The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619
KATHLEEN E. WALSH
MAURA T. HEALEY Secretary
Governor
Robert Goldstein, MD, PhD
KIMBERLEY DRISCOLL Commissioner
Lieutenant Governor
Tel: 617-624-6000
www.mass.gov/dph
October 29th, 2024
Steven T. James
House Clerk
State House Room 145
Boston, MA 02133
Michael D. Hurley
Senate Clerk
State House Room 335
Boston, MA 02133
Dear Mr. James,
Pursuant to Section 9 of Chapter 41 of the Acts of 2019, please find enclosed an annual report from
the Department of Public Health on the Massachusetts Childhood Lead Poisoning Prevention Program
(CLPPP).
Sincerely,
Robert Goldstein, MD, PhD
Commissioner
Department of Public Health
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 Revenues and Expenditures
Title
from the Massachusetts
Childhood Lead Poisoning
Prevention Program (CLPPP)
Trust Fund
January 2024
Date
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 I. Legislative Mandate
The following report is hereby issued pursuant to Section 9 of Chapter 41 of the Acts of 2019 as follows:
Not later than October 1, the commissioner shall provide an annual report to the joint committee on public
health and the senate and house committees on ways and means providing a description and accounting of the
revenue credited to the fund and expenditures made from the fund.
II. Executive Summary
The Massachusetts Childhood Lead Poisoning Prevention Program (CLPPP) within the Department of
Public Health (DPH) was established to implement the Massachusetts Lead Law (MGL c. 111, §§ 189A-
199B, “Lead Law”). The Lead Law is one of the most comprehensive statutes in the country to ensure the
prevention, screening, diagnosis, and treatment of lead poisoning. Under this law, CLPPP is required to
provide services to children who are identified with lead poisoning through clinical case management
services and environmental code enforcement where that child resides, including mandatory lead
inspections, lead abatement activities, and court enforcement, if necessary.
CLPPP activities are funded through a combination of federal grants, state budget appropriations, and
surcharges deposited into the Childhood Lead Poisoning Prevention Trust Fund account (“Lead Trust”).
To comply with Lead Law mandates and to ensure that lead poisoned children receive timely services to
reduce their blood lead levels, CLPPP requires approximately $7 million annually. In FY23, CLPPP
received an estimated $1.2 million in federal grants, $2.7 million in state budget appropriations into the
Lead Trust, and $3.1 million in surcharge revenue deposited into the Lead Trust. In addition to the $1.2
million CLPPP expended from the federal grant, an amount of $4,951,000 was expended from the Lead
Trust to support CLPPP’s work, including lead inspections and code enforcement for lead-poisoned
children, deployment of an enhanced online portal with resources for the public, and a database for blood
lead screening, environmental data, and case management. At fully staffed capacity, CLPPP will require
approximately $5.8 million annually from the Lead Trust.
Childhood Lead Poisoning Prevention Program Highlights
• Massachusetts is one of the few states to require homes to be free from lead hazards regardless of
ownership or a child’s blood lead level. To support property owners to meet this requirement, CLPPP
trains, licenses, and monitors private sector lead inspectors, who conduct an average of 8,000
inspections annually.
• Massachusetts has the highest percentage of children who are screened for lead in their blood in the
country and was one of the first states to publish lead screening data reports and to use its data to
evaluate community-specific needs. DPH identifies communities with a higher risk of lead poisoning
to better target resources to vulnerable children and to reduce health disparities and racial inequities
associated with lead exposure.
5
From 2017-2020, the number of seriously poisoned children (25 µg/dL or greater) 1 in Massachusetts
dropped by 26% when CLPPP changed its regulations in 2017 to allow for state interventions and
services at lower blood lead levels. This rapid decrease demonstrates the effectiveness of CLPPP’s efforts
to identify lead-exposed children and to intervene more quickly to protect children from continued risk.
At 70%, lead screening rates continued to improve in 2022, almost back to the 2019 pre-pandemic level
of 72% and up from 68% in 2021 and 62% in 2020.
III. Introduction
The Massachusetts Lead Law (MGL c. 111, §§ 189A-199B) established universal screening (blood lead
tests) for childhood lead poisoning and requires landlords and homeowners to eliminate sources of lead in
dwellings where children under the age of six years reside, regardless of a child’s blood lead level or
whether a property is rented or is owner-occupied. The statute also created the Childhood Lead Poisoning
Prevention Program within DPH to implement its directives. CLPPP is a statewide program for the
prevention, screening, diagnosis, and treatment of lead poisoning, and is charged with the elimination of
sources of such poisoning through research, educational, epidemiologic, enforcement, and clinical
activities.
Childhood lead exposure is a serious public health issue with significant health implications. Exposing a
child to even small amounts of lead can cause severe and irreversible damage to mental and physical
development. 2 Numerous studies have documented correlations between childhood lead poisoning and
future school performance, unemployment, crime, violence, and incarceration. 3 Despite substantial gains
made over 45 years of public health and healthcare interventions, lead exposure remains a significant
health risk for children in Massachusetts.
