Office of Legislative Services
State House Annex
P.O. Box 068
Trenton, New Jersey 08625
Legislative Budget and Finance Office
Phone (609) 847-3105
Fax (609) 777-2442
www.njleg.state.nj.us
LEGISLATIVE FISCAL ESTIMATE
[First Reprint]
SENATE, No. 1507
STATE OF NEW JERSEY
220th LEGISLATURE
DATED: NOVEMBER 3, 2022
SUMMARY
Synopsis: Revises and codifies schedule for childhood lead screenings; requires
lead screenings as precondition of child's initial entry into school
system.
Type of Impact: Annual increase in State expenditures, annual increase in State
revenues, potential increase in local government costs.
Agencies Affected: Department of Human Services, Department of Education, local health
departments.
Office of Legislative Services Estimate
Fiscal Impact Annual
State Cost Increase Indeterminate
State Revenue Increase Indeterminate
Potential Local Cost Increase Indeterminate
The Office of Legislative Services (OLS) concludes that the State Medicaid program,
commonly known as NJ FamilyCare, will incur an indeterminate increase in annual
expenditures under the bill in order to provide one additional lead screening test for all children
prior to enrollment in school. Since the majority of NJ FamilyCare beneficiaries are enrolled
in managed care, and provider reimbursement rates negotiated by the NJ FamilyCare managed
care organizations are proprietary information, State costs to provide the additional blood tests
are uncertain.
To the extent that the federal government provides matching funds for qualifying State
Medicaid expenditures, State revenues will also increase by an indeterminate amount from
federal reimbursements.
Any increase in the number of children undergoing lead screenings will almost certainly
increase costs for local boards of health, which provide case management services for children
with elevated blood lead levels and their families. Because the number of children who will FE to S1507 [1R]
2
be referred to a local board of health for case management services is unpredictable, the fiscal
impact on local governments cannot be estimated.
BILL DESCRIPTION
This bill amends current State requirements for childhood lead screening by: (1) codifying the
Department of Health’s existing schedule for required childhood lead screening; (2) increasing the
number of required childhood lead screening tests from two to three, with the third screening test
to be conducted immediately prior to the child’s enrollment in school; and (3) requiring a child’s
parent or guardian to provide the child’s school with documentation showing the child’s lead
screening results, as a precondition of the child’s initial entry into the school system. Existing
State regulations require primary care providers to screen a child for elevated blood lead levels at
the ages of 12 months and again at 24 months. Primary care providers are also currently required
to conduct a lead screening for a child under the age of six years, who has not previously been
tested.
Pursuant to the bill, the department will develop an educational outreach campaign to inform
parents and guardians, as well as health care providers, about the updated lead screening schedule
and conditions for initial school enrollment. The bill additionally requires the department to update
its existing lead screening public information campaign to reflect the requirements established
pursuant to the bill. Any information disseminated through the public information and educational
outreach campaigns is to be publicly posted on the department’s website.
The bill clarifies that any departmental regulations concerning the provision of insurance
coverage for childhood lead screenings are to be consistent with the revisions to the State’s lead
screening laws adopted under the bill.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS concludes that the State will incur an indeterminate annual increase in expenditures
under the bill, due to the requirement that all young children undergo one additional lead screening
test prior to enrollment in a pre-kindergarten class or a kindergarten class. Pursuant to current law,
most private insurers and the NJ FamilyCare program cover the cost of required lead screening
tests with no cost sharing. As such, the NJ FamilyCare program costs would increase in order to
provide one additional lead screening test for all enrolled children under the age of six years.
Because greater than 95 percent of NJ FamilyCare beneficiaries are enrolled in managed care, and
provider reimbursement rates negotiated by the NJ FamilyCare managed care organizations are
proprietary information, the additional costs accruing to the State under the bill cannot be
incorporated into this analysis. To the extent that the federal government provides matching funds
for qualifying State Medicaid expenditures, State revenues will also increase by an indeterminate
amount from federal reimbursements.
For context, the Department of Health’s Childhood Lead Exposure in New Jersey Annual
Report shows that 139,596 children, or 21.4 percent of children under the age of six years in the FE to S1507 [1R]
3
State, were screened for lead during FY 2020. However, this rate is likely somewhat low given
the temporary moratorium on non-essential in-person medical care put in place toward the end of
FY 2020 during the COVID-19 pandemic. Of the children undergoing lead screening tests in FY
2020, 2.1 percent had elevated blood lead levels.
Any increase in the number of required childhood lead screening tests will almost certainly
increase the number of test results showing elevated blood lead levels among young children.
According to guidance published by the department, families without health insurance may access
childhood lead screenings at their local department of health. Moreover, departmental regulations
stipulate that local boards of health are responsible for providing case management services for
children with confirmed elevated blood lead levels. Case management services provided by local
boards of health may include, but are not limited to: referrals for medical evaluation and care,
monitoring blood lead retesting, providing caregiver education and counseling, and arranging for
lead screening for siblings. Because the number of children who may be referred to a local board
of health for case management services, and the specific services that a child may require, is
unknown, this analysis cannot quantify the increased costs that local boards of health will likely
incur under the bill.
The Department of Health will incur marginal costs to update its existing lead screening public
information campaign to inform parents, guardians, and health care providers about the revised
lead screening schedule and requirements. The OLS assumes that the department will utilize the
materials from the public information campaign to implement the public educational outreach
campaign established under the bill.
Finally, the Department of Education will realize marginal additional costs to update its
regulations to incorporate the revised childhood lead screening schedule for children entering
school beginning with the 2024-2025 school year.
As of October 28, 2021, the Centers for Disease Control and Prevention revised its elevated
blood lead level downward from 5 micrograms per deciliter to 3.5 micrograms per deciliter. Lead
screening of children consists of two components: (1) a verbal risk assessment, done by a primary
care provider during each of a child’s well visits between the ages of six months and six years; and
(2) a capillary or venous blood test conducted at the ages of 12 months and 24 months. If the blood
tests reveal an elevated blood lead level, the child will be retested. If the second test also shows
that a child has an elevated blood lead level, the child will be referred for follow-up medical care
and the child’s family will receive case management services from the local board of health.
Section: Human Services
Analyst: Anne Cappabianca
Associate Fiscal Analyst
Approved: Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the
failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).