Lead testing program for kids ready to start

By Stacy Gittleman

After multiple years of testing the municipal water in the beleaguered city of Flint every six months, the United States Environmental Protection Agency (EPA) in May of this year determined that lead levels in Flint’s municipal water consistently measure at three parts per billion (ppb). That matches lead levels in drinking water supplies of Birmingham and Bloomfield Township and is far below the federal actionable levels of 15 ppb or state actionable levels of 12 ppb as of January 2025.

To further improve the safety of drinking water for Michigan’s youngest children, Gov. Gretchen Whitmer in 2023 signed into law the Filter First Program. Managed by the Michigan Department of Environment, Great Lakes and Energy (EGLE), Filter First is a $600 million grant program to replace outdated porcelain drinking fountains with hydration stations that have become a familiar addition in schools and childcare centers. The metal and refrigerated touch-free stations provide cold, filtered water which students and staff can either sip directly from the fountain or refill a water bottle in schools and daycare centers.

EGLE advises schools, daycare centers, and other institutions to limit the number of water fixtures used for drinking and food preparation. If water is unpotable, EGLE provides signage and instructions to let people know not to use the water source for drinking or cooking.

But there remains a larger source for lead exposure than drinking water.

This was also addressed in 2023 with the passage of a law to screen all children under age six for lead exposure.

In October 2023, Whitmer also signed Public Acts 145 and 146 for universal blood lead level (BLL) testing for every child in Michigan at 12 and 24 months and six years of age. State and Oakland County health officials praise the legislation because they say it is the best way to protect children from lead exposure when they are most vulnerable to the heavy metal’s long-term harmful effects on their developing bodies.

The law also provides that test results will be recorded as a permanent part of a child’s immunization record. The law went into effect at doctor’s offices and health clinics in late April of this year. The law also provides funds for lead testing through the Children’s Health Care Access program.

According to the Centers for Disease Control (CDC), lead poisoning is most harmful to human health in children under the age of six. This is because even low levels of lead can damage developing brains and nervous systems, delay cognitive growth, and impair physical development. Exposure to lead can cause problems with learning, behavior, speech, hearing, growth rates, and the development of the nervous system.

On a national scale, blood lead levels are based on the 97th percentile of all tested children ages one to five nationwide, according to a 2007-2010 National Health and Nutrition Examination survey published by the CDC. Two percent of surveyed children nationwide had blood lead levels greater than five micrograms per deciliter.

Nationwide, 1 in 40 children ages 1-5 have unsafe BLLs. The CDC also points to research that concludes over half the U.S. population was exposed to high lead levels in early childhood due to lead in soil, the toys they played with, or the paint used to paint their homes. Even leaded paint lurking beneath layers of newer paint in well-maintained homes can crumble, flake off, and become dust. National statistics say that 40 percent of all housing units contain some lead-based paint. There are still 9.2 million lead service lines providing water across the country, with federal programs expected to replace them all by 2041.

According to state public health officials, Michigan has three million homes built before 1978, and a million of them were built before 1950. Unless they have undergone complete lead remediation, all have some lingering lead dust. This dust then settles to the floor where babies and toddlers spend lots of time crawling, playing and exploring their world with their mouths.

Dr. Natasha Bagdasarian, Michigan’s chief medical executive at the Michigan Department of Health and Human Services (MDHHS) stressed that this legislation package was decades in the making. Its goals and impetus are separate from the Flint Water Crisis which began in April 2014, she added.

“What happened in Flint was an absolute tragedy, but when it comes to looking at testing, we have to separate that story from the reality with which we are still dealing,” Bagdasarian said. “Lead in water is not the primary means by which kids are exposed. We must now put the focus on lead paint and lead dust in housing to achieve our goals. In the conversations I have had, I have been confounded that the focus keeps coming back to Flint. What we need to address is the lead found in layers of old paint and the soil where kids play. That’s the holistic approach. That’s where most kids encounter lead.”

Bagdasarian said early intervention is key when it comes to remediating lead exposure. Overall, she added that the MDHHS is taking a “Maslow's Hierarchy of Needs” approach when it comes to children’s health and well-being. This means prioritizing all angles; starting with proper housing and nutrition and then moving up through other measures such as lead safety and vaccination.

“To me, weighing out factors that lead to healthy children is not an ‘either-or’ prioritization,” Bagdasarian said. “It is everything together. This new law about universal lead testing has been the result of decades of effort. This is the work that needs to continue so long as there are kids who are being exposed to lead. We also need to examine how other contaminants such as forever chemicals are affecting the health of children. We will continue this work so long as funding remains.”

Bagdasarian explained that up until this April, Michigan was only required by the CDC to test targeted populations receiving Medicaid.

“The targeted testing numbers were not giving public health experts, pediatricians and other lead exposure experts the data we needed to catch lead exposure early enough in childhood for all our children,” explained Bagdasarian, who also chairs the state’s Lead Exposure Commission. “Now, universal testing will change the game in terms of preventing and treating lead exposure in children which could lead to a better quality of life that is marked with enhanced physical and intellectual health.”

