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E-M:/ state ducks lead poisoning issue

Enviro-Mich message from Dave Dempsey <davemec@voyager.net>

Last year, MEC worked with children's advocates to insert an amendment to
state law requiring the Department of Community Health to annually report
on the level of blood lead screening among young children in Michigan and
to make recommendations on how to improve that screening.  A few weeks ago
DCH delivered the first, and disappointing report.  Below is an analysis.


	A report recently submitted to Michigan legislators on screening of
children for lead poisoning fails to fulfill a legislative mandate to
recommend ways to further protect kids from both immediate and lifelong
health effects.  It also engages in spin control rather than providing a
full picture of a problem plaguing thousands of our children.

	Last year, the Legislature ordered the Department of Community Health to
report annually on the number of children age 6 or under screened for lead
poisoning in the state, while also recommending methods for improving
compliance with federal blood lead screening guidelines, including
necessary legislation or appropriations.

	The first report from the Department, due January 1, 1999, was transmitted
in mid-April.  

	Sprinkled with misleading statistics and assertions, the report does not
fulfill the legislative mandate to provide recommendations on how to
improve the state's deplorably low rate of blood lead screening for at-risk
kids.  It simply catalogues existing efforts.  The Department should be
ordered to go back to the drawing board.

	The Department's positive spin on this chronic problem includes:

	*   Misleading commentary on the performance of local health departments
and managed health care plans in providing blood lead screening as part of
the Medicaid Early, Periodic, Screening, Diagnosis and Testing (EPSDT)
program.  While performance by local health departments in providing blood
lead screening as part of EPSDT needed improvement, there is every
indication that it has deteriorated further as children moved into managed
care in the mid-1990s.

	*  A failure to report the full picture on children with elevated blood
lead levels. The report says that while only 31% of the Michigan children
who should have been tested actually received a blood lead test in 1997-98,
this level is "considerably above the Medicaid national average of 19%
reported by CDC."  But the 1998 legislation called for reporting the number
of all children under age 6, not just those from Medicaid-eligible
families,  who had been screened for lead.  The actual percentage of all
Michigan children age 6 and under tested for lead is an estimated 8%.

	*  A chart at the end of the report also may mislead readers.  It simply
reports the number of children confirmed as lead-poisoned in Michigan -
6,600 in 1997-98.  Because of the lack of adequate screening, most of the
estimated 40,000 children in Michigan with elevated blood lead levels are
neither screened nor confirmed.
	At a minimum, the following recommendations should be required of the
Department of Community Health as means to achieve increased blood lead
testing of children:

 Require all managed care providers of service to Medicaid clients to test
children for blood lead status at specified intervals, and require
providers to report the percentage of children tested each year.
 Set progressively higher goals of screening compliance each year (as has
been done with immunization rates), and utilize the same reward/sanction
criteria as for immunization.
 Provide Medicaid reimbursement to public health agencies that complete a
blood lead test for a child who has not been tested at a specified interval
by the managed care provider, again as is done for immunization.
Alternatively, the managed care providers could be required to pay the
public health agency from their capitation.
 Closely monitor statistics for blood lead tests, and report at least
annually on the number and percentage of children tested at the
HCFA-specified intervals.

The report is a whitewash designed to make Department programs look good,
and not a serious effort to improve detection of children with elevated
blood lead levels and to prevent childhood lead poisoning.  Our children
deserve better.

Dave Dempsey
Policy Director
Michigan Environmental Council
119 Pere Marquette, Suite 2A
Lansing, MI 48912
517-487-9541 (fax)

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