When children are identified with lead poisoning in Massachusetts, the source of the exposure is most
often the ingestion of dust or soil that is contaminated by loose or deteriorated lead paint, frequently on
windows and exteriors, or disturbed by unsafe home renovation work. 4 For this reason, age of housing
stock is important when considering the risk of childhood lead poisoning. Massachusetts has some of the
country’s oldest housing stock, with approximately 67% of housing stock built before 1978. 5 Historically,
lead paint accounted for approximately 95% of all lead poisoning cases in Massachusetts. In more recent
years exposure from alternative sources such as spices and herbal remedies has increased..
1
The amount of lead found in a blood sample is measured in micrograms of lead per deciliter of blood (µg/dL).
2
See Lanphear, BP, “The Conquest of Lead Poisoning: A Pyrrhic Victory,” Environmental Health Perspectives, Oct
2007, A484–A485.
3
See, e.g., Brown, MJ. “Costs and Benefits of Enforcing Housing Policies to Prevent Childhood Lead Poisoning.”
Medical Decision Making, 2002, 22:482-492; Gould, E. “Childhood Lead Poisoning: Conservative Estimates of the
Social and Economic Benefits of Lead Hazard Control.” Environmental Health Perspectives, 117(7):1162-1167;
Reyes, Jessica, “Environmental Policy as Social Policy? The Impact of Childhood Lead Exposure on
Crime.” National Bureau of Economic Research, May 2007. Available at http://www.nber.org/papers/w13097.
4
In 2017, 88% of childhood lead poisoning cases were caused by exposure to lead paint. Alternative sources such as
spices or herbal remedies accounted for 9% of cases.
5
U.S. Census Bureau. (2018). Year structure built (Table B25034), 2013-2017 American Community Survey 5-year
estimates. Available from: data.census.gov.
6
While lead continues to affect children in all communities across the state, lead exposure
disproportionately impacts gateway and lower income communities, making lead exposure a critical
health equity issue. In Massachusetts, children living in low-income communities are 3.6 times more
likely to have elevated blood lead levels than children living in high-income communities; multi-race
children are 3.6 times more likely than white children to have dangerous levels of lead in their blood; and
black children are nearly 1.6 times more likely to have lead poisoning than white children.
IV. CLPPP Funding Structure
Historically, CLPPP’s programmatic activities have been primarily funded from the Lead Trust and two
Federal grants. The Lead Trust receives surcharges from the licensure or certification of certain
professionals including mortgage lenders, insurance brokers, real estate agents, and private lead
inspectors. The surcharge amounts were established in 1993 and have not been increased since.
In December 2017, DPH amended its regulation under the Lead Law to lower the legal definition of lead
poisoning from 25 µg/dL to 10 µg/dL. 6,7 Defining lead poisoning at levels of 10 µg/dL broadened
protections for children and increased the number of lead-safe homes; it also led to a resource shortage for
CLPPP. Consequently, the number of cases of children identified with dangerous levels of lead
dramatically increased and created a backlog of CLPPP case management services for families, including
inspections of homes to identify lead hazards. To address this risk area and ensure that CLPPP can
adequately enforce the Lead Law and protect children from lead exposure, the legislature approved
Governor Baker’s request of an additional $2.7 million for the Lead Trust as an annual investment for
CLPPP beginning in FY20.
V. FY23 Lead Trust Revenues and Expenditures
The breakdown of revenues and expenditures for the Lead Trust are summarized below.
TABLE A – Surcharge Revenues:
The table below shows surcharge revenues collected by CLPPP by payee type for FY23.
FY 23 Surcharge Amount # of Payees Amount Collected
Banks/Mortgage $100 1,078 $107,800
Lenders
Insurance Brokers $25 83,541 $2,088,525
Real Estate Agents $25 34,819 $870,475
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The amended regulations also created a Blood Lead Level of Concern of a venous blood lead level from 5-9
µg/dL. Consistent with CDC best practices for children at this BLL, CLPPP developed a service delivery plan to
extend voluntary lead exposure prevention and inspection services to families with children identified with BLLs of
5-9µg/dL and enhanced outreach to health professionals on the importance of lead screening and management of
BLLs 5-9µg/dL.
7
The definition of lead poisoning is a legal definition which triggers mandatory activities by CLPPP that include
code enforcement investigation and correction of identified lead violations.
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 Lead Abatement $25 1,020 $25,500
Contractors
Lead Inspectors $25 78 $1,950
TOTAL $3,094,250
TABLE B – Total Revenues:
The table below shows the total revenues deposited into the Lead Trust for FY 23:
FY 23 Amount Collected
Surcharge Revenue $3,094,250
Budget Investment $2,700,000
TOTAL $5,794,250
TABLE C – Expenditures from the Lead Trust:
The following provides a breakdown of CLPPP’s FY23 expenditures from the Lead Trust and projected
expenses for FY24. The expenditures for FY23 more accurately reflect spending levels necessary for full
staffing and operation of CLPPP, as described in the footnotes below.
