OLYMPIA — Washington is struggling to meet a requirement that it test all children on Medicaid for lead, even though exposure to the metal is especially harmful to kids, according to a new state report.
A report from the state auditor's office, released Tuesday, says that 74% of Washington kids on Medicaid born from 2014 to 2016 had not undergone a blood test for lead between their first and sixth birthdays. A blood test is the only way to reliably determine lead exposure.
The auditor's office focused on Medicaid because federal rules require that all kids enrolled in it be tested for lead at 12 and 24 months old, or by the time they're 6 years old if there's no record of a previous test. Medicaid covers low-income people and is known in Washington state as Apple Health.
The share of all children, not just those on Medicaid, tested for lead in Washington is even lower: Just 4.2% of all kids were tested as of 2018, according to data from the Centers for Disease Control and Prevention.
Lead is especially harmful to kids, who can be exposed through paint, household products made in other countries like toys and tableware, and contaminated soil.
Kids can also be exposed to lead through drinking water. Lead pipes are not common in Washington, with fewer than 2.5% of homes served by a lead service line and fewer than 8% by lead components, according to a state survey. Earlier this year, the state was struggling to hand out an influx of federal cash to local governments to help them identify and replace lead pipes.
But the risk of exposure still exists here, especially for kids who live in homes built before 1960, in high-poverty areas and in areas formerly used as orchard land or near a former smelter. Auditors estimate that roughly 46,000 to 60,000 Washington kids born between 2017 and 2019 were not tested although they may be at higher risk of being exposed to lead.
The share of children tested at least once, at 1 or 2 years old, varies widely by county, according to the new report. Clallam County had the lowest rate, with 7% of kids on Medicaid tested for lead at least once at those ages. The share was highest in Walla Walla County, at 55%. King County fell about in the middle at 26%.
The state Health Care Authority bears responsibility for making sure Washington meets the requirement to test all kids enrolled in Medicaid.
But the agency hasn't worked to "actively monitor" compliance with the testing requirement, auditors said. Other states, like Wisconsin, New York and North Carolina, use billing information to find out which Medicaid providers aren't testing as many kids and inform them.
Some providers in Washington use a questionnaire to determine which kids are at high risk for exposure, but that alone doesn't meet the requirement, state auditors said.
Auditors also said the Health Care Authority and the state Department of Health, a separate agency that collects information on all blood tests for lead, don't coordinate to analyze which kids need a screening. In a response to the audit, agency leaders said they were working on an agreement to share data.
Since 1989, the federal government has required all kids on Medicaid be tested for lead, according to a 2016 Reuters investigation into low rates of lead testing in the U.S. Washington has twice applied for a waiver of the requirement, in 2015 and 2019, but neither application was approved. Arizona is the only state to have gotten such a waiver.
Washington has long trailed other states when it comes to the share of kids tested for lead, but testing rates did increase for Washington kids on Medicaid between 2018 and 2022, according to the new state report.
The Health Care Authority, Department of Health and Office of Financial Management acknowledged "that we can do better to help individuals most vulnerable to lead exposure be identified, tested and connected to the care and resources needed to help reduce long-term impacts," officials from all three agencies wrote in a response to the report.
