Wisconsin

About the program

The State of Wisconsin received $665,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in the third funding year. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2023, to September 29, 2024.

The strategies focus on:

• Ensuring blood lead testing and reporting
• Enhancing blood lead surveillance
• Improving linkages to recommended services

To learn more about these efforts in Wisconsin, contact the program below.

Wisconsin Department of Health Services

Wisconsin Childhood Lead Poisoning Prevention Program

1 W Wilson Street, Room 651

Madison, WI 53701

Phone: 608-266-5817

Success story: funding year 2

Using provider testing reports to improve Wisconsin blood lead testing for children enrolled in Medicaid

Challenge

Blood lead testing for children enrolled in Medicaid programs in Wisconsin decreased from 50% before 2020 to 38% in 2020. The federal Medicaid program requires blood lead testing of all children enrolled in Medicaid at 12 and 24 months of age or at least once from 24–72-months of age if not previously tested. Despite this requirement, only 61% of one-year-olds, 39% of 2-year-olds, and 7% of previously untested 24- through 72-month olds received the required testing in 2020. In 2022, testing was still below pre-pandemic levels (in 2022, 63%, 42% and 10% of 1-, 2-, and 24- through 72-month old children, respectively, were tested).

Intervention

The Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) linked Medicaid enrollment and billing data to WCLPPP blood lead testing data to identify children who had not received the Medicaid-required testing. In the fall of 2021, WCLPPP and Wisconsin Medicaid collaboratively designed and distributed provider testing reports to primary care providers to improve their testing and reporting of children enrolled in Medicaid. Reports were sent to 3,182 healthcare providers who had seen at least 5 children enrolled in Medicaid in 2020. The reports included 2020 data on the number of children enrolled in Medicaid seen by the healthcare provider, the number tested, the overall healthcare provider testing rate, and comparison data for the top-performing healthcare providers in the state. Each report also included names of any pediatric patients seen for other reasons in 2020 who had never had a blood lead test (29,327 total statewide). WCLPPP also shared the data with several health systems, local health departments, and a local advocacy group (the Coalition on Lead Emergency [COLE] in Milwaukee, Wisconsin).

Impact

Distribution of healthcare provider reports improved blood lead testing and reporting in Wisconsin. After reviewing the list of children who were not tested, 46 healthcare providers contacted WCLPPP with information on 48 previously unreported tests, and gaps in reporting were identified. WCLPPP personnel collected provider feedback on the reports and discussed solutions to barriers to testing, state reporting, and meeting Medicaid testing requirements. Some healthcare providers reported contacting families of children who were not tested to schedule appointments for blood lead tests. An additional 22% (n=6,558) of the previously untested children were tested for blood lead from Fall 2021 (when the reports were sent) to Fall 2022. COLE used WCLPPP's provider testing rate data to identify providers with the highest blood lead testing rates. The group then reached out to these healthcare providers about how they were able to maintain their high testing rates despite challenges. In 2022, COLE created a report of "stellar" healthcare provider practices, and they plan to distribute this list to healthcare providers interested in improving their childhood blood lead testing rates.

Funding for this work was made possible in part by [6NUE2EH001467-01-01] from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Leveraging Medicaid funding for lead-related interventions in Wisconsin

Challenge

In Wisconsin, most local health departments (LHDs) were not seeking Medicaid reimbursement for lead-related activities because reimbursement rates were historically low and only provided for children with very high blood lead levels (BLLs).

Intervention

Between 2017 and 2018, the Wisconsin Childhood Lead Poisoning Prevention Program supported the development of new policies to financially support LHDs conducting lead-related services. Under the new policy, LHDs were reimbursed for several lead-related services for children enrolled in Medicaid. Key elements of the new reimbursement policy include:

• Services being reimbursed for children with a BLL as low as 5 µg/dL (capillary or venous).
• Prior authorization from Medicaid no longer being required before submitting a reimbursement claim.
• Field representatives are available to assist LHDs with billing questions.
• The reimbursement rate for nurse education visits is $100/hour (the previous reimbursement was $27/hour), and LHDs can bill for multiple visits.
• The reimbursement rate for the initial environmental investigation of a home is $800 (the previous reimbursement was $105), and LHDs can bill for investigations of two residences in cases of shared custody.
• The reimbursement rate for a follow-up lead investigation is $300 (the previous reimbursement was $50), and the LHD can bill for additional follow-up investigations until the property passes clearance.

Impact

• Five additional LHDs billed Medicaid for lead-related services.
• Compared with 2017, LHDs received $53,000 in additional Medicaid reimbursement for lead investigations and $5000 in additional Medicaid reimbursement for nurse education visits in 2018.

Funding for this work was made possible in part by NUE2EH001384 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.