Lead exposure can harm nearly every organ in the human body, and millions of U.S. children are exposed to significant lead hazards. Identifying chidlren with elevated blood lead levels via blood lead testing is essential for connecting them to appropriate follow up services. However, no states have achieved full compliance with federal or state blood lead testing requirements. This analysis aims to provide critical evidence-based information to understand better which of the following state-level policies/strategies (or combination thereof) are more effective at increasing childhood blood lead testing rates: 1) metrics, 2) incentives, 3) other managed care organization (MCO) guidance, 4) provider guidelines, 5) mandatory reporting of results to state health departments, 6) data sharing between Medicaid and other state agencies, and 7) proof of testing for school enrollment. This analysis included 33 states with complete data on the number of children who received blood lead testing in 2017-2018 as reported to the Centers for Disease Control and Prevention. SAS 9.4 was used to conduct unadjusted and adjusted linear regression modeling. Fully adjusted models included percentages of the population living in pre-1980 housing, < six years of age with Medicaid coverage, and foreign-born. Requiring proof of testing for school enrollment produced the strongest unadjusted regression coefficient (0.12, p = 0.03). Requiring reporting of lead metrics produced the strongest adjusted regression coefficient (0.06, p=0.01). For policy/strategy combinations, the strongest unadjusted regression coefficient was observed for “proof of testing for school enrollment and metrics” (0.16, p<0.01). For adjusted models, the strongest regression coefficients were a tie between “metrics and MCO guidance” (0.08, p=0.04) and “metrics and provider guidelines” (0.08, p<0.01). To increase childhood blood lead testing rates, states should focus on requiring proof of testing for school enrollment, requiring reporting of lead metrics, and providing MCO guidance. To facilitate adoption of additional policies, states should work with local American Academy of Pediatrics chapters, disseminate data on lead testing performance to providers, and raise awareness among decision-makers about the importance of identifying lead-exposed children to mitigate the harmful effects of lead. Children who receive interventions to reduce the adverse impacts of lead exposure are more likely to exhibit academic readiness, spend less time in special education, graduate high school, and have reduced contact with the criminal justice system which results in overall benefits to society.
