact

The Ohio Department of Medicaid, in partnership with the Ohio Department of Health, proposes to invest $10 million ($1.7 million state GRF) for lead testing and abatement activities over the biennium. These funds will also assist with marketing efforts and the development and maintenance of the Lead Safe Housing Registry.

Background

Lead is toxic to young, developing brains, and lead poisoning has well-documented, long-lasting adverse health effects. Lead-based paint and lead-containing dust in deteriorating homes are the most common sources of lead poisoning among children,¹ and nearly 70 percent of Ohio’s housing stock was built before 1979, the year after lead-based paint was banned for housing use.² The Ohio Department of Health considers lead poisoning to be one of the greatest environmental threats to children in the State. Despite dramatic improvements in blood lead levels in recent decades, in 2016, 4,591 children, representing 2.83 percent of the population tested, had confirmed blood lead levels of 5μg/dL or greater,³ which is the level at which the Centers for Disease Control and Prevention (CDC) recommends intervention. Lead poisoning continues to be a serious hazard for many Ohio children, presenting considerable risk to their health and ability to learn.

All children enrolled in Medicaid are required to receive blood lead screening tests at 12 and 24 months of age, but less than 60 percent of Medicaid children have had blood tests reported to the State’s registry in recent years. More testing may occur without reporting, but the State does not have visibility into unreported tests.

When a child has a blood level of 5μg/dL or greater, their home should be investigated for lead hazards, and identified sources of lead, including paint, dust, soil, and water, should be controlled or abated. Preventive measures should also be taken to address lead hazards before children are poisoned.

Policy Proposal

To make significant advances in identifying and eradicating lead exposure and its consequences, children need to be routinely tested in keeping with best clinical practice, and funding should be directed at preventing lead poisoning and abating lead hazards. Medicaid proposes the following activities for the next biennium to identify lead exposure and to address health and associated learning disabilities:

•  Partnering with health care providers and the Medicaid managed care plans to encourage appropriate blood lead testing. As part of Medicaid’s changes to our Comprehensive Primary Care program for pediatric providers, we will be including practice-level tracking of lead testing for children.

•  Comprehensively reviewing gaps in lead testing and reporting and increasing multi-agency efforts to increase reporting to the Department of Health’s Lead Poisoning Surveillance System.

•  Aligning cooperative efforts with the Ohio Department of Health for using Medicaid dollars to perform environmental lead risk assessments in homes where kids are found to have elevated blood lead levels.

•  Leveraging work with the Ohio Department of Developmental Disabilities to ensure affected children have access to early intervention programs.

Additionally, Ohio Medicaid is reenergizing our partnership with the Ohio Department of Health on lead hazard control and abatement initiatives through our Children’s Health Insurance Program (CHIP) Health Services Initiatives program, which will include the following:

•  Funding lead hazard control and abatement activities for homes of Medicaid-enrolled and other low-income children and pregnant women at an amount of up to $10M over the biennium.

•  Requesting federal government approval for changes in the program to allow for greater flexibility in funding lead abatement and hazard control activities.

•  Developing messaging and marketing to encourage tenants looking for rental property in high risk zip codes to use the lead-safe registry so they can find housing that is safe from lead exposure.

•  Encouraging rental owners to responsibly document lead safe maintenance activities and place lead-safe properties on the registry.

¹ Centers for Disease Control and Prevention. Lead Prevention Tips. 2014.
² Ohio Housing Finance Authority. 2018 Housing Needs Assessment, Technical Supplement to the Fiscal Year 2018 Annual Plan. 2018.
³ Ohio Lead Advisory Council. 2017 Annual Report. 2017.