Indiana Medicaid Progresses on Lead Poisoning But Still Falls Short

When it comes to preventing lead poisoning, Medicaid has two expectations for states:

1. Ensure that children on Medicaid are given a blood lead test.

2. Ensure that the children with serious lead poisoning receive case management and an environmental investigation to help reduce their blood lead levels. While long required by Medicaid, the federal government made this expectation explicit in September 1998.

Regarding testing, Indiana has made progress. The critical age group is children between 1 and 2 years old. These children must be tested at their 12-month and their 24-month visits. Out of total of 111,987 medical screens given to these children, blood lead tests could be documented in only 4% of those screened. Assuming that each test was for a different child, 10% of the children could have been tested. In 1999, the maximum percentage that could be documented was only 0.37%. Nationally, the testing rate is around 20%. All rates are a far cry from the requirement that 100% of the children be tested twice.  See testing results.

Unfortunately, the data is not complete. Health maintenance organizations often do not report the specific tests that are done. They get paid for providing the set of services and do not need to report the specific tests to get reimbursed. However, in the Medicaid reporting system, a blood lead test must be specifically reported to be counted. 95% of children 1 to 2 years old in Medicaid belong to an HMO.

Blood lead screening is recommended but not required for children before their 12-month visit. It is only required for children three to five years old if they were not previously tested.

Regarding case management and environmental assessment, proposals have passed between ISDH and FSSA, but Indiana’s children appear to be months away from receiving this coverage. As a result, health departments are unable to be reimbursed when they provide those services to children on Medicaid despite federal and state mandates. For many health departments, they see this lack of support as a reason not to provide the needed services at all.