Nebraska

It’s estimated that one-third of Nebraska’s housing stock was built before 1978 and contains lead-based paint. Low-income and minority children are particularly at risk for lead exposure and lead poisoning, as they are more likely to live in older housing. Early identification of lead-exposed children and prompt linkages to supportive services are critical to reducing lead poisoning’s detrimental effects. Case management for lead-exposed children is key to monitoring compliance with blood lead testing, medical follow-up, medical treatment, and referral to early intervention services. While the Nebraska Department of Health and Human Services has collaborative arrangements with local health departments across the state to provide follow-up for lead-exposed children, some children need more intensive clinical case management above the local health department’s capacity.

Nebraska has a robust Medicaid-managed care system encompassing a statewide network of case management teams among three managed care organizations (MCOs). Upon confirmation that all parties adhere to HIPAA regulations, the Nebraska Childhood Lead Poisoning Prevention Program (NeCLPPP) collaborated with the Division of Medicaid and Long-Term Care (MLTC) to access the N-Focus application, which houses Medicaid enrollment data for the state. With access to this information, NeCLPPP and MLTC developed the following protocol for medical case management referral for children enrolled in an MCO plan: 

Step 1: Using Nebraska’s Blood Lead Surveillance System, NeCLPPP identifies children eligible for case management based on a confirmed venous blood lead level (BLL) of ≥5 μg/dL or several elevated capillary blood lead tests of ≥5 μg/dL with no confirmatory venous testing. NeCLPPP checks in N-Focus to see if that child is enrolled in Medicaid.

Step 2: If the child is enrolled in Medicaid, NeCLPPP notifies MLTC staff members, who forward a referral to the case management team of the MCO serving that child.

Step 3: The MCO reports the status of the referrals back to MLTC and NeCLPPP every month.

Within the first five months of initiating this protocol, 21 children received intensive clinical case management services who otherwise would not have had access. Because NeCLPPP’s collaborative and resourceful protocol builds upon existing services of the MCOs, the impact gained from these services came at no additional cost. As the work of NeCLPPP continues to promote BLL testing in vulnerable low-income and minority populations, this protocol will be invaluable for linking children with identified elevated BLLs to these needed services.