At a glance
CDC supports Maine and other state and local health departments, or their bona fide agents, through cooperative agreements to support childhood lead poisoning prevention activities. Read about the program's successes.
About the program
The State of Maine received $515,000 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 Maine, contact the program below.
Maine Department of Health and Human Services
Division of Environmental Health
221 State St
Augusta, ME 04330
Phone: 207-287-4311
Note:
Success story: funding year 3
Maine makes blood lead testing a required quality measure under Medicaid alternative payment model
Challenge
Maine children enrolled in Medicaid are twice as likely to be identified with lead poisoning compared to those not enrolled in Medicaid. Despite this disparity and state and federal requirements to conduct blood lead testing of children enrolled in Medicaid at ages 1 and 2 years, testing rates of Maine children enrolled in Medicaid have remained relatively low. In 2021, 56% of 1-year-old children and 43% of 2-year-old children enrolled in Maine's Medicaid insurance program were tested for blood lead; testing rates for Medicaid-enrolled children have remained about the same since 2017.
Intervention
In 2019, Maine's Department of Health and Human Services made improving blood lead testing a department-wide child health priority. As part of this effort, Maine's Childhood Lead Poisoning Prevention Program (CLPPP) and Maine's Office of MaineCare Services (i.e., the office that administers Medicaid) expanded their long-time collaboration to identify and implement new initiatives aimed at increasing blood lead testing among children enrolled in Medicaid. As a result of the department-wide focus on lead testing, and with the support of Maine's CLPPP, the Office of MaineCare Services made blood lead testing a required performance measure under a new Alternative Payment Model for primary care services. The Office of MaineCare Services launched the new model in July 2022 and began data collection and monitoring of blood lead testing in 2023.
The new model, called Primary Care Plus (PCPlus), emphasizes primary care quality and incentivizes providers to improve testing, screenings, and immunizations, including blood lead testing for children enrolled in Medicaid. PCPlus replaced three older primary care initiatives with a model that offers more flexibility to providers in return for greater accountability and care delivery expectations; PCPlus includes over 225 primary care practices in Maine.
Impact
Under the new program, payments to providers will increase or decrease based on their performance on a set of performance measures, including blood lead testing. Once enough data are available to analyze, Maine's CLPPP and the Office of MaineCare Services will identify and learn from high-performing provider practices and offer technical support to providers with lower lead testing rates.
Funding for this work was made possible in part by NUE2EH001453 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Success story: funding year 2
Maine gains ability to analyze lead testing and exposure data by race and ethnicity
Challenge
Approximately 60% of blood lead test records reported to the Maine Department of Health and Human Services’ Childhood Lead Poisoning Prevention Unit (CLPPU) include information on race, and 53% have information on ethnicity. Lack of completeness for these variables has limited Maine CLPPU’s ability to analyze data about blood lead testing and blood lead levels (BLLs) by race and ethnicity to determine the extent of disparities.
Intervention
To close these data gaps, Maine CLPPU conducted a pilot data-linkage project during March 2022 to match blood lead test data to Maine’s birth certificate and immunization registry data. After matching to birth certificates, the percentage of blood lead test records with race and ethnicity information was about 95% and 90% complete, respectively. Matching to the immunization registry also produced more complete data for race and ethnicity, but the matching rates were lower (90% and 80%, respectively). Based on the successful pilot data linkage project, Maine CLPPU linked its blood lead test data in 2022 for children born in the years 2015–2018 to Maine’s birth certificate data to obtain missing race and ethnicity information. They then analyzed blood lead testing and blood lead levels by race and ethnicity for children born in these years.
Impact
Maine CLPPU is continuing to refine and solicit input on its analyses. However, preliminary findings suggest these analyses will provide useful information about testing and blood lead levels that Maine CLPPU and its partners can use to launch prevention initiatives and track changes in disparities over time.
Funding for this work was made possible in part by NUE2EH001453 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
Maine eases reporting burden by achieving electronic blood lead test reporting goal
Intervention
CLPPU initiated a collaboration with Maine’s Immunization Program to develop a Blood Lead Module within its web-based immunization registry. One of several improvements included in the Blood Lead Module is a user interface for providers to report in-office blood lead tests electronically. In early 2019, providers who conducted in-office testing began using the module for electronic reporting of in-office blood lead test results.
Impact
As of October 2019, CLPPU trained nearly all provider offices that conduct in-office blood lead tests on using the Blood Lead Module to electronically report test results. As a result, CLPPU reduced the amount of time spent entering in-office test results by more than 80%, from over 400 hours annually to about 70 hours annually. In-office testing also increased during this time from 3,630 in-office tests completed from January to December 2018 to 3,863 tests completed from January to October 2019.
Funding for this work was made possible in part by EH17-1701 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.