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For Healthcare Providers

Healthcare provider wearing gloves to perform a blood lead test on a young boy
Department of Health and Human Services

For Healthcare Providers

IMPORTANT UPDATES

New requirements for blood lead testing of young children: By law, Michigan now requires blood lead testing for all children at 12 months and 24 months of age and at other intervals based on exposure risk. This approach is commonly called “universal blood lead testing”. It is the physician’s responsibility to test or order the test.

The law updates the Public Health Code, adding MCL 333.5474d and amending MCL 333 9206(1). Administrative rules (R 330.301-304) for implementation of the law were made official on April 30, 2025.   

For more information go to:

 

BLOOD LEAD REFERENCE VALUE UPDATE

On October 28, 2021, The Centers for Disease Control and Prevention (CDC) updated the blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL (MMWR 2021). As of May 1, 2022, State of Michigan Medicaid policy will align with this update (MDHHS Health and Aging Services Administration Bulletin 22-11). The blood lead reference value is based on the 97.5th percentile of the blood lead distribution in U.S. children ages 1-5 years from the National Health and Nutrition Examination Survey.

No level of lead in the blood is safe, and MDHHS welcomes the update of the BLRV for clinical management and public health response for children with lead exposure.  As outlined in updated guidance from the CDC, American Academy of Pediatrics, and the Pediatric Environmental Health Specialty Units, health care providers should begin providing follow-up testing and other recommended actions for children with BLL ≥ 3.5 µg/dL. 

Blood Lead Reference Value Resources 

WHO NEEDS A BLOOD LEAD TEST?

  • Michigan now requires blood lead testing of all young children at specified ages and with selected lead exposure risk factors. The requirements include:
    • It is the physician's responsibility to test or order the test.
    • Children must be tested at 12 months and 24 months of age or by 72 months of age (age 6) if there is no record of a previous test.
    • Children must also be tested as follows:
      • Between 48 to 60 months of age (age 4) if they live in one of the 82 cities and townships designated by MDHHS as high risk. Visit Additional Blood Lead Testing for High-Risk Jurisdictions to view the complete list of areas listed in the administrative rules.
      • At least once between their most recent test and age 72 months if they are at high risk because they live in a home:
        • Build before 1978 or
        • Where other children with elevated blood lead levels live.
      • Within three months of when a physician or parent determines that they are at high risk. Risk factors to consider are described at MDHHS Quick Reference Guide for Providers.
  • Testing requirements do not apply if the parent/guardian objects to the test.
  • Physicians must ensure that the child's blood lead test results are included in the child's immunization certificate.
  • Children who are refugees ages 6 months through 16 years. CDC recommends a blood lead test within 90 days of arrival in the US.
    • Retest after 3-6 months for refugee children < 6 years (Immigrant, Refugee, and Migrant Health (CDC.gov)).
Blood lead test tube laying on paperwork indicating lead present

Important notes on blood lead testing:  

  • Blood lead tests via capillary sampling are for screening only, all elevated capillary samples require venous confirmatory testing. 
  • At a blood lead level of 45 µg/dL or greater, any treatment should be performed in consultation with Michigan’s Poison Control Center. Hospitalization and/or chelation should be considered. Other children who may have also been exposed should be tested. The family should NOT return to the lead-contaminated home. 

Michigan Care Improvement Registry (MCIR)

The Blood Lead Module is a component of a patient's MCIR record. If the patient has had a blood lead test, the results will be displayed in the record, as well as how to interpret the results with corresponding recommended actions.

Provider Resources

Pediatric Blood Lead Level Quick Reference for Primary Care Providers

Lead and Your Health - Educational Resources

Childhood Lead Poisoning Prevention (CLPPP) Learning Module - CE available

MDHHS CLPPP Policy on Definition of Elevated Blood Lead Test Result

MDHHS MiTracking - Michigan Environmental Public Health Tracking

Childhood Blood Lead Testing: Michigan Data Briefs for Health Care Providers

Blood Lead Testing - Impact of COVID-19 (04/2021)

Blood Lead Testing - Update on Impact of COVID-19 (03/2022)

Childhood Blood Lead Testing in Michigan - Data Brief for Health Care Providers (12/2022)

Patient Resources

MDHHS Lead and Health Resources

Adult Exposure to Lead 

Pregnant and Nursing Persons Factsheet  

Lead Poisoning: Know The Facts 

Other Agency Resources for Health Care Providers

Centers for Disease Control and Prevention Childhood Lead Poisoning Prevention Program (CDC.gov)

American Academy of Pediatrics; Lead Exposure (AAP.org)

The Pediatric Environmental Health Specialty Units (PEHSU) Management of Childhood Lead Exposure

 

Important notes on blood lead testing:  

  • Blood lead tests via capillary sampling are for screening only, all elevated capillary samples require venous confirmatory testing. 
  • At a blood lead level of 45 µg/dL or greater, any treatment should be performed in consultation with Michigan’s Poison Control Center. Hospitalization and/or chelation should be considered. Other children who may have also been exposed should be tested. The family should NOT return to the lead-contaminated home. 

Michigan Care Improvement Registry (MCIR)

The Blood Lead Module is a component of a patient's MCIR record. If the patient has had a blood lead test, the results will be displayed in the record, as well as how to interpret the results with corresponding recommended actions.