January 10, 2023
Dear Colleagues:

The Health Resources and Services Administration (HRSA) and the Centers for Disease Control
and Prevention’s (CDC) National Center for Environmental Health/Agency for Toxic
Substances and Disease Registry (NCEH/ATSDR) would like to share important information
concerning childhood lead poisoning prevention and blood lead testing.

CDC recently established a new blood lead reference value of 3.5 micrograms per deciliter.
This means that CDC now recommends that children with blood lead levels between 3.5 and 5.0
micrograms per deciliter be provided case management to mitigate health effects and remove or
control lead exposure sources, according to state and local provisions. Approximately 500,000
U.S. children between ages one and five have blood lead levels at or above this new reference

Despite an overall decline in blood lead levels in children across the United States, significant
disparities in exposure to lead exist by geographic location and race/ethnicity. Additionally,
children from households with incomes below the federal poverty level are more likely to be
exposed to lead. There are many locations in the United States where large numbers of children
have blood lead levels at or above the blood lead reference value. More information is available
CDC’s Childhood Lead State Surveillance Data webpage. Contributing to this problem,
fewer children received blood lead testing be cause the Coronavirus Disease 2019 (COVID-19)
pandemic disrupted access to care. In some places, as many as two out of three children missed
being tested during the early part of the pandemic.

Children’s blood lead levels should be tested according to the following:

Children enrolled in Medicaid must be tested at 12 months and 24 months.
In addition, children between the ages of 24 and 72 months with no record of a previous
blood lead test should be tested.

All children at higher risk for lead poisoning should be tested according to state and local

Consult your
state or local health department for information on areas at higher risk in your
practice community and local testing guidelines.

HRSA-supported health centers play a key role in preventing lead poisoning by identifying
children at higher risk of lead exposure, testing their blood lead levels, and connecting families
to needed case-management follow-up services. HRSA-funded health centers provided more
than 575,000 lead screenings to children in 2021.

Childhood exposure to lead is preventable. As healthcare providers, you can help by:
Learning about childhood lead exposure and appropriate prevention strategies.
Educating parents/guardians about the ways to prevent children from becoming exposed
to lead.

Following CDC’s Recommended Actions Based on Blood Lead Levels.
Ensuring all Medicaid recipients in your practice are tested for lead according to federal

Ensuring all children at higher risk for lead poisoning are tested.
Ensuring all children with confirmed blood lead levels at or above 3.5 micrograms per
deciliter and their families connect with follow-up services for case management.

This fall and winter, health professionals across the country have been working to increase well-
child visits and routine pediatric immunizations while also encouraging children and families to
receive updated COVID-19 vaccines. We encourage you to increase the number of childhood
lead screenings and to take steps to prevent childhood lead exposure among your patients and
their families.

Thank you for your dedication to keeping the nation’s children healthy.