Federal support for state and local response operations - PHE

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The Federal Response: This Week in Flint

The federal government is working with the community of Flint to help it recover from the recent water crisis. The federal government is taking action to improve environmental quality, health, human services and nutrition in response to the crisis. Find out how the U.S. government is mobilizing its the capabilities and resources as part of response and recovery activities. Learn More >>

Flint, Michigan, Water Contamination Crisis

February 17, 2016

Federal agencies continue to support state and city officials in responding to the Flint, Michigan, water crisis. Since this problem is primarily a public health crisis, the U.S. Department of Health and Human Services (HHS) was designated the lead federal agency responsible for coordinating the federal response and recovery efforts.

This means that HHS is working across the federal partners from across the U.S. government to mobilize the capabilities and resources of existing programs. Federal agency partners include: the Federal Emergency Management Agency, the Environmental Protection Agency, Small Business Administration, Department of Housing and Urban Development, Department of Education, and the Department of Agriculture.

These agencies are supporting the state and city in:

identifying the size and scope of the problem and
making and executing a plan to mitigate the short- and long-term health effects of lead exposure.

All efforts to date are allowable under the Department’s statutory and regulatory authority.

To help the state in ensuring a safe water supply and provide immediate access to safe water:

Ongoing or Completed:

EPA is working with state and local officials to conduct water testing and to reduce lead levels in tap water and provide safe drinking water to the residents of Flint. Recent tests show that lead-removal filters are working as expected in Flint homes with high lead levels.
The U.S. Environmental Protection Agency (EPA) is working with state and local officials in encouraging Flint residents to take steps to remove debris that may have accumulated in faucet aerators, hot water heaters, and whole-house water filtration systems since this debris can affect water quality including lead levels.
EPA teams are collecting drinking water samples from Flint homeowners to better understand how lead is behaving in the plumbing in their homes and to ensure proper corrosion control is being restored in the drinking water system in order to lower lead levels. The samples are sent to an EPA laboratory for analysis and the preliminary results are shared with individual homeowners and posted to a publicly accessible website.
NSF-International certified lead-removal filters are being distributed in Flint by the State of Michigan to remove lead from household water and make it safe for people to drink. These filters are certified by NSF for use with water containing lead levels up to 150 parts per billion. Residents are encouraged to have their home water tested. EPA began sampling drinking water in households with known lead levels of 100 parts per billion or higher, in order to verify the effectiveness of these filters at removing lead at high concentrations.
The U.S. Department of Health and Human Services (HHS)-funded agency on aging in Michigan is organizing local meetings and distributing water bottles and water filters to home-delivered meal recipients. The agency is coordinating with Genesee County to assist seniors who need help installing water filters.
EPA also is working with drinking water system operators at the City of Flint treatment plant. EPA continues to collect chlorine samples at locations throughout the city system, with a focus on locations that would be the most likely to have lower chlorine levels. The sampling ensuring that chlorine concentrations in the system are sufficient. EPA is posting preliminary water quality data about chlorine levels in Flint’s drinking water, as well as an interactive map of sampling results in Flint. The map includes data from initial chlorine testing, and as additional and final data becomes available, EPA will post the sampling locations (not addresses) and data to the map. The map is available at www.epa.gov/flint. In locations where chlorine is not detected, EPA conducts follow-up testing for microbial contamination. The Centers for Disease Control (CDC) has information about chlorine and health available for the public.
EPA continues to inspect homeowner drinking water systems to determine the presence or absence of lead service lines in the water distribution system as it prepares for additional residential sampling.
The Federal Emergency Management Agency (FEMA) is providing bottled water, water filters, filter cartridges, water test kits, and other necessary items to the state of Michigan under the emergency declaration. At the request of the State, through the efforts of both door-to-door water response teams and water resource sites, a total of 1,982,844 liters of water, 168,256 water filter replacement cartridges and 40,968 water and pitcher filters.
EPA is conducting an audit of the Michigan Department of Environmental Quality (MDEQ) drinking water program to examine MDEQ's implementation of the Safe Drinking Water Act and related rules on lead and copper, total coliform, nitrates and ground water.
During the week of January 17, EPA issued a Safe Drinking Water Act Emergency Order to ensure the state and city immediately take actions necessary to protect public health. The Safe Drinking Water Act Emergency Order requires the State of Michigan and City of Flint to take a series of immediate steps to address the drinking water contamination in Flint.
U.S. Department of Housing and Urban Development (HUD) helped the city secure funding for the purchase and installation of water filters.
In mid-October, the EPA established a Flint Safe Drinking Water Task Force comprised of EPA scientists who are internationally recognized experts in the field of lead in drinking water. The EPA Task Force is providing technical assistance to MDEQ and the City of Flint to implement corrosion control treatment and to develop school and residential sampling protocols.

