Roughly Half Of Children On Medi-Cal Aren’t Getting Screened For Lead Poisoning, New Audit Shows

Around half of the nearly 3 million children enrolled in Medi-Cal aren't getting any of their state-required screenings for lead poisoning, according to a new report from the California State Auditor’s office. 

Doctors are supposed to screen children enrolled in the low-income health program at ages 1 and 2. High levels of lead content in a child’s blood can cause learning disabilities and other serious health problems if left untreated.

This has been an ongoing issue in California as groups have pushed for more screenings for children in low-income neighborhoods, where older homes may expose children to higher levels of lead. African American children have historically had higher rates of lead poisoning than children of other races.

But even with screening requirements in place, many low-income children fall through the cracks. The audit found that between 2009 and 2018, more than 1.4 million of the 2.9 million one- and two-year-old children enrolled in Medi-Cal did not receive any of the required tests, and another 740,000 children missed one of the two tests. 

Overall, less than 27% of eligible children received all required screenings during that time.

Three different areas in California are home to the state’s largest numbers of children with elevated blood lead levels. Those include the Arden-Arcade neighborhood in Sacramento, two census tracts near Eureka in Humboldt County and downtown Fresno.

State auditors pointed out problems in two different departments — the Department of Health Care Services and the California Department of Public Health. They listed the following reasons for why most children in Medi-Cal aren’t getting tested:

• The Department of Health Care Services is not effectively overseeing managed care plans to ensure that children receive the required lead tests.
• The department has not implemented a financial incentive program for health care providers to encourage lead testing.
• The California Department of Public Health has not identified areas of the state at high risk for childhood lead exposure, or taken steps to reduce risk in those areas.
• The public health department only monitors lead abatement activities in the homes of children who already have lead poisoning.
• The public health department does not assess the performance of local prevention programs tasked with addressing lead risks. 
• The public health department has not updated the factors health care providers use to identify children who need testing for lead poisoning. 

Kelly Hardy, who directs research and health policy for a nonprofit advocacy group called Children Now, said the issue has become an unnecessary blame game between providers, plans and state departments. 

“The plans are pointing at the Department of Health Care Services, and the Department of Health Care Services is pointing at the plans,” she said. “And nobody is looking at the bottom line, which is kids aren’t getting the services the state’s paying for. So from a taxpayer standpoint … that  doesn’t work out. And of course, the kids and the families suffer.”

In response to the audit, the Department of Health Care Services says it will launch an outreach campaign to Medi-Cal beneficiaries informing them about the availability of lead testing services for children by March. And by June, Medi-Cal managed care plans will need to identify all children who haven’t received required lead tests and remind their physicians to complete the screenings. Sanctions and penalties for managed care plans that don’t reach the national benchmark for blood lead screening should be in place by December.

The California Department of Public Health says it will release a map by the end of January showing the percentage of children with a blood lead level above a certain threshold, arranged by local health jurisdiction, for 2016, 2017 and 2018. 

By June, the department promises to develop a plan for increasing oversight of local programs, including scheduled site visits, technical assistance and measures for program evaluation. 

“Low-income children such as those served by Medi-Cal are disproportionately exposed to lead,” said Dr. Mark Ghaly, Secretary of Health and Human Services, which oversees both departments. “I have pledged to the governor that we will do more to get children tested and also make sure all Californians know about the importance — and availability — of lead testing and ways to reduce lead exposure.” 

The auditor stated that these proposed implementation plans don’t “sufficiently address” the concerns in the report.

In March, the state auditor released a report showing that millions of children on Medi-Cal are not receiving check-ups, vision and hearing screenings due to oversight shortfalls in the Department of Health Care Services.