Under a lawsuit settlement, all Washington children covered by Medicaid will be eligible for lead-poisoning testing if their parents request it — or if they live in old buildings, are recent immigrants or face other exposure risks.
After years of living in public housing, Virla Spencer worried that her children might have been exposed to lead from peeling paint or other sources in the environment.
But when she asked for blood tests under the state’s Medicaid program, her doctor refused.
“She said, ‘We don’t really test for lead here in Washington,’ ” Spencer recalled.
So when Spencer heard about a class-action lawsuit to force the state to expand lead screening for low-income kids, she signed on as the primary plaintiff.
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“If I have to beg to get my kids tested, that’s a problem,” said Spencer, who eventually lifted her family out of poverty and works at the Center for Justice in Spokane.
Under a settlement filed last week, all children in the state covered by Medicaid will be eligible for testing if their parents request it — or if they live in old buildings, are recent immigrants or face other exposure risks.
The state Department of Health also unveiled an online map that allows residents to determine the relative risk from lead in their neighborhoods.
The result should be more extensive testing to identify children with lead poisoning, which can damage the brain and nervous system, interfere with learning and impair motor skills, said David Bricklin, the Seattle environmental attorney who organized the suit.
“Lead poisoning is so insidious,” Bricklin said. “It’s a silent debilitation … and parents may not even know about it.”
More testing should also help health officials identify hot spots and get a better handle on how prevalent lead exposure is across the state, Bricklin added.
“If you don’t do the testing, you won’t know if there’s a problem.”
Lead testing in Washington has lagged the rest of the country for years. Though Medicaid long mandated universal testing for kids covered by the low-income health-care program, in recent years only about 3 percent were screened in Washington compared to about 11 percent nationwide.
The reason for the low rate is that most experts were convinced lead poisoning was very rare in Washington, especially compared to East Coast cities with older homes and more pervasive use of lead paint.
“The standard practice was not to test,” said Dr. Charissa Fotinos, deputy medical director for the Washington State Health Care Authority.
A 1999 survey found only about 1 percent of children in Washington had blood lead levels above 10 micrograms per deciliter, the action level at the time. Since each test costs Medicaid about $16, the thinking was that scarce resources would be better spent on more common health concerns, Fotinos said.
But the action level was recently halved, as mounting evidence suggests the toxic metal can be harmful even in very tiny amounts.
“I don’t believe there is any safe level of lead,” said epidemiologist Dr. Elisabeth Long, who monitors childhood lead poisoning for the Washington Department of Health.
In 2012, the most recent year for which data are available, 461 children across the state tested positive for blood lead levels above the current action level. If those results are representative of the entire population, nearly 14,000 Washington youngsters may have undetected lead poisoning, the lawsuit argues.
Lead poisoning has dropped precipitously across the country since leaded gasoline was phased out. Lead paint is the major source of exposure now.
The lawsuit estimates that nearly 500,000 older homes and apartments in Washington could still contain lead paint. People with low incomes are more likely to live in old housing, and children are most vulnerable because of their propensity to put objects in their mouths.
The settlement proposes targeted screening that focuses on high-risk kids. A detailed questionnaire will help doctors determine whether children might be exposed based on their living situation, family income, or their parents’ profession.
Employees of some smelters or battery recycling facilities, for example, might carry lead on their clothing. Also, some small airplanesuse leaded fuel, so living near an airport could raise the odds of exposure.
“My hope is this will provide an easier road map for physicians to follow,” Fotinos said. “At a minimum it will draw attention to the topic.”
For children not covered by Medicaid, private insurance often covers the cost of lead testing.
DOH’s new online map lets residents zoom in on their neighborhoods down to census tracts. Relative risk of lead exposure is ranked on a scale of one to 10, based on income levels and age of housing, said Rad Cunningham, who developed the tool.
But a high ranking doesn’t mean everyone who lives in an area is at high risk of lead exposure, he cautioned.
“It’s just more likely that there are more individuals at risk because of the age of housing and the level of poverty,” Cunningham said.
A person who lives in a new home, or in a home where lead paint has been covered over, would have negligible exposure, even if their neighborhood ranks high on the map.
There’s no treatment for lead poisoning, but early detection will help parents eliminate additional exposure, Bricklin said. “Everyone of those kids, you’re basically saving a life.”
The settlement and testing plan must be approved by the federal Centers for Medicare and Medicaid Services before it can go into effect.
As soon as it does, Spencer intends to get her five youngest kids tested.
“I’m super excited,” she said. “This opens the door for other people to be able to get the testing they need and find out if there are any problems, and head them off.”