New Issue Brief Highlights Opportunities for States to Protect Children from Lead

What does Children’s Health Insurance Program (CHIP) funding have to do with lead abatement efforts? As outlined in a new brief released today by SHVS, states have a valuable opportunity to leverage CHIP funding to protect low-income children from lead.

Despite recent headlines, we aren’t confronting the ubiquity of lead in our homes and communities, even though we know that lead exposure is harmful to children as they grow. With rare exceptions like the Flint water crisis, it’s a problem that often remains unseen. The federal government banned lead-based paint in 1978, and public attention shifted to other concerns. But lead in our homes (especially those constructed prior to 1980) and in some water pipes remains and continues to pose a serious hazard for many children. Today more than 4 million families with children live in homes with high levels of lead, and approximately half a million children under the age of five require treatment as a result of exposure.

The pervasiveness of lead often outstrips the resources available to remove it, but this is where CHIP comes in. The program offers state leaders a practical tool to develop and implement health initiatives for low-income children that target lead abatement in particular. Using a state plan amendment (SPA) to propose a health services initiative (HSI), states can draw on an enhanced federal match without a CMS waiver. All of this is explained in the brief, but in short, this is a new avenue states can use to access CHIP funding to support a non-medical intervention to improve children’s health.  Specifically, states need to describe these things to successfully propose an HSI:

• the need for the initiative;
• the timeframe for the initiative;
• the strategy underpinning its proposal;
• the source of state funding; and
• the estimated number of children who will benefit from the initiative

A majority of states are well-positioned to establish their own programs and leverage the opportunities that CHIP provides. Currently, 19 states have approved HSI SPAs for a variety of children’s health initiatives. Of these, Michigan and Maryland have been approved for funding in support of lead initiatives. Michigan has been approved to use approximately $24 million per year for five years on various tactics to ameliorate lead risk. Maryland’s lead-focused HSI SPA advances a two-pronged initiative to expand lead identification and abatement programs for low-income children and to expand county-level programs on environmental assessment and education.

With the health care system in a time of uncertainty, this is an important reminder that states should look to Medicaid as a tool, not just for healthcare delivery, but as a pipeline to improve the social support that low income children and families need to live healthier lives. These programs are also prime examples of how state and federal policymakers are working together to build strong partnerships with social service agencies in a concerted effort to integrate and enhance service delivery, reduce costs, and improve individual and population health.