Updated child blood lead action level

Washington State Health Care Authority sent this bulletin at 01/29/2026 08:05 AM PST

January 29, 2026

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Child blood lead action level lowered to 3.5 µg/dL

This bulletin is being sent by the Health Care Authority (HCA) on behalf of the Department of Health (DOH).

The Washington State Department of Health (DOH) is lowering the state blood lead action level to 3.5 micrograms per deciliter (µg/dL) beginning February 5.

There is no safe blood lead level. Lowering the action level allows for earlier identification of children with elevated blood lead levels and earlier intervention to prevent further exposure. A blood lead level of 3.5 µg/dL is higher than more than 97% of U.S. children under age 6.

Providers play an important role in identifying children with elevated blood lead levels. Even low levels of exposure can be harmful to a child’s development and young children are particularly vulnerable to the damaging effects of lead exposure.

Updated DOH guidance

DOH recommends testing all children, including those not served by Apple Health (Medicaid), who have risk factors outlined in the clinical algorithm.

DOH guidance:

Health care providers should begin follow-up and confirmatory testing starting at 3.5 µg/dL.
Local health jurisdictions (LHJ) may also begin providing follow-up services at 3.5 µg/dL, depending on local resources and capacity.

Reporting requirements for laboratories remain the same.

Medicaid lead testing requirements

Federal Medicaid requirements mandate blood lead testing for:

Medicaid-enrolled children at 12 and 24 months of age, or
At least once before 72 months if no record of a prior test exists.

A screening or risk questionnaire does not meet this requirement.

Washington's low testing rates

Washington state is falling short of the Medicaid testing mandate.

Only 26% of Apple Health-enrolled children were tested at least once between age 1 and 6.
In 2024, only 31.3% of Apple Health-enrolled children received at least one blood lead test before their second birthday. Washington was over 25 percentage points behind the national median of 68.3% for this measure.

Visit the blood lead testing information webpage

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.