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Update: Almost Three-Fourths of Medi-Cal Toddlers Miss Annual Lead Tests Required by Law

Policy Analysis
Wednesday, January 31, 2018

In September, EWG reported that each year about a third of California toddlers enrolled in Medi-Cal don’t receive lead testing required by law. But the problem is much worse than we estimated.

EWG’s new analysis of state records shows that between 2012 and 2016, almost three-fourths of 1- and 2-year-olds enrolled in the state-run low-income health insurance program were not tested for lead in their blood.

This new calculation is especially alarming because Medi-Cal children are seven times more likely to be lead-poisoned than children from higher-income families. If children with high blood lead levels are not identified through testing, they cannot receive treatment.

These figures are culled from Medi-Cal billing data from the California Department of Health Care Services. The previous estimate was based on incomplete data from the Department of Public Health, obtained through an open records request. The Department of Health Care Services released its billing data at the request of Assembly Member Bill Quirk, D-Hayward, co-author of a bill signed into law last fall to expand lead testing.

Almost Three-Fourths of Medi-Cal Toddlers Were Not Tested for Lead Poisoning

Fiscal Year

Number of 1- and 2-Year-Olds in Medi-Cal Who Received Blood Lead Tests

Number of 1- and 2-Year-Olds in Medi-Cal

Number of 1- and 2-Year-Olds in Medi-Cal Who Were Not Tested

2012

 192,399

 682,330

489,931

2013

 199,793

 702,736

502,943

2014

 206,113

 728,158

522,045

2015

 212,770

 774,933

562,163

2016

 221,194

 787,506

566,312

Source: EWG, from Department of Health Care Services Medi-Cal billing records provided by the California State Assembly.


The new Medi-Cal billing data show that in the fiscal years 2012 to 2016, an annual average of about 529,000 toddlers enrolled in the program did not receive required lead tests. That means that during that time period, an average of only 28 percent of children in the program were tested.

Federal law and federal and state regulations require all children receiving Medicaid, called Medi-Cal in California, to be tested for lead exposure when they are 12 and 24 months old. EWG’s earlier investigation found that for decades California has fallen short of compliance.

The American Academy of Pediatrics and the Centers for Disease Control and Prevention agree that there is no safe level of lead in children. Lead is a carcinogen, harms kidney function, and has been linked to delayed growth. 

Lead also damages children’s brains. Even minute amounts of lead in the bodies of very young children cause harm to their central nervous systems. Damages caused by lead carry into adulthood, and recent studies demonstrate that adults who had elevated blood lead levels as children have smaller brains, lower IQs and lower socio-economic status. 

Lead poisoning can threaten children of any socioeconomic status, but those from lower-income families are more likely to live in older housing with lead paint or face exposure from other sources, such as factories and freeway traffic. According to the Department of Public Health, 88 percent of California children who are lead poisoned are enrolled in Medi-Cal.

California defines a case of child lead poisoning as when a child has a tested elevated blood lead level of at least 14.5 micrograms per deciliter of blood, or two consecutive tests of an elevated blood lead level of at least 9.5 micrograms per deciliter of blood.

 The new data show that the state’s failure to ensure lead testing for toddlers on Medi-Cal is an ongoing crisis that demands urgent attention. EWG is working with lawmakers in Sacramento to determine if more legislation is needed in this year’s session to safeguard children’s health. In addition, the Assembly’s Committee on Environmental Safety and Toxic Materials, chaired by Quirk, plans to hold an oversight hearing Feb. 13 to examine why California continues to struggle to lead-test its Medi-Cal toddlers.