Step 1. Check your state's specific lead-testing requirements
Who should be tested?

The Centers for Medicare and Medicaid Services (CMS) currently requires universal screening of Medicaid-covered one- and two-year olds. Children ages 36 to 72 months must also receive a blood-lead test if they have not been previously tested. Some states require universal testing in addition to testing all Medicaid children, while others require universal testing for children residing in zip codes with a large percentage of older housing built before 1978. New York also requires screening of pregnant women.

View a chart of states with additional testing mandates

How do I know whether there are special requirements for blood-lead testing?

The LeadCare II blood-lead test is a CLIA-waived system. All facilities that use the system to perform blood-lead tests must have a CLIA Certificate of Waiver (see Step 2). Some states have additional registration, reporting, or proficiency requirements for users. Please contact your state lead-poisoning-prevention program for the latest regulations and requirements (click on the map to access the CDC's listing of state programs nationwide). If you are in California or New York, you can find additional information by following the menu-bar links on the left of this page.

Take Action!

We can meet the Healthy People goal to eliminate childhood lead poisoning. But we all need to be advocates with city, state, and federal officials to help ensure that every at-risk child has access to rapid blood-lead testing:

State Medicaid plans must ensure that healthcare practitioners receive adequate reimbursement for blood-lead screening and follow-up services
Managed care contracts and state policies should be amended to require plans to offer point-of-care blood-lead testing to at-risk children outside of capitation fee schedules, if necessary
Federally Qualified Health Centers and others that serve low-income children need funding to ensure that all children can receive point-of-care blood-lead testing
Restrictive state regulations governing laboratories, blood-lead testing, and reporting need to be updated to support in-office and community-based testing made possible by the FDA clearance of the CLIA-waived blood-lead-testing device

States that also require testing of non-Medicaid children - at a glance

While we work hard to keep this information up to date, please check directly with your state's lead poisoning prevention program. Use the map to access the CDC's list of programs nationwide. Click on the state name in the chart to visit its lead poisoning prevention program Web site.

