Blood Lead Testing
All children enrolled in Medicaid, regardless of whether coverage is funded through title XIX or XXI, are required to receive blood lead screening tests at 12 months and 24 months of age. In addition, any child between 24 and 72 months of age (2-6 years old) who has no record of a previous blood lead screening test must receive one.
Completion of a risk assessment questionnaire does not meet the Medicaid requirement. The Medicaid requirement is met only when the two blood lead screening tests identified above (or a catch-up blood lead screening test) are conducted.
Consider testing any child if they have risk factors such as anemia, behavioral concerns, developmental delay, or pica behavior (repeatedly eating non-food items).
Methods of testing:
Capillary testing (finger prick)
- A screening test to see if a child has lead in their blood. Provides fast results but can be inaccurate if lead is on the skin. If the test shows lead in blood, a healthcare provider will order a blood draw to confirm the result.
Venous testing (blood draw)
- Drawing blood from a vein provides confirmation of lead in blood and blood collected from the vein is less likely to be contaminated with lead during the collection process. It may take several days to get results from the laboratory.
The Centers for Disease Control (CDC) has set a reference value of 3.5 micrograms per deciliter (μg/dL). This level is not considered a safe threshold; instead it's meant to be a reference value to trigger public health action.
When to schedule future tests
If Seeking Test Confirmation
TABLE 1 shows when a child with an elevated capillary blood lead level should receive a blood draw to confirm the elevated result.
TABLE 1: Recommended Schedule for Confirmatory Venous Testing
If Capillary Blood Lead Level (μg/dL) is...
Get a Venous Confirmation Test...
|Greater than or equal to 3.5-9||within 3 months|
|within 1 month|
|within 2 weeks|
Greater than or equal to 45
within 48 hours
If Seeking Follow-up Testing
TABLE 2 provides a schedule for follow up testing after an elevated blood lead level has been confirmed.
TABLE 2: Schedule for Follow-up Blood Lead Testing
Venous Blood Lead Level (μg/dL)
Early Follow-up Testing
(2 to 4 tests after initial test above specified venous blood lead levels)
After Blood Lead Level is Declining
|Greater than or equal to 3.5-9||3 months||6 to 9 months|
|10-19||1 to 3 months||3 to 6 months|
|20-44||2 weeks to 1 month||1 to 3 months|
|Greater than or equal to 45||As soon as possible||As soon as possible|
All confirmed elevated lead levels should be followed-up with venous testing.