Illinois and Ohio this year made children with even low levels of lead in their blood automatically eligible for physical, developmental and other therapies at an earlier age, when those interventions are likely to have the most impact.
Except for Michigan, which adopted a similar policy several years ago, Illinois and Ohio are the first states to make the change, according to the Legal Council for Health Justice, a Chicago-based health advocacy group that pushed for the measure in that state.
The move comes amid growing public concern about lead in drinking water and several high-profile cases of contamination. Just last week in Newark, New Jersey, officials handed out free bottled water to residents because of contamination in the public drinking supply.
Lead poisoning has been associated with lower IQs and academic achievement, impaired speech, hearing and motor skill difficulties, and cognitive and behavioral delays.
Often, such problems don’t emerge until an affected child reaches school age. But child development experts say it’s most effective to intervene before the age of 5.
The new rule in Illinois “is going to allow us to provide help when it matters most,” said Amy Zimmerman, who oversees child health policy at the Legal Council for Health Justice.
The blood lead level that makes children eligible for services in Illinois, Michigan and Ohio is 5 micrograms per deciliter. That aligns them with the latest recommendations from the U.S. Centers for Disease Control and Prevention (CDC), which in 2012 lowered the level that should prompt action — though the agency doesn’t specifically call for the therapies Illinois, Michigan and Ohio are making available — from 10 to 5 micrograms.
The CDC acted despite a steady 40-year decline in the lead levels of American children, from an average of 15 micrograms in the late 1970s to about 1 in 2011-2014, the most recent period for which data is available. That decline is mostly attributable to the introduction of unleaded gasoline and paint and environmental regulations that have removed lead from water, soil and air.
Still, children continue to be exposed to lead in several ways, including through the contamination of drinking water. The most notorious recent case occurred in Flint, Michigan, beginning in 2014, when officials there began drawing drinking water from the Flint River without the required corrosion controls. As a result, lead from the city’s old pipes leached into the water, causing an alarming spike in the blood lead levels of residents. The fallout included criminal charges against state and local officials.
Children also may have elevated lead levels if they live in older homes with lead paint. The CDC says 24 million housing units have deteriorated lead paint and elevated levels of lead-contaminated dust. Young children live in 4 million of those homes.
“To completely isolate a child from lead exposure at this point is not entirely realistic in some areas because it is so ubiquitous,” said Dr. Nicole Hamp, a fellow in developmental and behavioral pediatrics who studies the impact of lead on children at University of Michigan Health Systems.
The CDC has said that no level of lead in the blood is safe for children. Federal law requires that all Medicaid-insured children be screened for lead at 1 and 2 years old. States vary in their requirements for children whose families have private insurance, with more stringent requirements in geographic areas found to have high lead exposures.
In Illinois, the change could result in as many as 2,000 children becoming eligible for early intervention services, according to data collected by the Illinois Department of Public Health.
The services that will be provided are specified in the 1975 federal Individuals with Disabilities Education Act, which requires all states to offer early intervention services for children at risk of developmental delays or disability before they are 3. Early intervention services help infants and toddlers overcome physical, cognitive, communication, and social or emotional development deficits.
The services are paid for by a combination of federal and state sources, including Medicaid, as well as private insurance and out-of-pocket payments by families who can afford it.
Democratic state Rep. Robyn Gabel, who helped lead the legislative effort in Illinois, said providing early intervention services is expected to cost between $3 million and $6 million a year, depending on the number of children who enroll. Ohio has not yet determined how much the change will cost there.
The federal government largely leaves it up to the states to determine which children receive early intervention services. In most of them, children with lead poisoning must first exhibit quantifiable delays in cognition or emotional, social or physical development before they would qualify.
But the University of Michigan’s Hamp said for children exposed to lead, those deficits often don’t emerge until after age 5, “and at that age, we’re already late.” The most effective interventions come earlier, when the brain is most elastic, she said.
“Can you undo the problems caused by lead?” she asked. “The answer is ‘no.’ There is actual damage to the brain but in early childhood there is incredible growth in the brain and the neural circuitry. By getting in early enough, we can give the child the best chance for overcoming the damage.”
Other states also use blood lead levels for determining automatic eligibility for therapy, but at higher levels than the 5-microgram standard Illinois, Michigan and Ohio have adopted. Oregon, Missouri and Wisconsin use 10 micrograms and Iowa and Maryland use 20, according to the Legal Council for Health Justice, which appears to be the only group that tracks standards across the 50 states.
Zimmerman said other states, even some that use blood testing, do not qualify children for early intervention services unless they show developmental deficits, which means waiting until later, by which point they will have aged out of early intervention services.
And waiting, she said, “is nothing but a missed opportunity.”