Missouri bill eliminates mandatory childhood lead testing in hopes of increasing access • Missouri Independent

From left, a lead pipe, a corroded steel pipe, and a lead pipe treated with protective orthophosphate (Photo courtesy Environmental Protection Agency).

Doctors would no longer be required to test young children living in high-risk areas for lead poisoning under a Missouri House bill heard in committee Tuesday.

But supporters of the bill, including the Missouri chapter of the American Academy of Pediatrics, say the legislation would increase access to lead testing and education and streamline requirements for doctors in Missouri.

"We all want unleaded children," Rep. Kent Haden, R-Mexico, said in a House Children and Families Committee hearing Tuesday. He said the bill would make lead poisoning prevention "less obtrusive" while still accomplishing the goal of reducing lead poisoning.

Haden is sponsoring a bill he said was suggested to him by the Missouri Department of Health and Senior Services to clean up and clarify the state's requirements around lead poisoning. As home to the Old Lead Belt, Missouri has a history of childhood lead poisoning. Thousands of Missouri children test with elevated levels of lead in their blood each year.

Lead is a dangerous neurotoxin that is unsafe at any level. Elevated blood lead levels can reduce IQ and cause behavioral problems. Later in life, it can increase the risk of cardiovascular disease mortality.

In high doses, lead is fatal. Women in the 19th Century used lead pills to induce abortions.

Childhood lead poisoning has dropped precipitously since lead was banned from gasoline, new pipes and paint. But the U.S. has not historically mandated eradication of existing paint and pipes, so it can linger in homes built before the 1980s.

Currently, Missouri requires that all children living or spending more than 10 hours per week in high risk areas be tested for lead poisoning. Children who aren't in high risk areas are evaluated based on a questionnaire and given a blood test if they are found to be at risk based on other factors.

Known to be toxic for a century, lead still poisons thousands of Midwestern kids

The bill would do away with the mandatory testing and instead require that all children be evaluated based on a questionnaire. If they are thought to be high risk based on the questionnaire, they would be tested if their guardians consented.

It would also do away with a goal of testing 75% of children receiving Medicaid. The bill would require that health care providers educate parents and guardians of all children under the age of four about lead hazards and give them the option to have their children tested.

Under the initial version of the bill, the Department of Health and Senior Services, which receives reports when children are found to have elevated blood lead levels, would no longer have to inform local health departments. But Haden said DHSS and the committee are working on a substitute bill to change that.

Local health departments offer services that can include case management, lead inspections and retesting.

Haden said in an interview Wednesday that the mandatory testing requirement hadn't been effective and that a more streamlined approach — while voluntary — would lead to more testing.

"It is insidious," Haden said of lead, "so we have to always be on guard for it."

The bill had support from the Missouri chapter of the American Academy of Pediatrics. The group's lobbyist, Garrett Webb, said the current testing scheme relies on physicians to know which ZIP codes may have high concentrations of lead.

Physicians may not realize that even affluent areas, like the St. Louis suburb Ladue, can have high concentrations of lead because of historic homes, he said.

The Missouri Department of Health and Senior Services has maps on its website identifying high risk areas where it currently requires that all children be tested. Ladue is one of them.

Ben Terrell, legislative director for the Missouri Department of Health and Senior Services, said the current testing requirements are difficult to follow. The bill, he said, makes it more straightforward.

Katie Gamble, a lobbyist for the Missouri Center for Public Health Excellence, said the group supports "increased access to both education on lead poisoning and testing."

Gamble said the organization was concerned about doing away with the requirement that DHSS inform local health agencies of elevated blood lead tests. Once that is fixed as Haden has promised, her client will support the bill.

This story has been updated since it first published.

by Allison Kite, Missouri Independent March 1, 2023

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Allison Kite is a data reporter for The Missouri Independent and Kansas Reflector, with a focus on energy, the environment and agriculture. A graduate of the University of Kansas, she previously covered City Hall for The Kansas City Star, as well as state government in both Topeka and Jefferson City.