To help the state address near-term physical and mental health needs of children, pregnant women and families potentially impacted by lead-contaminated water:

Ongoing or Completed:

HHS U.S. Public Health Service (USPHS) Commissioned Corps officers with expertise in mental health are working with the American Red Cross and Genesee County Health Department to provide Psychological First Aid training community members in Flint. The officers also are providing psychological first aid train-the-trainer sessions and stress management workshops for health care providers, behavioral health providers, and caregivers.
On February 10, the U.S. Department of Agriculture (USDA) announced it is temporarily allowing Michigan to use Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) funds to conduct lead testing for WIC participants. This action could led to 3,800 WIC participants being tested for lead.
USDA also is allowing schools in the Flint area to adopt a provision in the National School Lunch Program known as the Community Eligibility Provision to ensure universal access to school meals for all children in the school to ensure more kids benefit from nutritious school meals.
USDA expanded eligibility for the Summer Electronic Benefits Transfer for Children program to include areas experiencing extreme circumstances, such as Flint. This program delivers nutrition assistance benefits to families with children eligible for free or reduced-price school meals.
Over the weekend of February 6-7, USPHS Commissioned Corps officers assisted the overwhelmed Genesee County Health Department in clearing a month-long backlog of blood lead level screening results. The federal team cataloged results of almost 800 finger-prick blood tests, primarily from children, and packaged letters to parents with the test results and educational materials for mailing. In addition to providing results to parents, the data also now can be reported to the state as required. The officers were part of the team of 14 Commissioned Corps personnel that HHSdispatched to work with the county health department. Other officers are assisting the county’s staff developing additional materials needed to answer questions from callers to the county’s information hotline. Commissioned Corps officers also are helping state authorities develop information materials for distribution to Flint residents.
HHS’ Administration for Children and Families is working with the Michigan Department of Health and Human Services regarding using Temporary Assistance for Needy Families non-recurrent, short-term benefits to help eligible Flint families. These could include short-term (four months or less) payments or vouchers to low-income families with children for purchase of bottled water; and gas cards/bus passes for these families.
The U.S. Food and Drug Administration (FDA) updated a safety message reminding consumers not to use unapproved chelating products. Products may be available over the counter or from online retailers. These products claim to remove lead from the body but none have been approved by FDA for this use.
U.S. Department of Agriculture’s (USDA) provided the Michigan Department of Education (MDE) a list of items available through USDA Foods that are rich in Vitamin C, iron, and calcium, highlighting the percent daily value of these nutrients. USDA Foods are healthy, high quality, 100 percent American-produced foods distributed to schools, food banks and other meal service providers to help stretch tight budgets and feed millions of Americans in need every year. This list will help MDE, the state administering agency for USDA’s TEFAP (The Emergency Food Assistance Program), manage its inventory and deliver USDA Foods high in the targeted nutrients to the Flint food bank. The Flint food bank will then distribute the USDA Foods to their member food pantries, soup kitchens and other agencies.
EPA established a High Lead Homes Strike Team to obtain grab samples at homes with the highest lead levels.
USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is allowing participants to use WIC vouchers for ready-to-feed infant formula, which does not need to be mixed with water. Participants also can swap powdered formula for ready-to-feed formula. WIC participants are being referred to the local health department for lead screenings and provided nutrition education on mitigating lead absorption through dietary changes.
On January 25, USDA approved the Michigan Department of Education’s $62,700 request in additional funds for the USDA Fresh Fruits and Vegetables Program. These funds can be used to help affected schools purchase foods high in Vitamin C. Foods high in Vitamin C are among the foods recommended by the CDC that may help keep lead out of the body, along with foods high in calcium and iron.
The HHS Office of the Assistant Secretary for Preparedness and Response is using existing resources to help state health officials identify vulnerable populations in Flint who may need further targeted outreach and assistance.
The Disaster Distress Helpline, sponsored by the HHS Substance Abuse and Mental Health Services Administration (SAMHSA), is available to provide crisis counseling and support to people – including children and families in Flint – who are experiencing emotional distress related to natural or human-caused disasters. Residents can call (800) 985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.

