North Carolina child lead testing coverage by Medicaid providers 1998-2006

Background: In 1998, the Health Care Financing Administration (HCFA) tightened its policy requiring Medicaid providers to test all Medicaid children at ages 12 and 24 months, during routine Health Check (EPSDT) visits, for lead. A study of 1998-1999 North Carolina lead testing rates of Medicaid children showed that a large percentage of providers failed to comply with the policy. The present study calculates testing rates across NC Medicaid providers from 1998 through 2006 to examine annual improvements in testing rates. The study also examines rates by provider specialty to identify provider types that continue to fail to comply with policy.

Methods: 1998-2006 NC Medicaid claim records were linked to NC lab records to determine lead test match rates. Testing rates for one and two years-olds were examined by year and by provider.

Results: There were 123,080 children identified with Health Check visits in 2006 between the ages 9-35 months. Of these, 56.8 percent were tested for lead. Providers showed small or no increases in provider rates from 1998-2006. Among providers, health departments tested 80.1 percent of children ages 9-35 months and private providers tested 54.9 percent.

Conclusion: Initial increases in lead testing rates following the 1998 HCFA policy were short lived. Although overall rate increases were small, rates for health department providers were much higher than private providers. Private providers may benefit from individual provider report cards that show performance rate.