Letter to Ms. Elizabeth Connolly and Ms. Cathleen Bennett - Answers from State on Hurricane Sandy Lead Testing Program

Letter

Dear Ms. Connolly:

We are writing to request information regarding the New Jersey Department of Health's (NJ DOH) provision of lead poisoning screenings for pregnant women, children, and uninsured adults in the nine counties impacted by Hurricane Sandy, pursuant to funding received under the Disaster Relief Appropriations Act of 2013 ("Hurricane Sandy Supplemental"). According to documents submitted to the U.S. Department of Health and Human Services (HHS), NJ DOH has tested only a fraction of the individuals the State originally planned to test back in 2013. The significant gap between the number of individuals tested and the number of individuals the State had planned to test raises questions about the efficiency and management of this program, and whether federal funds are truly being optimized to address the significant threat of lead poisoning raised by Hurricane Sandy.

Following the January 2013 passage of the Hurricane Sandy Supplemental, the New Jersey Department of Human Services (NJ DHS) received supplemental funding through the Social Services Block Grant (SSBG) from the HHS Administration on Children and Families (ACF), in the amount of $226.7 million. SSBG supplemental funds are intended to help Sandy-affected states provide a range of social services related to the disaster, such as child welfare services, case management, and mental health services. As a requirement of receiving funding, states were required to submit a SSBG Supplemental Funds pre-expenditure report and Intended Use Plan that outlined how the state planned to use available funding.

According to the Intended Use Plan submitted by the NJ DHS in May of 2013, $11.7 million of the SSBG supplemental funds were originally earmarked for increasing access to blood lead screening and case management to address "new environmental hazards in New Jersey Homes" created by Hurricane Sandy. Additionally, according to the plan, "[f]or high-risk residents living in the nine most impacted counties by Superstorm Sandy, 220,000 blood lead screenings yearly will be performed by LeadCare II pilot project agencies with children under 6 years, pregnant women, and uninsured adults."[1]

However, according to the NJ DOH--the agency implementing the program--only 14,150 individuals had been tested for lead poisoning as of December 2015.[2] This number includes roughly 5,000 people in Monmouth County, 3,320 in Essex County, 3,000 in Hudson County, and 1,300 in Ocean County.[3]

It appears that the program experienced significant delays and administrative difficulties getting off the ground, and that the state has made the decision to reallocate a significant portion of the $11.7 million to other priorities. According to documents submitted to HHS by NJ DHS, the state requested a waiver so that it could expend SSBG funds beyond September 30, 2015.[4] Supporting documentation reveals that NJ DOH did not purchase blood lead analyzers until August 2014, and grantees did not even begin blood lead testing until September 2014--nearly two years after Hurricane Sandy occurred and at least a year after New Jersey received the supplemental funds.[5] Indeed, according to the State's Annual Report on Childhood Lead Poisoning, lead testing rates for children in affected counties actually declined in the year following Hurricane Sandy, from 43.0 percent to 40.4 percent.[6]

Additionally, it appears that the state has lowered the overall amount of funding allocated to this program, from $11.7 million in the original Intended Use Plan, to approximately $5 million.[7] According to HHS, NJ DOH provided the following explanation for the reduced funding:

"Funding was reduced to reflect the shortened project period and reduction in projected expenditures. Administrative approvals and increased oversight and monitoring resulted in an initial delay starting this project. Accordingly, the project period was adjusted which required less personnel costs and supplies, including blood analyzers and testing kits. It's important to recognize that a bulk of the funding was allocated for the testing kits; more so, a reduction in the project period also limited the amount of time people had to receive testing. This resulted in a $10/person surplus of funding for anyone no longer forecasted to be tested. Once the project was finally underway, and we began to receive data from our grantees, we were able to refine our projections and proactively reallocate surplus funds back to the Department of Human Services to use in other recovery projects."[8]

I am deeply concerned by these delays and have serious questions regarding the State's leadership and commitment to ensuring that vulnerable children and adults affected by Hurricane Sandy are tested for lead exposure and provided with appropriate follow-up services. Lead exposure can cause serious damage to the heart, kidneys, reproductive system, and brain.[9] Lead exposure is particularly harmful to the developing brains and nervous systems of young children--even low levels of exposure are associated with irreversible neurologic damage and behavioral disorders.[10] According to the Agency for Toxic Substances & Disease Registry, the elimination half-life for lead in the blood is approximately 28 to 36 days.[11] The longer that members of the targeted population go unscreened, the more their blood lead levels may drop and adverse exposure to lead could go undetected.

Hurricane Sandy occurred in October 2012--the more time that passes, the more the potential for effective detection declines. I am greatly concerned about the length of time it has taken for the State to establish a testing program, and the shortfall between the target of 220,000 screenings per year and the actual number of children and vulnerable adults screened to date.

To assist in our inquiry, I ask that you provide the following information by March 31, 2016:

Please provide all documents and communications relating to the SSBG supplemental funds, including any and all correspondence with HHS, waiver requests, expenditure plans, post-expenditure reports, and Quarterly Progress reports.

Please provide the precise number of children under 6 years, pregnant women, and uninsured adults that have received yearly blood lead screenings under the SSBG lead screening and case management program to date, broken down by county.

How many individuals within the targeted population screened for lead exposure exhibited elevated blood lead levels? What case management and follow-up services did they receive?

How many individuals does the state project that it will be able to screen by the end of the grant term (September 2017)?

How much grant funding has the state spent on the SSBG lead screening and case management program to date? Please provide supporting documentation demonstrating a cost breakdown (e.g. personnel, testing supplies, case management).

Please provide a written explanation for the reduction in the budget for the SSBG program for blood lead screening and case management from $11.7 million down to less than $5 million.

Did the state revise its annual screening goal in light of the reduced funding and delays in starting the program? If so, please provide all documents and communications related to this decision, including any analyses conducted to assess the need for ongoing lead testing.

Was the unused money returned to HHS, or reallocated to other Hurricane Sandy-related spending priorities? If it was reallocated, please provide an explanation of where the funding was reallocated, and provide supporting documentation.

Please explain the delay between the State receiving funds and the start of the lead testing program. The state's response to HHS asserts that "[a]dministrative approvals and increased oversight and monitoring resulted in an initial delay starting this project." Please elaborate on the nature of these administrative delays.

When was the State first able to draw down the SSBG supplemental funds?

When did the State actually begin to draw down and spend SSBG supplemental funds?

Please provide a written explanation for the discrepancy between the NJ DHS's stated goal of annually screening 220,000 individuals impacted by Hurricane Sandy for lead exposure, and the 14,150 individuals who have actually been screened by NJ DOH and its grantees as of December 2015.

Please provide all documents and communications pertaining to the state's original goal of screening 220,000 individuals annually, including any analyses of the potential population-wide lead exposure due to Hurricane Sandy, and any other assumptions underlying the 220,000 figure.
Thank you for your prompt attention to this matter.

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