Bagdasarian said because universal testing only began in late April, the numbers and data are not yet available to discuss. The data collected from the tests will eventually be available to the public in an updated MiTracking online database that contains public health data including targeted lead testing since 2012.

In its March 2023 report to the State Legislature for fiscal years 2021 and 2022, the MDHHS’s Childhood Lead Poisoning Prevention Program stated that a consensus on what was considered an elevated BLL was not reached until 2022. There had been previous years on record when 3.5 micrograms per deciliter was considered elevated. Moving forward, five micrograms or higher is deemed as an actionable level of concern.

According to the report, in FY 2021, the state tested 102,968 children under age six for lead. A total of 2,038 or two percent of tested children had BLLs greater than or equal to five micrograms per deciliter and 500, or .05 percent, had BLLs of over 10 micrograms per deciliter.

In FY 2022, blood lead tests for 100,830 children under age six were reported by laboratories. A total of 2,090 or two percent of tested children had BLLs greater than or equal to five micrograms per and 478, or .05 percent had BLLs of over 10 micrograms per deciliter.

The number of children tested remained relatively constant from FY 2012 - FY 2019.

The program costs $2.9 million each year and half of the funding comes from federal Health and Resources and Services Administration grants.

Children with elevated blood lead may qualify for services provided through the state’s Lead Safe Program. Eligible families based on Medicaid or household income are matched with resources to remediate lead hazards.

As the data from universal testing comes in, state public health officials and healthcare professionals said they will be able to get a better understanding and ability to detect patterns on where pockets of lead contamination exist and be more effective in delivering care and remediation services.

According to MDHHS Public Information Officer Lynn Sutfin, the next steps in the universal testing rollout involve a robust outreach and education campaign directed at county public health officials, individual pediatric and family healthcare providers, and families with young children. These efforts include in-person and online training seminars spearheaded by lead poisoning prevention professionals, lead poisoning prevention staff, and a digital media and mailing campaign.

“It is essential we get the word out to parents and caretakers to talk to their healthcare provider about blood lead testing and things to look out for in a child’s home surroundings,” Sutfin said.

According to the MDHHS, blood lead testing is a preventive health service under the federal Affordable Care Act (ACA). It is covered without additional copayment or coinsurance charges. This includes Medicaid and most private insurers.

Sutfin said some local health departments and programs offer free blood lead testing even for the uninsured. One example is the Wayne State Mobile Unit which offers tests at community events.

“If a child has an elevated blood lead level, it’s important to identify and remove that exposure source so the child’s lead level can be lowered,” said Sutfin. “If a child has a venous confirmed elevated blood lead level, the local health department will reach out to provide in-home nursing case management services to educate the family about nutrition and safe cleaning, conduct a nursing assessment, and connect the family to resources to find and remove lead hazards from the home.”

One medical practice that is welcoming the start of universal lead testing in Washtenaw County is the Corner Health Center in Ypsilanti. The practice focuses on at-risk patients aged 12 to 25 years old and their children. Nearly all its patients receive Medicaid.

"Our patients tend to be at higher risk of environmental pollutants," Wells said. "Kids are always lower to the ground, and pollutants tend to settle downward. Another thing that makes our patients vulnerable is their housing instability. They often move back and forth between counties and Detroit as their families move or lose housing status."

Wells said her practice’s one-stop shopping for care, including check-ups, tests, and day-of lab test results for blood testing means that a parent will not have to take off more work to schedule another appointment to get test results and treatment options.

“We do our best to minimize barriers for patients,” Wells explained. “If a child’s test returns with high lead levels, I can have that counseling and referral for treatment while the patient is still in the room. This approach is crucial for marginalized families with limited resources. I need to give as much care as possible while the patient is with us in the examination room. That way, nothing can slip through the cracks because the patient or their caregiver does not have to schedule another follow-up appointment.”

In Washtenaw County, current rates of high lead exposure are rare. In 2012, 4.8 percent of 2,700 selected children tested for high BLLs. In 2024, elevated BLLs fell to 2.5 percent of 4,700 tested children in the county.

Wells explained when a child tests positive for elevated lead levels, results are reported to the local health department through the Michigan Care Improvement Registry. For acutely high levels, chelation therapy may be prescribed to remove heavy metals from the body.

Wells explained the new lead testing legislation benefits patients by ensuring insurance coverage and promoting early detection.

"(The legislation) gives us the data we need to offer another piece of evidence that can lead to a child’s optimal health," Wells explained, "Though parents can deny testing, universal testing provides healthcare professionals more authority to screen and ensure children are free of lead toxins.”

Wells said the new law is a model example of how public health should function.

“One of the problems with making people understand the importance of funding public health is that people don't see the need for it until there is a problem,” Wells said. “The critical work of public health agencies happens behind the scenes. It is always in the background, quietly investigating potential public health crises, from measles outbreaks to lead exposure. The passing of this legislation sends a simple but powerful message that we need to protect our most vulnerable children from the hazards of lead poisoning one test at a time.”

