LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 7012 NOTE PREPARED: Jan 3, 2020
BILL NUMBER: SB 286 BILL AMENDED:
SUBJECT: Lead Poisoning Prevention.
FIRST AUTHOR: Sen. Breaux BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: X GENERAL IMPACT: State & Local
X DEDICATED
X FEDERAL
Summary of Legislation: Definitions: The bill defines "elevated blood lead level" for purposes of the
Health Law and the Education Law as a blood lead level of at least five micrograms of lead per deciliter of
whole blood. The bill also defines "lead poisoning" for purposes of the Health Law.
It defines "dwelling unit lead hazard" for purposes of the Property Law as:
(1) the presence of lead-based paint on a wall of a dwelling unit;
(2) the presence of lead-contaminated soil outside a dwelling unit; or
(3) the presence of lead in the drinking water system of a dwelling unit.
Blood Level Testing - School Corporations: The bill provides that the governing body of a school corporation
shall require all students who initially enroll in a school of the school corporation to be tested for an elevated
blood lead level. It provides that a student may not be allowed to initially enroll unless the student has been
tested and documentation of the test, including the test result, is provided to the school corporation.
The bill requires the Indiana State Department of Health (ISDH) to adopt rules establishing requirements for
the testing of individuals for an elevated blood lead level, and to amend those rules when necessary to ensure
that the rules appropriately reflect and are consistent with the ongoing guidance of the federal Centers for
Disease Control and Prevention.
It provides that a physician, registered nurse, or health care facility, agency, or program that receives a test
result indicating that a child has an elevated blood lead level shall:
(1) notify the child's parent or guardian in writing of the test result;
(2) provide the parent or guardian with a plain language explanation of the significance of
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 lead poisoning; and
(3) take appropriate measures to ensure that any other child under six years of age living in
the same household is tested for an elevated blood lead level.
Dwelling Rental: This bill prohibits renting a dwelling unit to a tenant family that includes a child not more
than six years of age if the dwelling unit is subject to a dwelling unit lead hazard. It provides that a landlord
who knowingly or intentionally:
(1) violates the prohibition;
(2) represents to a tenant family that the tenant family may waive the prohibition;
(3) misrepresents the age of a member of a tenant family to conceal a violation of the
prohibition; or
(4) induces a member of a tenant family to misrepresent the age of another member of the
tenant family to conceal a violation of the prohibition;
commits a Class C misdemeanor.
Effective Date: July 1, 2020.
Explanation of State Expenditures: The bill will increase workload for the ISDH Blood Lead Laboratory
which provides sampling supplies and testing for Medicaid and non-Medicaid individuals.
State Medicaid costs for additional testing of children so that all children are tested before entering school
will increase. Treatment costs of Medicaid children with elevated blood lead levels will also increase given
the change in the blood level standard. Any increase in treatment costs will depend on the services required.
Additional Information - ISDH’s Blood Lead Laboratory provides sampling supplies, and also bills Medicaid
and private insurance for the blood lead tests. A federal grant pays the chemists who perform the analyses
and the testing equipment was paid for by a CDC grant. The average Medicaid reimbursement for a blood
lead test in FY 2019 was $9.
Children enrolled in Medicaid or Children’s Health Insurance Plan are to have blood lead screening tests
between 9 and 12 months of age, and again at 24 months of age. Children at high-risk of lead contamination
are to have three screenings. Children between 36 and 72 months of age must receive a blood lead screening
if they have not been previously tested for lead poisoning. In 2018, the ISDH reported the number of
screenings as 68,868, an increase of 68.7% since FY 2014. The CDC reports that in Indiana, 9.8% of all
children under 72 months have been tested for lead blood levels. ISDH reports that approximately 21% of
Medicaid-enrolled children receive the required tests prior to being 24 months of age.
The state requires providers to report the results of testing not more than one week after completing an
evaluation. The FSSA provides guidance and reminders of these policies in its provider newsletters. ISDH
indicates that the low rate of testing is due to providers failing to report tests completed.
The federal Medicaid program recognizes 5 micrograms per deciliter as threshold at which action must be
taken. This aligns with CDC recommendations as well. The bill would align Indiana with these standards.
Explanation of State Revenues: Blood Tests and Treatment: To the extent health insurers increase
premiums as a result of increased testing or treatment, this bill could increase revenue to the General Fund
from increases in insurance premium tax or adjusted gross income (AGI) tax collections. Additionally, any
increase in spending within Medicaid and CHIP will result in additional federal matching funds to partially
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offset these costs.
Dwelling Rental: If additional court cases occur and fines are collected, revenue to both the Common School
Fund (from fines) and the state General Fund (from court fees) would increase. The maximum fine for a
Class C misdemeanor is $500. However, any additional revenue would likely be small.
Additional Information - Domestic health insurers have the option to pay taxes on insurance premiums
written in the state or to pay the AGI Tax. Foreign insurers are required to pay taxes on premiums written
in the state, and some foreign insurers are assessed additional retaliatory taxes. In these cases, the minimum
tax rate would be 1.3% of written premiums. Revenue received from the AGI and Insurance Premium Tax
is deposited in the General Fund. For FY 2019, the insurance premium tax generated approximately $251.6
M in revenue.
Medicaid medical services will matched by the effective federal match rate (FMAP) in Indiana at
approximately 66% for FFY 2020. Indiana receives an enhanced FMAP of 88% for CHIP in FFY 2020. The
CHIP FMAP is expected to decrease to 76% for FFY 2021. Administrative expenditures with certain
exceptions are matched at the federal rate of 50%.
Explanation of Local Expenditures: Blood Level Testing - School Corporations: School corporations that
do not already require blood lead testing will incur additional costs to review records of registering students
under the age of 6. Costs will vary across the state yet could be significant for some schools.
Dwelling Rental: A Class C misdemeanor is punishable by up to 60 days in jail.
Explanation of Local Revenues: Dwelling Rental: If additional court actions occur and a guilty verdict is
entered, local governments would receive revenue from court fees. However, any change in revenue would
likely be small.
State Agencies Affected: ISDH, Medicaid.
Local Agencies Affected: Schools, trial courts, local law enforcement agencies.
Information Sources: CDC, CBLS National Table updated April 26, 2019; Medicaid Claims and Encounter
Database, accessed on January 2, 2020; FSSA, Monthly Enrollment by Age Group and Health Program, June
2019; http://provider.indianamedicaid.com/ihcp/Banners/BR201640.pdf;
https://www.cdc.gov/nceh/lead/data/national.htm;
https://www.in.gov/isdh/files/2018%20Lead%20Report.pdf; https://www.in.gov/fssa/ompp/4881.htm.
Fiscal Analyst: Karen Rossen, 317-234-2106.
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Statutes affected:
1. Introduced Senate Bill (S): 16-18-2-106.6, 16-41-39.4-1, 20-34-3-11