Few children on Medicaid get lead test

SEATTLE — For years, Washington state has been ignoring a federal law that requires all children insured under Medicaid to be screened for lead poisoning.

The state instead has been relying primarily on doctors who test children they suspect have been exposed to lead.

Under rules adopted in 1989, all children enrolled in the federal health care program for the poor are considered at risk for lead poisoning and must be screened at 1 and 2 years of age.

But the Seattle Post-Intelligencer reported Saturday that last year, less than one half of 1 percent of the 560,000 Washington children enrolled in Medicaid were screened.

“Nobody here in our community thinks it’s worthwhile,” Dr. Bill Robertson, a pediatrician and medical director of the Washington Poison Center, told the newspaper. “The reason is very clear. … It’s scientifically absolutely ludicrous to abuse children with needle pokes when the frequency of (high lead blood) elevation is so low.”

Children enrolled in Medicaid account for 60 percent of children found with elevated blood lead levels greater than 10 micrograms per deciliter and for 83 percent of children with elevated blood levels greater than 20, according to a 2000 report by the Centers for Disease Control and Prevention.

In 2002 and 2003, 12,454 children – from newborns to age 6 – were tested in Washington state. Of those, 158, or 1.2 percent, had elevated lead levels in their blood.

In a random 1999 survey, state health officials found that 0.9 percent of 1- to 2-year-olds statewide had high blood lead levels, measured at 10 micrograms per deciliter or higher.

The figure for Hispanic children in central Washington was 3.8 percent. The state has supported increased screening there.

Lead poisoning is usually related to lead-based paint or industrial soil contamination, though higher-than-acceptable levels have been found recently in water from public-school drinking fountains in Seattle. That contamination has been blamed on corroded plumbing fixtures in older buildings.

Lead exposure, especially for children 5 years old or younger, can lower IQ, impair hearing and reduce attention span. At high levels, it can cause brain damage.

A 1999 report from the General Accounting Office, the investigative arm of Congress, criticized Washington for the failure, saying health providers here do not support testing “because lead poisoning is not viewed as a significant problem.”

There are no civil penalties for noncompliance by states, said Rod Haynes, spokesman for the regional district of Centers for Medicare and Medicaid Services.

Dr. Joel Kaufman, a University of Washington professor of environmental health and medicine, said he initially was concerned about lead screening in the state.

But “at this point in time in Washington state, universal screening of children does not seem to be necessary, based on what we know about the prevalence of lead in children,” Kaufman said.