Public health officials in Oakland County say they are well underway in ramping up their plans to accommodate for an anticipated bump in lead exposure cases as universal testing takes off.

Oakland County Health Officer Kate Guzmán said a highlight of her early career was spearheading the community lead program as a public health nurse. Guzmán said that starting in early January, her department has already had visits or planned visits with over 80 percent of the county’s 145 pediatric offices to educate them about the changes that will be coming to their practices.

Already in Oakland County, Pontiac is classified by the MDHHS as one of 83 “cities of concern” when it comes to lead exposure.

There are no specific numbers on how many children have tested for high BLLs in Pontiac. The state only gives that breakdown for Detroit. However, according to 2020 data from Michigan’s Lead Poisoning Prevention Dashboard, 17,101 children under the age of six in Oakland County were at risk for elevated blood lead levels. In 2024, 433 tested children in Oakland County had elevated blood lead levels.

In cases where children have been found to have elevated blood lead levels, Oakland County offers nursing case management services to families. These services include assessing the child's growth and development, examining the home environment, identifying potential lead hazards, and referring families to social and medical services.

Michelle Allread, Oakland County’s nurse supervisor who oversees the county’s child lead program said her “small but mighty” department is gearing up for an anticipated increase in cases. She heads a staff of two full-time lead nurses, one full-time auxiliary clerk, and two part-time clerks.

To make the public understand the urgency for early testing for all children, she presented the following facts.

“Children who are lead poisoned at an early age are seven times more likely to drop out of high school and six times more likely to enter the criminal justice system,” Allread said. “This is the reality that few people are aware of, including pediatricians and other healthcare providers. Sometimes the urgency is not there because lead poisoning symptoms may present and resemble other illnesses.”

Guzmán said as of April 30 the Oakland County Health and Human Services Department has been informing pediatric and healthcare practices that in-office testing is a simple and reimbursable service under the Affordable Care Act.

“Another message we are trying to communicate to our clients is that they can trust government agency employees who are experts in lead remediation to enter their home,” Guzmán said. “That trust is developed through good communication from the county as well as their healthcare provider. We need families to understand that these workers are here to help you. This is a free service the county can offer that includes a nurse, a registered dietician, and an environmental health professional who can conduct a full home inspection.”

Guzmán said she has always been passionate about being on the lookout for lead exposure in children since the earliest days of her career as a public health pediatric nurse. That is because early intervention changes the entire trajectory of a child’s life.

“Ever since I was 23 and brand new in public health, one of the reasons lead testing as a public health initiative was so compelling to me is because exposure (to lead) plays a large role in continuing the cycle of poverty,” Guzmán said. “Lead poisoning can lead to poor literacy and (impact) high school graduation rates. Preventing this poisoning can be so powerful for a child and their life outcome. It is meaningful and impactful if we can prevent, detect, and treat it.”

One sticking point in the logistics of the rollout is doctor’s offices having access to testing and diagnostic equipment onsite. Ideally, a caregiver would have their child tested and get the results the same day at their pediatrician’s office or healthcare clinic so follow-up treatment could get immediately underway rather than sending the family home with a script to make another appointment at a separate lab.

According to Sutfin at the MDHHS, there is no additional funding to provide lab equipment for lead testing attached to the newly enacted legislation. However, the MDHHS is providing 100 Leadcare II point-of-care machines and test kits to healthcare providers within 82 high-risk areas in the state.

Sutfin said the machines allow for in-office testing with immediate results. If the result comes back as greater than 3.5 micrograms, patients will need another test in a laboratory to confirm the elevated level.

Guzmán said in Oakland County her staff is coordinating grant-seeking efforts with the Neighborhood Housing division to help pay for lead abatement costs for Medicare recipients and others who cannot afford to pay for lead cleanup in their homes.

“As the testing ramps up, the need for services and staffing at the county level will increase dramatically,” said Guzmán. “We will need even more nursing, auxiliary health clerk, and sanitorium power which means more funding. We have a commitment from the Oakland County Executive’s office to use county general funds to supplement our lead team. But we will need more, including federal funding, to match the expected increase in demand for our services.”

Dr. Ehud Kapen is a pediatrician with Southfield Pediatrics with offices in Bingham Farms and Novi. Kapen said because many of his patients receive their insurance through Medicare, his office will not see a great change in the way they practice patient care in lieu of the new testing law.

Kapen said in his office, infants are tested for lead at nine months, which he said is a common timeline followed by many other board-certified pediatricians in Michigan. His practice was petitioning the state to change the milestone marker from 12 to nine months. All testing and lab work are conducted at his practice’s offices so he and his colleagues can offer caregivers of his littlest patients same-day results.

Overall, Kapen said a “minuscule” number of patients have their bloodwork coming back with elevated levels of lead.

Still, he is pleased that the universal testing law has now gone into effect.

“I am all for it,” Kapen said. “The earlier we test and detect high lead levels in our patients, the sooner we can help and treat them. It’s a great piece of legislation.”