State	Testing requirement beyond the Medicaid testing mandate	Comments
Connecticut View requirements	Primary care providers must perform annual blood-lead screening of all children less than three years of age and screen any child between the ages of 36 and 72 months who has not been previously screened.
District of Columbia View requirements	Blood-lead tests must be performed as part of the well-child visit once between the ages of 6-9 months, and a second time between the ages of 22 and 26 months. If a child's age exceeds 26 months, and a blood-lead screening has not been performed, the child shall be screened twice, prior to age six.	DC does not currently recognize the LeadCare II CLIA-waiver designation, and requires all blood-lead testing to go to a laboratory licensed to conduct blood-lead testing. Take Action! Encourage DC to change its lead testing regulations and provide adequate Medicaid reimbursement so that DC children have access to rapid, point-of-care blood-lead testing. Mayor Adrian M. Fenty To provide feedback by phone, dial 311. The Mayor's office can also be reached by mail at: Executive Office of the Mayor, 1350 Pennsylvania Avenue, NW, Suite 316, Washington, DC 20004. Click here to e-mail Dr. Pierre Vigilance Director, Department of Health District of Columbia Department of Health 825 North Capitol Street, NE Suite 4400 Washington, DC 20002 (202) 442-5955
Illinois View requirements	IN HIGH-RISK AREAS (click here) Testing should occur at ages 1 and 2 years. If lead exposure changes, or if a child is new to your practice and you do not know his/her past blood lead levels, blood lead testing at ages 3 through 6 years should also be performed. IN LOW-RISK ZIP CODE AREAS; RISK ASSESSMENT IS REQUIRED, FOLLOWED BY BLOOD LEAD TESTING, AS NECESSARY. Routinely assess risk of exposure to lead sources at office visits of children 6 months through 6 years old by using the Childhood Lead Risk Assessment Questionnaire. A "YES" or "DON'T KNOW" response to any of the questions means that the child has a higher likelihood of exposure to lead contamination and will require you to perform a blood lead test. IN CHICAGO, A BLOOD LEAD TEST IS REQUIRED FOR ALL OF THE CITY'S CHILDREN A blood lead test for children age 3 and younger should be obtained at 6, 12, 18, 24 and 36 months OR at 9, 15, 24 and 36 months. Children 4 through 6 years of age with prior blood lead levels <10 μg/dL should have an annual risk assessment. A blood lead test should be performed if risk increases or if the child exhibits persistent oral behaviors.
Iowa View requirements	All children entering kindergarten are required to have been tested for lead poisoning. The Iowa Department of Public Health recommends that all children be tested for lead poisoning before the age of two.
Kentucky View requirements	Perform a blood-lead test for children 9-12 months of age and again at 24 months of age. Additionally, provide a blood lead test for children who present to the health department between 25 and 72 months of age if they have not previously received a blood lead test. Click here for more information.
Maryland View requirements	All children residing in at-risk areas (click here) must have a blood-lead test at their 12-month and 24-month visit. All children residing in Baltimore City must receive a blood lead test at 12 months and 24 months of age. All children served under the EPSDT program must receive blood lead testing at 12 months and 24 months of age regardless of where they live. A lead exposure risk assessment questionnaire is also required of all children at their 12-month and 24 month visit.	Clinicians who would like to perform in-office lead testing using the LeadCare II system must apply to the Office of Health Care Quality in the Department of Health & Mental Hygiene. Click here for more information. Take Action! Encourage MD to change its lead testing regulations and provide adequate Medicaid reimbursement so that MD children have access to rapid, point-of-care blood-lead testing. John M. Colmers Secretary Department of Health & Mental Hygiene Office of the Secretary 201 West Preston Street 5th Floor Baltimore, MD 21201-2301 410 767-4639 JColmers@dhmh.state.md.us
Massachusetts View requirements	All children shall be screened once between the ages of nine months and 12 months, and again at ages two and three. In addition, children who live in one of the cities and towns at high risk for childhood lead poisoning, need to be screened again at age four. If children have never been screened for lead poisoning, they must be screened at entry to kindergarten. SCREENING OF CHILDREN AT HIGH RISK FOR LEAD POISONING (Click here for a listing) Children shall be screened for lead poisoning more than once a year when they meet one of the high-risk criteria listed below, or whenever in the sound medical judgment of the health care provider they are at high risk of lead poisoning: Living in a pre-1978 home with deteriorated paint or plaster, unless it has been inspected by a lead inspector and found not to contain lead-based paint: At least every six months between the ages of six months and three years, and again at ages four and five. Having siblings or playmates who are lead poisoned: At least every six months between the ages of six months and three years, and again at ages four and five. Living in a pre-1978 home undergoing renovation, unless it has been inspected by a lead inspector and found not to contain lead-based paint or plaster: Within four weeks of the start of the renovation project, once a month thereafter during its duration, and once after its completion.	Practices with fewer than three physicians and a CLIA Certificate of Waiver can perform in-office lead testing using the LeadCare II system. Practices with three or more physicians must be licensed through the state. Click here for more information. Take Action! Encourage MA to add the LeadCare II system to the Massachusetts list of exempt tests. Massachusetts Department of Public Health John Auerbach, Commissioner 250 Washington Street, 2nd Floor Boston, Massachusetts 02108-4619 (617) 624-6000 E-mail: http://www.mass.gov/?pageID=eohhs2terminal&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions&L3=Department+of+Public+Health&sid=Eeohhs2&b=terminalcontent&f=dph_g_feedback_form&csid=Eeohhs2
Michigan View requirements	Children living in the following communities should be tested at 12 and 24 months of age. Children between 25 and 72 months of age need to be tested as soon as possible, if not previously tested. Battle Creek Benton Harbor Dearborn Detroit Flint Grand Rapids Hamtramck Highland Park Jackson Kalamazoo Lansing Muskegon/Muskegon Hts Pontiac Saginaw For other children - the child's parents/guardians should be asked specific exposure questions to determine each child's risk. If the response to any of the exposure questions is "Yes" or "Don't Know," the child should be tested. Click here for a PDF outlining Michigan's guidelines for testing	Click here access specific information regarding LeadCare II testing.
