Executive Councilor Demands Accountability in Blood Lead Screenings for NH Children

CONCORD — At the November 8, 2023, Executive Council meeting, District Three Executive Councilor Janet Stevens, demanded accountability and compliance from the three Managed Care Organizations (MCO), which oversee delivery of the state's Medicaid and Children's Health Insurance Program (CHIP) to 82,462 New Hampshire children and young adults. By statute, all Medicaid-eligible children are required to receive blood lead screenings at ages 12 months and 24 months. For 2022 – only 39% of two-year-olds and 50% of one-year olds receiving healthcare coverage through Medicaid were tested for blood lead levels. Rates for all children in NH in 2021 were 60% for one-year olds and 51% for two-year olds – which represents a 25% drop in blood lead level testing since 2019.

"The data is disconcerting and it's imperative that the three managed care organizations overseeing the delivery of care to more than 181,000 New Hampshire residents fulfill their contractual obligation with the State of New Hampshire, uphold New Hampshire's designation as a 'Universal' State for pediatric blood lead testing which mandates the testing of all children at the ages of one and two, comply with federal Medicaid rules and get the job done of protecting our most vulnerable residents. There is a disparity in blood lead level testing for children enrolled in Medicaid vs. non-Medicaid enrolled children. Bottom line – the data indicates that across the board there has been a decline in testing for all New Hampshire children. There is no safe level of lead and lead poisoning is a preventable disease. The decline and disparity in blood lead testing – unacceptable", stressed Executive Councilor Stevens.

According to Children's Hospital Boston – Latent effects of lead exposure in children can affect growth, language, attention, and even IQ. Lead can affect people of all ages, but children aged 6 and younger are especially at risk, in part because their growing bodies absorb more lead.

The most common causes of lead poisoning are lead-based paint and lead-contaminated dust in older buildings.

Lead exposure can harm young children and babies — even before they are born.

Even children that seem healthy can have high levels of lead in their bodies.

High levels of lead may also cause seizures, coma, and, in rare cases, death.

The Centers for Disease Control and Prevention (CDC) estimated that almost 500,000 children between the ages of 1 and 5 living in the United States have elevated lead levels. Approximately one out of every 25 children has dangerous levels of lead in their bloodstream.

According to Stevens, a myriad of factors, including pandemic-related disruptions to routine pediatric care, a nationwide recall of blood lead testing equipment, and a shortage of healthcare providers, have significantly reduced pediatric blood lead testing. "To address this, our Managed Care Organizations (MCOs) must prioritize testing, support the 2800 primary care and 400 pediatric Medicaid providers with necessary tools, and actively engage families in understanding and participating in pediatric blood lead testing. Success requires collaboration to increase testing capacity, identify deficiencies, provide point-of-care testing, and educate families on the crucial significance of testing –it's all hands-on deck," stressed Executive Councilor Stevens.

The existing five-year Medicaid contract in New Hampshire with the current three MCOs is set to conclude on August 31, 2024, with a total cost ceiling of $6.1 billion. Executive Councilor Stevens expressed optimism about ongoing discussions she has had with New Hampshire's Medicaid Director, highlighting the positive developments in the proposed guidelines that will be integrated into the upcoming contract during the re-procurement process. While aiming for a 100% improvement, Councilor Stevens acknowledges that these changes represent a positive starting point.

Pending reprocurement requirements under consideration will measure lead testing based on the HEDIS and title XIX/XXI designations and impose financial penalties for failure to improve testing rates. New Hampshire expects improvement in testing rates based on the State requirements of blood lead screening tests at ages 12 months and 24 months. Goals will begin at-

fifty-five percent (55%) for 12-month olds and

forty-four percent (44%) for 24-month olds,

with incremental increases of five percent (5%) for each category annually.

At the end of the 5-year contract period, the expectation for successful testing rates will be seventy-five percent (75%) for 12-month olds and sixty-four percent (64%) for 24-month olds.

The importance and maintenance of child wellness visits with a child's primary care provider – which include blood lead level screenings (a covered service) – is critical (see) LeadFreeKidsNH video for information. Outside of wellness visits, families can contact their providers and discuss concerns and get an order for a lab test or request a nurse visit with their provider to get the capillary/in-office test done. Residents can contact the Healthy Homes & Lead Poisoning Prevention Program (HHLPPP) AT 603 271-4507 or [email protected].