Report 2019-105 Recommendation 7 Responses

Report 2019-105: Childhood Lead Levels: Millions of Children in Medi-Cal Have Not Received Required Testing for Lead Poisoning (Release Date: January 2020)

Recommendation #7 To: Public Health, Department of

To offset the cost of mitigating lead exposure in the highest-risk areas of the State, CDPH should seek out and apply for additional lead prevention funding as funding opportunities become available from CDC, the Department of Housing and Urban Development, and CMS. To the extent necessary, CDPH should enter into a memorandum of understanding with DHCS to apply for and obtain this funding

Annual Follow-Up Agency Response From October 2021

CDPH applied for CDC funding (CDC-FRA-EH21-2102: Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children) on May 14, 2021. This grant consists of two components; Component A would enhance blood lead surveillance and improve linkages to recommended services. Component B would pilot targeted, population-based interventions aimed at primary prevention of lead exposure with a focus on community-based approaches for lead hazard elimination in housing. As of August 17, 2021, CDPH has been awarded grant funding by the CDC for Component A.

CDPH applied for HUD funding (FR-6500-N-13: Lead Hazard Reduction Grant Program) on July 9, 2021, which was awarded on August 30, 2021. This grant will provide funding for lead hazard reduction to low-income households in two high-risk areas of the state and increase CLPPB's capacity for primary prevention.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

CDPH has been collaborating with DHCS to identify CMS funding opportunities for lead abatement. CDPH plans to apply for new CDC funding that will become available in February 2021. The funding supports primary and secondary prevention strategies for childhood lead poisoning including: ensuring blood lead testing and reporting, enhancing blood lead surveillance, improving linkages to recommended services, and developing policies for targeted, population-based interventions (https://www.grants.gov/web/grants/view-opportunity.html?oppId=329557).

From April through October of 2020, CDPH posted eight funding opportunities for which local jurisdictions may qualify, including five from HUD. CDPH continues to update its website with and notify local jurisdictions of newly identified grants available to help eligible entities reduce lead hazards (https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/Grants.aspx).

CDPH is currently collaborating with HUD in preparation for applying for a lead hazard reduction grant in 2021.

California State Auditor's Assessment of 1-Year Status: Pending

As CDPH described, its efforts are ongoing and it has not yet applied for funding from any of the agencies we identified in our recommendation.

6-Month Agency Response

CDPH is currently collaborating with DHCS to identify CMS funding opportunities, which could be accessed via an MOU. On March 18, 2020, DHCS indicated that CMS guidance directs that Medicaid funds must be used for direct patient care and could not be used for "broader social or environmental concerns." However, DHCS is currently looking into the possibility of using Medicaid Children's Health Insurance Program (CHIP) Health Service Initiatives (HSIs) for lead abatement.

CDPH prepared an application for a CDC grant (CDC-RFA-EH20-2001) for blood lead surveillance in three high-risk areas. CDC notified CDPH that the Notice of Funding Opportunity was cancelled with COVID cited as the reason. CDPH will continue to apply for CDC funding opportunities as they become available in the future.

CDPH continues to search for lead abatement grant opportunities to abate lead hazards in California. CDPH has posted on its website a list of identified grants available to help eligible entities reduce lead hazards (https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/Grants.aspx). Some of the federal grant offers have recently been removed due to resources directed to COVID-19.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

As CDPH described, its efforts are ongoing and it has not yet obtained funding from any of the agencies we identified in our recommendation.

60-Day Agency Response

On January 16, 2020, the Centers for Disease Control and Prevention (CDC) informed CDPH that their grant funding is not available for lead abatement. Thus, CLPP will research grant opportunities on an ongoing basis to seek out other possible funding opportunities, create a list of these funding opportunities and share with local health jurisdictions (LHJs) on-going. In addition, CDPH will continue to provide technical assistance to LHJs to apply for these additional resources, when applicable.

CDPH will work with DHCS to explore the process of using CMS funds to pay for mitigation of lead exposure and the possibility of a memorandum of understanding to achieve this purpose. CDPH will continue to encourage use of federal Department of Housing and Urban Development (HUD) funding by state and local jurisdictions to abate lead hazards in California.

California State Auditor's Assessment of 60-Day Status: No Action Taken

All Recommendations in 2019-105

Agency responses received are posted verbatim.