Minnesota View requirements	Child health-care providers should use a blood-lead test to screen children at one and two years of age, and children up to six years of age who have not previously been screened if: The child lives within the city limits of Minneapolis or St. Paul; The child receives services from Minnesota Care (MnCare), the Supplemental Food Program for Women, Infants, and Children (WIC), or Medical Assistance (MA) - which includes the Prepaid Medical Assistance Program (PMAP); The child does not fit the criteria above, and the answer to any of the screening question is "yes" or "don't know" Minnesota also recommends blood-lead tests for pregnant women if they answer "yes" or "don't know" to screening questions. Click here for screening questions and an overview of requirements.
Missouri View requirements	Click here to view Missouri lead testing areas map. Universal Testing - Annual testing for all children less than 6 years of age. Targeted Testing - Annual testing of MO Healthnet children at 12 and 24 months of age and children spending more than 10 hours per week in a Universal Testing area. Annual screening questionnaire, testing based upon a positive response.
New Jersey View requirements	Requires universal screening of children at 12 and 24 months, and any child between ages three and six who has never previously been screened. Any child, six months of age or older, who is exposed to a known or suspected lead hazard should also be screened.	Practices with fewer than five physicians and a CLIA Certificate of Waiver can perform in-office lead testing using the LeadCare II system. Practices with five or more physicians must be licensed through the Clinical Laboratory Improvement Service in the Department of Health and Senior Services. Click here for more information. Take Action! Encourage NJ to change its lead testing regulations and provide adequate Medicaid reimbursement so that NJ children have access to rapid, point-of-care blood-lead testing. Heather Howard, Commissioner NJ Department of Health and Senior Services John Fitch Plaza  PO Box 360  Trenton, NJ 08625  Telephone (609) 292-7837  Fax (609) 292-0053 Click here to e-mail
New York View requirements	The New York State Public Health Law requires all health care providers to test all children for blood lead levels at age 1 and again at age 2. In addition, health care providers are also required to evaluate all children 6 months to 6 years of age each year, as well as women who are pregnant, for risk of lead exposure as part of routine care. Health care providers also are required to test those children and pregnant women found to be at risk for lead exposure.	New York Medicaid began reimbursing for LeadCare II tests on September 1, 2009
Ohio View requirements	Administer two tests at age 1 and 2 years, or up to age 6 years if no test has been administered before (or as medically necessary) based on the following criteria. 1) Is the child on Medicaid? If yes, TEST - IT'S OHIO LAW AND A FEDERAL REQUIREMENT. If no, go to step 2. 2) Does the child live in a High Risk ZIP Code? (contact OCLPPP or visit www.odh.ohio.gov for list) If yes, TEST - IT'S OHIO LAW! If no, go to step 3. 3) Ask the parent five key questions to assess risk. Use the Risk Assessment Questionnaire (If the family answers "yes" or "do not know" to any of the questions, TEST. If the family answers "no," provide anticipatory guidance and follow up at the next visit. Click here for Ohio high-risk zip codes
Pennsylvania View requirements	Obtain blood lead screening tests on all children in Pennsylvania at age one and two years of age. Obtain blood lead screening tests on all children in Pennsylvania at age three to six years in the absence of prior screening information	Pennsylvania does not recognize the LeadCare II CLIA waiver status and requires all blood-lead testing to go to a laboratory licensed to conduct blood-lead testing. See a summary of requirements by clicking here Take Action to encourage PA to change its lead testing regulations so that PA children have access to rapid, point-of-care blood-lead testing. Contact PA Department of Public Health Everette James, Secretary 1-877-PA-HEALTH
Rhode Island View requirements	All children under 6 years of age are required to be screened for lead at least once annually. For children between 9 and 36 months of age: Screen once between 9 and 15 months of age, and, Screen again 12 months later, between 21 and 27 months of age. Click here to download a pamphlet, "Understanding Rhode Island's Lead Poisoning Prevention Law"	Rhode Island requires that all blood-lead testing is performed at the state laboratory. Take Action! Encourage RI to change its lead testing regulations and provide adequate Medicaid reimbursement so that RI children have access to rapid, point-of-care blood-lead testing. Contact David R. Gifford, MD, MPH, director of the Rhode Island Department of Health 3 Capitol Hill Providence RI 02908 Information Line 401-222-5960 E-mail form
Virginia View requirements	Virginia health care providers should test all children up to and including 72 months of age for elevated blood-lead levels according to the following schedule unless they are determined under 12 VAC 5-120-60 to be at low risk for elevated blood-lead levels. 1. Children should be tested at ages one and two years. 2. Children from 36 through 72 months of age should be tested if they have never been tested. 3. Additional testing may be ordered by the health care provider. Click here for a listing of VA high-risk zip codes Click here for a PDF of Virginia screening guidelines Click here for a PDF of Virginia regulations	The use of the LeadCare system must be approved through the Lead-Safe Virginia Program at 804-864-7694 to assure proper quality assurance and reporting of data
Wisconsin View requirements	If the child lives in city of Milwaukee or Racine: Test all children at 12, 18, and 24 months Test any child age 3-5 who has never been tested If enrolled in Medicaid or WIC, continue to test annually until age 6 If the child lives outside the cities of Milwaukee and Racine: Assess for lead exposure by asking the "4 Easy Questions" at every well-child check-up from age 6 months to 5 years: 1. Enrolled in Medicaid or WIC? 2. Live in a building built before 1950? 3. Live in a building with remodeling built before 1978? 4. Have a sibling with lead poisoning? If the answer to any question is "yes" or "I don't know" obtain a blood-lead test at age 1 and 2; Test any child age 3-5 who has never been tested Click here for a PDF regarding Wisconsin screening guidelines	Providers holding a CLIA certificate of waiver or higher complexity CLIA certification level may be reimbursed for on-site blood-lead testing using LeadCare II system if the following guidelines are met: Providers are successfully participating in the proficiency testing (PT) program as administered by the Wisconsin State Lab of Hygiene (WSLH) or another Centers

To purchase a LeadCare II system, call (800) 305.0197

To request details on the LeadCare II test: Doctors click here
Public health click here

Step 1. Check your state's specific lead-testing requirements Who should be tested?

How do I know whether there are special requirements for blood-lead testing?

Take Action!

States that also require testing of non-Medicaid children - at a glance

To purchase a LeadCare II system, call (800) 305.0197

Step 1. Check your state's specific lead-testing requirements
Who should be tested?