To assist the state, city and residents in understanding the potential impacts lead can have on health:

New:

Michigan State University (MSU) Cooperative Extension, partially funded by USDA National Institute of Food and Agriculture (NIFA), is providing an educational response to the situation in Flint, MI. The state's extension system currently has 12 full-time employees in Flint and is leading the University-wide response to the crisis, which includes MSU's College of Medicine and others. To date, the MSU Cooperative Extension has provided research based on how to eat healthy to prevent lead poisoning, including a diet with higher calcium, iron, and vitamin C; modified its nutrition and cooking classes to feature foods high in these nutrients and developed educational materials mitigating risk from irrigated and non-irrigated home gardens; guidance for domesticated pet owners if they suspect lead poisoning; andgeneral information about lead poisoning.
Using the College's existing relationships with the grower community, Cooperative Extension supported the Michigan Milk Producers Association and Kroger Co., with donating and shipping 12,000 gallons of milk into the city of Flint. MSU also is working with vegetable growers to ship additional vegetables containing high calcium, iron, and vitamin C into the city. Cooperative Extension is an integral part of the Flint Downtown Farmers Market, which is serving as a hub not only for produce but also health and nutrition extension education.

Ongoing or Completed:

EPA is printing more than 20,000 additional fliers to be distributed to Flint residents about how they can reduce lead in the water in their homes.
EPA will send letters to Flint homeowners notifying them of sampling results of their homes’ water and what they mean.
The National Library of Medicine, part of the National Institutes of Health, developed the Lead in the Flint, Michigan Water Supply Resource Guide to provide professionals, scientists and members of the public with easy access to information on the health effects of lead and lead exposure in vulnerable populations. The guide incorporates links to a variety of local, state, and federal resources, including Flint specific information. The library will continue to update and maintain this resource guide, adding new topics as needed and new links as they become available.
USDA continues coordinating increased nutrition education efforts in Flint among the state administered USDA Food and Nutrition Service program providers [e.g., Child and Adult Care Food Program, SNAP Nutrition Education, food banks], community-based partner organizations and farmers’ markets on important foods to consume to mitigate lead absorption. USDA nutrition programs provide not just nutritious food but also nutrition education for a large number of Flint infants, children and adults. This education information ensures local schools and child care and day care operators serving meals under USDA school meals and its Child and Adult Care Food Program continue to provide children the healthiest possible meals and share information with parents about preparing meals at home. SNAP Nutrition Education funding (SNAP-Ed) and SNAP-authorized farmers markets help disseminate nutrition guidance and increase SNAP participants’ knowledge of how to optimize their diets.
To date, SNAP-Ed has distributed more than 10,000 copies of nutrition-lead resources in the Flint area. Additional booklets are being printed, with revised recipes for the next wave of distribution, as well as a Spanish version. This information captures not only the target foods to mitigate lead absorption but also provides helpful information on other food resources for Flint residents.
The CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) is providing technical assistance to the state on lead exposure, and water sampling protocols. CDC and ASTDR are working with the state to determine the number of children exposed to lead in Flint to ensure that children who should be screened are getting screened.
FDA’s local office assessed potential impacts on FDA-regulated industries in the Flint area, including human food and animal feed production. No impacts were found, and FDA continues to assess and monitor the situation.
HHS is working with the State of Michigan and the local health department to develop a health monitoring plan for the City of Flint to understand the extent of potential lead exposure.
HHS deployed experts to Flint to provide public health assistance in the areas of health surveillance and monitoring, behavioral health, and risk communications.
HHS Health Resources and Services Administration-funded health centers in the Flint area are offering lead testing, conducting outreach and educational sessions, and providing primary care and behavioral health services to their patients and communities.
The HHS Administration for Children and Families (ACF) and Health Resources and Services Administration (HRSA) are working with their grantees in the area to disseminate public health education through Head Start, Community Health Centers and other programs to help families understand the risks of lead in the water, encouraging residents to have their children screened, and assisting families in obtaining screening for their children. Medicaid regularly requires that all Medicaid-eligible children up to age 6 be tested for lead poisoning; treatment for these children is covered under Medicaid. As a diagnostic benefit, home investigations for Medicaid-eligible children also are covered under Medicaid. The state can expedite enrollment into Medicaid for eligible children in need of immediate medical attention.
The National Institutes of Health has an expedited process for reviewing research proposals and funding grants to address environmental emergencies, such as the lead-contaminated water crisis in Flint. The NIH is soliciting these research proposals now. Additionally, the new NIH Disaster Research Response initiative is working to improve research tools, protocols, and training necessary to conduct time-critical health research in response to disasters.
HHS Substance Abuse and Mental Health Services Administration are working the state to determine the need for increased screening for behavioral health disorders in the public health system to facilitate early intervention for those who might need additional support.

