May 3, 2004

Lead Astray in Ohio: Ohio's New Testing Law

In Ohio, only one in seven children under six years of age receives screening for blood lead poisoning. This is due to a lack of a requirement for screening the general population and a failure on the part of health care providers to comply with the federal mandate to test all children on Medicaid.

With the exception of children on Medicaid, no requirement existed for testing of children for lead poisoning in Ohio prior to April 1, 2004. In fact, if a child in Ohio was identified with a confirmed elevated blood level exceeding 10 µg/dL, the Ohio Department of Health (ODH) was not required to conduct any follow-up with the poisoned child. Ohio did have "recommendations" for screening and follow-up, but there was no firm requirement, and, in turn, no enforcement of these recommendations.

Under Ohio's recently adopted targeted screening law that went into effect on April 1, all medical care providers must conduct blood lead tests for children who live in "high risk" ZIP codes designated by ODH and for those who are likely to have exposure to lead. [1] Because Ohio has never conducted universal screening of children for lead poisoning, the ODH high-risk designation is not based on the actual prevalence of lead poisoning in the Ohio population. For those children who do not live in a targeted ZIP code, a verbal screen is required to determine a child's level of risk for exposure to lead. If a child or their parent/guardian answers yes to one of the following questions, a health care provider must conduct a lead screen:

  1. Does the child live in or regularly visit a home, child care facility or school built before 1950?
  2. Does the child live in or regularly visit a home, child care facility or school built before 1978 that has peeling, chipping, dusting, or chalking paint, or is being remodeled?
  3. Is the child exposed to an adult who has a lead-related hobby?
  4. Does the child have a sibling or playmate who has or did have lead poisoning?

(Ohio Administrative Code 3701-30-01)

All results of blood lead tests must be reported to the Ohio Department of Health, or ODH (OAC 3701-32-14). Once ODH is notified that a child under six has lead poisoning, or a confirmed level of blood lead at or above 10 µg/dL, ODH must identify the source of the lead poisoning (OAC 3701-30-07). If the source is a home, child-care facility, or school, ODH must conduct a risk assessment and order the property owner to control the existing lead hazards (OAC 3701-30-07, 3701-30-08, 3701-30-09). As of April 2004, the Ohio Childhood Lead Poisoning Prevention regulations require ODH issue guidance to medical care providers explaining the requirements for follow-up of blood lead screens (OAC 3701-30-03). [2]


[1] According to ODH guidelines which pre-date the new law, a high-risk zip code is an area which has at least 27% pre-1950 housing and at least 15% of the children under age five below poverty, or at least 12% of the children under age 3 with blood lead levels above 9 mg/dL (Ohio Childhood Lead Poisoning Prevention Program Medical Management Recommendations).

[2] As of the date of publication of this report, such guidance had not yet been produced.


Centers for Disease Control and Prevention, Recommendations for Blood Lead Screening of Young Children Enrolled in Medicaid: Targeting a Group at High Risk, December 8, 2000, at p. 3.

The Childhood Lead Poisoning Prevention Working Group (CLPP) Report to Ohio General Assembly, July 30, 2000 (amount adjusted for inflation).

Ohio Dept. of Jobs and Family Services (ODJFS) Medicaid-Contracting Managed Care Plans Provider Agreement State Fiscal Year 2004-2005 at Appendix G.

Ohio Department of Health, Childhood Lead Poisoning Report 2002.