Regional Disparities in Lead Testing Among Medicaid-Eligible Children in Alaska

BACKGROUND: Federal Medicaid guidelines require that all children enrolled in Medicaid receive blood lead screening tests at ages 12 months and 24 months or between 24 and 72 months if not previously tested. While the lead screening rate is low in Alaska, large variations in screening rates are hypothesized across the state by area. Quantifying screening rates by area will inform efforts to increase testing and remove barriers to testing in areas with previously low lead screening rates.

METHODS: The population of Medicaid-eligible children (MEC) under 72 months of age in each borough and unorganized census area of Alaska was estimated from U.S. Census figures. Lead screening test data for Medicaid-enrolled children from 2011 to 2015 were obtained from Medicaid billing codes. Screening rates among MEC were calculated by borough and unorganized census area for any MEC who were under 72 months of age during 2011-2015.

RESULTS: Lead screening rates among MEC under 72 months of age ranged from under 1% to about 13% by borough and unorganized census area, with a median of 4% for the years 2011 to 2015. Less than 1% of MEC received the required two tests at ages 12 and 24 months in each area.

CONCLUSIONS: Lead screening among MEC in Alaska varies widely by area. Screening rates are low in most areas of the state. Stakeholders describe barriers to screening in these areas such as low public knowledge of lead risk, lack of access to health care, a perception of low lead risk, and competing health priorities among clinicians in the state. This study is limited by the use of only Medicaid data to represent the MEC population, which may underrepresent screening, and differential Medicaid enrollment by region. The Divisions of Public Health and Health Care Services in the Alaska Department of Health and Social Services intend to collaborate to raise awareness about lead exposure and associated risks, remove barriers to testing, and increase testing among children in Alaska.