To support the state, city and residents in responding and recovering from the economic impact of this crisis:

Ongoing or Completed:

The Small Business Administration (SBA) on February 5 approved Governor Snyder’s request for low-interest disaster loans for businesses in Genesee County (which includes Flint) and the surrounding counties of Lapeer, Livingston, Oakland, Saginaw, Shiawassee and Tuscola. The approval provides access to federal Economic Injury Disaster Loans, which are working capital loans to small businesses, small agricultural cooperatives, small businesses engaged in aquaculture and most private, non-profit organizations. Business owners have until November 7, 2016, to apply.
SBA opened a Business Recovery Center in Flint to administer the loans on February 10.
The Federal Housing Administration (FHA) acts on the emergency declaration for the residents of the State of Michigan due to water contamination. Although FHA typically requires lenders to ensure properties have a safe and potable supply of water, when public water systems do not meet these basic requirements, the property may still qualify for an FHA-insured mortgage if the individual water purification system meets all federal, state and local standards.
The U.S. Department of Housing and Urban Development (HUD) is working closely with the city on economic development and interagency coordination and successfully assisted the city with the purchase and installation of water filters. HUD had an existing lead hazard grant to Flint, targeted to lead paint, $325,000 of which can be used for addressing the water lead contamination.
HUD also has provided a data tracking and reporting system for the State of Michigan to use in its lead investigations.
Since October, HUD has worked with the Flint Housing Commission (FHC) to install filters in all public housing units and provide them to all Housing Choice Voucher (HCV) assisted households by the end of October. FHC has provided maintenance equipment for filters in public housing units, including providing the first round of replacement filters in January. HUD is also working to ensure 100% installation and upkeep of filters at all HUD-assisted and HUD-insured properties.
HUD is also working with FHC to provide resources and access for FHC residents including:

Working with local partners to have water delivered to public housing locations where seniors and disabled residents did not have the mobility to visit the city water resource centers
Paying for private testing of FHC units to determine the level of lead exposure in units and determine how best to address. Testing is underway now and results should be available in late February/early March
Working with FHC and a local provider to schedule onsite blood lead testing for children in public housing

HUD is exploring funding opportunities to send testers to homes of voucher users to test water and to provide filter maintenance as needed.
President Obama on January 22 announced $80 million available from the water infrastructure state revolving fund allocated to the State of Michigan as part of the President's enacted 2016 budget. The Administration has moved to ensure that money is available in Michigan immediately.
In 2014, Flint was identified as one of six target cities in the second round of the Strong Cities – Strong Communities White House initiative. This program focuses on enhanced federal agency support in areas of blight reduction, public safety and economic development. Discussions are ongoing to identify opportunities for Departmental programs and initiatives to provide resources to help address the Flint water crisis and for collaboration through existing federal engagement with city, county and state agencies.