State made limited progress in expanding childhood lead exposure testing, audit finds

Washington has taken some steps to improve the number of children tested for lead exposure, but it has not fully implemented any of the recommendations from a previous report on the issue, according to a follow-up audit published today. 

In 2023, the Office of the Washington State Auditor reported that only 26% of children enrolled in Medicaid received at least one federally required test for lead exposure between 1 year and 6 years old. Lead is a toxic metal, and missed tests increase the risk that children who have been exposed to lead will not get the care they need. 

The audit made recommendations to improve testing rates. However, a follow-up performance audit found the Health Care Authority partly followed some recommendations, while progress on others only began during the audit. None had been fully implemented.  

For example, the 2026 audit found the Health Care Authority did not work with the Department of Health as recommended to ensure all guidance to health care providers around Medicaid lead testing requirement is clear and consistent. The agency also did not begin work on two related recommendations until May 2026: 

• To educate Medicaid providers about the effectiveness of testing children while they are already in the provider’s office, rather than sending them to another facility, and 

• To use health records systems prompts to remind providers to test for lead exposure while the patient is with them.   

“As I said of our previous audit, the state can soon improve the number of children tested for lead – if it acts with a sense of urgency equal to the issue,” said State Auditor Pat McCarthy. “The progress made during this review shows the power of follow-up audits to highlight important issues and the efforts to address them.” 

The full report, including the status of each recommendation, can be found on the State Auditor’s Office website:
Lead Testing for Children Enrolled in Medicaid: Following up on selected issues (PDF)

Media inquiries: Assistant Director of Communications Adam Wilson, Adam.Wilson@sao.wa.gov, 564-999-0799.