Report shows mixed results for lead screening rates in children

The New York State Attorney General Eliot Spitzer has released a report finding that certain Medicaid and Child Health Plus (CHP) managed care health plans have lead screening rates for infants and young children below the statewide average.

The Attorney General's Health Care Bureau has begun an inquiry to determine whether plans are complying with state law that mandates universal lead screening and identify steps plans may take to increase their childhood lead screening rates. Senator David A. Paterson, Senator John Sampson, Councilman Bill Perkins, and the New York City Coalition to End Lead Poisoning joined Spitzer in the announcement to create awareness about the importance of childhood lead screening.

Studies have demonstrated that lead poisoning can result in mental and physical impairments, such as cognitive deficits resulting in lower IQ scores, learning disabilities, behavioral problems, growth delays and hearing loss. A disproportionately high number of low-income, African-American children in New York City are victims of such poisoning. If lead poisoning is promptly detected though routine screening in the pre-school years, children can be effectively treated and lead contamination can be removed from their homes before severe damage occurs.

"The tragedy of being permanently damaged by lead poisoning is that every affected child can be treated, if detection occurs early. However, many children continue to fall through the cracks," said Spitzer. "A child's health and development should not be compromised simply because the luck of the draw has landed them in a health plan that does not screen for lead poisoning at an acceptable level."

New York law requires health maintenance organizations, physicians, and other health care providers to ensure that all children are screened, or referred for screening, for lead poisoning at the ages of 1 and 2. The New York State Department of Health (DOH) reports each health plan's compliance annually as a percentage of 2-year-olds that were screened for lead poisoning. Statewide average percentages are also calculated and reported for each year.

Using these DOH figures for the last three years, the report tracked the plans' performance and presented a Compliance Profile. The profile shows the Medicaid and CHP plans that consistently screened enrolled children for lead poisoning by age 2 at a rate significantly below, above or near the average statewide rates for the past three years. Medicaid and CHP plans are the primary focus of the inquiry because they serve low-income children who are at greatest risk of exposure to lead in their homes.

The report concluded that:

• Average statewide lead screening rates among all Medicaid managed care plans in the state have declined from 2000 to 2002; among CHP plans, statewide rates have remained at the same level;
  • For example, average lead screening rates for Medicaid plans were 76% in 2000 and 2001, and then declined to 74% in 2002. Similarly, average CHP rates were 68% in 2000, 70% in 2001, and then fell back to 68% in 2002;
• Several health plans have lead screening rates that are consistently below the statewide average, including ABC Health Plan, Community Blue, Community Choice, Empire Blue Cross and Blue Shield, HealthNow, HIP, United HealthCare, Vytra and WellCare;
  • For example, WellCare's Medicaid plan exhibited lead screening rates of 58% in 2000, 61% in 2001 and 56% in 2002, well below the statewide averages of 76%, 76% and 74% for those same years;
• Several other plans consistently achieved high lead screening rates that exceeded the statewide average, including Buffalo Community Health, Community Premier Plus, Excellus-Rochester, Metro Plus, New York Presbyterian CHP, Preferred Care-Rochester and Suffolk Health Plan;
  • For example, Metro Plus' Medicaid plan reported lead screening rates of 86% in 2000, 88% in 2001 and 86% in 2002, significantly above the statewide averages; and
• High-performing plans cover service areas throughout the entire state, demonstrating that high lead screening rates can be achieved in any region, regardless of demographics.

With release of this report, the Attorney General has sent letters to each of the health plans to request that they provide specific information about their compliance with the state's lead screening mandate. This inquiry is designed not only to determine whether there is non-compliance with the state mandate, but also to identify specific strategies that the consistently high-performing plans employ to promote effective lead screening efforts.

To reduce the chance of contracting lead poisoning follow these suggestions:

• Find out when the building was constructed and if it has been tested for lead, including the water.
• Check the condition of all painted surfaces to make sure paint is intact.
• Thoroughly wash the entire home before moving.
• Vacuum carpeted areas thoroughly, using a vacuum cleaner equipped with an agitator.
• Wash children's hands, faces and toys frequently.
• Use only cold, fully flushed tap water for cooking, drinking and baby formula preparation.
• Don't allow preschool children to play or dig in outdoor soils that may be contaminated with lead.
• Have children tested, lead poisoning is usually a hidden disease.

This report is part of Spitzer's long-standing involvement in childhood lead poisoning issues. His office led a multi-state effort that resulted in paint manufacturers agreeing in 2003 to place warning labels on all paint products explaining the risks of disturbing and preparing lead-contaminated surfaces. That same year, the Office of the Attorney General filed an amicus brief on behalf of the New York City Coalition Against Lead Poisoning in its lawsuit against the City of New York, which ultimately resulted in a stronger lead poisoning ordinance.

The report was prepared by Assistant Attorney General Paul Beyer of the AG's Health Care Bureau, under the supervision of Troy Oechsner, Albany Section Chief, and Joseph Baker, Bureau Chief.

Consumers and providers with questions or concerns about health care matters, can call the Attorney General's Health Care Bureau Hotline at 1-800-771-7755. The full text of the report is available on the Attorney General's website: www.oag.state.ny.us.