Only a quarter of Washington’s Medicaid-enrolled children are tested for lead, audit finds

Dec 12, 2023

Washington does not meet federal requirements to test children for lead exposure, according to a new performance audit by the Office of the Washington State Auditor.

Auditors found only 26 percent of children enrolled in Medicaid received a blood test for lead between their first and sixth birthday – the program’s minimum requirement. Federal guidelines set a specific goal of two lead tests, at 1 and 2 years of age. Only 3 percent of enrolled children had blood lead level tests at both these ages. This undertesting is especially relevant for the 240,000 children aged 6 and under who are enrolled in Medicaid, the joint federal and state health program.

There is no safe level of lead in the body. Universal childhood testing is intended to identify exposure early and allow for immediate mitigation. Across Washington, lead testing rates for children enrolled in Medicaid varied significantly by county, but not as significantly by demographic factors such as race, the performance audit found. A notable exception were children who did not speak English, who were twice as likely to be tested as native English speakers, possibly due to increased outreach by health care workers.

“This performance audit shows we can never be complacent about the risks our children face, even here in the beautiful Evergreen State,” said State Auditor Pat McCarthy. “Importantly, we found state agencies have the tools and data they need to increase the number of children screened for lead exposure. This report makes recommendations to better communicate testing requirements to health care providers and identify communities at higher risk for lead exposure.”

The audit makes detailed recommendations to the Health Care Authority and the Department of Health. Both agencies have advocated for focusing blood lead testing only on children who have been identified as having one or more risk factors, but the agencies have not received federal approval to use this approach.

The full report, as well as summary material, can be found on the State Auditor’s Office website here: Lead Testing for Children Enrolled in Medicaid