Expense FY23 FY24 (Projected)
Salaries $1,980,237 $2,322,406
Fringe and Indirect $1,004,603 $1,270,064
Database management, equipment, and $270,260 $280,0001
maintenance
Workplace Modernization Project $151,911 $290,0002
Legal $143,504 $175,0003
Travel, office supplies, IT equipment, $1,400,130 $1,470,800
testing equipment, and space and
utilities
TOTAL $4,950,645 $5,808,270
1
CLPPP anticipates additional costs for program enhancements such as database management, equipment upgrades
and replacements in FY24.
2
The workplace modernization project for digitizing paper records has been progressing in phases and expected to
be completed in FY24.
3
CLPPP anticipates increased support for Special Assistants to the Attorney General to help address complaint
investigations and agency administrative/ licensing actions.
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 VI. Programmatic Updates
Continued support of the Lead Trust is critical to fund initiatives to identify lead-exposed children and
investigate their homes, and to implement wide-scale prevention efforts among those most at risk for
potential lifelong ill-effects of lead poisoning. CLPPP’s challenges and responses, supported by the
legislative investment in the Lead Trust, are described below.
Staffing:
In FY23, CLPPP, like other areas of public health, experienced higher than normal rates of staff turnover,
and retirements including the loss of experienced code enforcement lead inspectors. These positions
require significant training as well as a lengthy apprenticeship before staff can manage their own
poisoned child caseload. To address these vacancies and increased training and oversight demands,
CLPPP promoted staff to Acting Deputy and Acting Director positions, including promotion of an
experienced staff person to assist with data extraction and management from the updated CLPPP
application CLPPP leadership continued focus on hiring and training new field inspectors as well as
bolstering local capacity with health departments. CLPPP continues to prepare for the anticipated
retirements of several code enforcement inspectors in the coming years.
Surveillance - Screening and Prevalence Rates:
The prevalence of lead poisoning, a venous blood lead level (BLL) ≥10 µg/dL, remained the same in
calendar year 2022 as in 2021, at 2.8% per 1,000 children with 449 children between 9 months to less
than 4 years of age identified as lead poisoned; the prevalence of children estimated to have a BLL ≥5
µg/dL increased slightly from 13.1 per 1,000 children in 2021 to 13.4 per 1,000 children in 2022 with a
total of 1,780 children. Increases in the prevalence of lead poisoning observed since the pandemic have
been disproportionately seen among high-risk communities identified in 2022, which make up 57% of
cases in 2022. At 70%, lead screening rates continued to improve in 2022, almost back to the 2019 pre-
pandemic level of 72% and up from 68% in 2021 and 62% in 2020.
In 2020, CLPPP first published data comparing rural and urban geographies and observed the most
substantial disparities among a subset of rural communities that are the least densely populated, most
remote, and most isolated from urban core areas, defined by the DPH Office of Rural Health as rural level
2 communities. In 2022, the screening rate in these most rural areas of the state decreased slightly to 49%
from 52% in 2021, substantially lower than the state’s overall screening rate of 70%. The prevalence of
blood lead levels ≥5 µg/dL in these areas remained double that of the state as a whole, though there was a
decrease to 26 per 1,000 children in 2022 down from 32 per 1,000 children in 2021 and 2020.
To address increased lead poisoning rates and reduced screening, CLPPP has continued to conduct
outreach in communities and with providers about the importance of screening and re-screening children
through its primary prevention program. Using this data, in FY 23 CLPPP engaged with the Montachusett
Public Health Network Area (MPHN)- Fitchburg, Leominster, Gardner, Athol, Clinton, Hubbardston,
Phillipston, Princeton, Royalston, Sterling, Templeton, Westminster and Winchendon, which provides
shared health services to communities in the North-Central rural cluster. Through this partnership, CLPPP
launched a pilot project in early FY 24 that included expanded outreach with medical providers, code
enforcement training with local health departments, as well as home visiting services for families with
blood lead levels between 3.5-9.9 µg/dL.
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Case Management and Primary Prevention:
Under CLPPP regulations, a blood lead level of concern is defined as a venous blood lead level from 5 to
<10 µg/dL. In October 2021, the CDC lowered the blood lead reference value from 5 µg/dL to 3.5 µg/dL.
In response, CLPPP conducted preliminary analysis to understand the potential impact of lowering this
definition to align with CDC’s updated reference value. Massachusetts saw a total of 3,122 children aged
9-47 months with blood lead level test results between 3.5 and 4.9 µg/dL, but more than half were
capillary test results which are unreliable at this low range. While capillary testing is a useful screening
tool, venous follow-up testing