Scientific studies have repeatedly shown that childhood lead poisoning is a major, preventable environmental health problem that disproportionately affects low-income children of color. In an effort to address this public health issue, the federal Medicaid Act requires state Medicaid programs to screen all Medicaid-eligible children under the age of six for lead poisoning and to provide treatment to those who are lead burdened. In New Jersey, where the percentage of children known to be suffering from this problem is almost four times the national average, the state's Medicaid agency is not providing low-income children with the lead screening or treatment services to which they are legally entitled.
Using the threat of litigation, the ACLU and a group of local advocates have persuaded the state to pilot various remedial measures in the township of Irvington and Camden City to increase screening rates and improve the quality of corrective treatment. According to the New Jersey Department of Human Services, only one-third of Medicaid-enrolled children under the age of six residing in Irvington and Camden City have ever been tested for lead. Yet, 17% of those Medicaid-enrolled children screened in Irvington are lead burdened and 5% of those screened in Camden City are lead burdened.
While there are many barriers to screening, the pilot project has focused on two: parental unawareness of the dangers of childhood lead poisoning and the need for lead testing; and the fact that many health care providers do not perform lead blood screens in their offices, but refer children to off-site laboratories for lead tests. Many families do not travel to the off-site laboratories because of time constraints, lack of transportation, or the laboratories' inconvenient locations.
To address the first issue, maternal and child health care nurses, WIC staff and day care providers are being trained to educate parents and caretakers, face-to-face, about the dangers of childhood lead poisoning and to actively encourage them to have their children tested. Prior educational efforts by mail have not been particularly successful.
To date, the ACLU and local advocates have sponsored roughly 10 training sessions for approximately 200 family day care providers and 130 day care centers. We have hosted special training sessions for day care nurses and day care family outreach workers. We have distributed to the day care staff over 6,000 individual packets of educational materials for parents and caretakers. We will continue to work with local unified child care agencies and health departments to ensure that parents and caretakers are educated.
To address the second barrier, all doctors in Irvington and Camden City who do not already screen Medicaid-enrolled children in their offices are being asked to do so using the filter paper method of testing. We want to ensure that every unscreened child who goes to a pediatrician for whatever reason does not leave the provider's office without receiving a screen.
The ACLU is working with the state's five Medicaid HMOs to reach the doctors. The state Medicaid agency now requires HMOs to pay providers additional compensation for each lead screen performed on-site. Provider representatives from the HMOs have contacted every provider in the pilot cities to explain the pilot, the filter paper method of testing and the fact that additional compensation is available. All providers have received letters from the New Jersey chapter of the American Academy of Pediatrics, the state Department of Health and the state Medicaid agency urging them to participate in the project. We are now in the process of identifying individual providers in the pilot areas who are not doing on-site screening and will target them for special educational efforts.
We will begin to evaluate the effects of the project in June 2003. If we are successful in increasing lead screening rates, the state Medicaid agency has promised to implement the reforms discussed above state wide.