Child advocates and environmentalists are suing the state of California for failing to provide routine lead-poisoning screening for all poor children in the state.
The lawsuit, apparently the first of its kind in the country, alleges that the state is not complying with a 1989 federal law that requires poor children enrolled in a part of the state’s Medicaid program to be screened for high levels of lead in their blood.
The suit was filed in a federal court in San Francisco in late December.
Since last January, under a little-noted provision in the federal law, poor children enrolled in a state’s early and periodic screening, diagnostic, and treatment (EPSDT) program as part of its Medicaid program have been required to be screened for lead when “appropriate for age and risk factors.”
Research suggests that children exposed to lead may have impaired nervous-system functioning, delayed cognitive development, and lower IQ scores.
The federal government, as well as most states, have interpreted the 1989 law in a way that allows the child’s doctor to determine when blood testing for lead is necessary.
But the California plaintiffs, which include the Natural Resources Defense Council, the NAACP Legal Defense and Educational Fund, and the American Civil Liberties Union, want all eligible children to be screened during their regular checkups, even if they have no known risks or symptoms of lead poisoning.
“It should be something that the provider initiates,” said Jane Perkins, a lawyer for the National Health Law Program, a Los Angeles-based advocacy group that is also part of the suit.
But California officials maintain that doctors should perform a lead blood test only if the child’s health history or environment suggests that such a step is necessary.
“We are doing what the law says we are required to do,” said Norman Hartman, a spokesman for the California Department of Health Services. He said the state has been told by the U.S. Department of Health and Human Services, which administers Medicaid, that its program is legal.
William Hiscock, chief of the program initiatives branch of the federal Medicaid bureau, said that, although EPSDT guidelines require that all Medicaid-eligible children ages 1 to 5 be screened for lead poisoning, it is still up to the states to determine appropriate ages and risk factors for such screening.
Initial screening, he said, could include checking children for signs of lead poisoning.
“It’s a judgment call to say what risk is,” he said. “We don’t say in our law that every child should be screened every time.”
Medicaid programs in California and all other states are required under federal law to cover poor women and their children up to age 6 who come from families with incomes less than 133 percent of the federal poverty level. States establish their own eligibility guidelines for older children and other adults.
Any child eligible for Medicaid is also eligible for the EPSDT program, but their parent must request their enrollment.
In California, almost two-thirds of the poor children who are enrolled in Medicaid participate in the state’s EPSDT program.
Nationally, HHS estimates that more than 200,000 children between the ages of 6 months and 5 years, or about 1.5 percent of all young children, have lead levels at or above 25 micrograms per liter of blood, the level at which action is recommended.
In response to evidence suggesting that children are affected by even lower levels of lead, the federal government later this year is expected to lower its recommended action level to 15 micrograms per liter of blood.
More than 3 million preschool-age children, including two-thirds of black inner-city children, have blood-lead levels that exceed this expected standard, the government estimates.
Last September, Massachussetts became the first state to require all entering kindergartners to show that they have been tested for lead poisoning. But neither the U.S. Centers for Disease Control nor the American Academy of Pediatrics recommends universal lead screening. (See Education Week, Sept. 19, 1990.)
