Blood Lead Testing

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 12 months and 24 months of age. In addition, any child between 24 and 72 months of age (2-6 years old) who has 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.

Consider testing any child if they have risk factors such as anemia, behavioral concerns, developmental delay, or pica behavior (repeatedly eating non-food items).

Watch the following video to learn more:
The Importance of Childhood Blood Lead Testing (video) | CDC

Methods of testing:

Capillary testing (finger prick)

• A screening test to see if a child has lead in their blood. Provides fast results but can be inaccurate if lead is on the skin. If the test shows lead in blood, a healthcare provider will order a blood draw to confirm the result.

Venous testing (blood draw)

• Drawing blood from a vein provides confirmation of lead in blood and blood collected from the vein is less likely to be contaminated with lead during the collection process. It may take several days to get results from the laboratory.

The Centers for Disease Control (CDC) has set a reference value of 3.5 micrograms per deciliter (μg/dL). This level is not considered a safe threshold; instead it's meant to be a reference value to trigger public health action.

Blood Lead Testing How-to Resources

• Mission Unleaded: How to test children for lead with maximum accuracy (YouTube)--Start video at 12:04 for blood draw information
• Steps for Collecting Fingerstick Blood Samples in Micro-Vials for Lead Testing (PDF)

When to schedule future tests

If Seeking Test Confirmation

TABLE 1 shows when a child with an elevated capillary blood lead level should receive a blood draw to confirm the elevated result.

If Seeking Follow-up Testing

TABLE 2 provides a schedule for follow up testing after an elevated blood lead level has been confirmed.

All confirmed elevated lead levels should be followed-up with venous testing.

Public Health Case Management

WHAT TO EXPECT if your child has a blood lead level ≥3.5 mcg/dL

These services are voluntary. Public Health Nurse Case Managers will work closely with the family and healthcare providers to reduce levels of lead in blood and to encourage follow-up testing. If a family declines case management, Public Health Nurses will continue to work with the Healthcare Provider to provide follow-up guidance.

Public Health Nurses work with families to identify possible lead exposures. Then, based on the exposures, a plan of care is developed and mailed to the family, along with links to health education materials in the family’s primary language. It is important for the family to review these materials to learn about lead risk, prevention, and nutrition. Public Health Nurses also encourage developmental screenings using the ASQ or use the ASQ screening on the WithinReach website (scroll down to Start an ASQ Screening). Families continue with public health case management until the child has a blood lead level less than 3.5 micrograms per deciliter.

A Public Health Nurse may offer a home visit with an Environmental Health Specialist so that risk areas can be tested for lead if a specific need has been determined by the Public Health Nurse, after the lead risk investigation phone call has been completed. Home visits for testing are limited due to staffing limitations. Our team can also assist families in getting referrals for development, nutrition, or other family resource needs.