the recordlast verified 2026-09-28

children on medicaid, state by state

every state hands cms the same three numbers about children and psychiatric medication: whether a child got talking treatment before an antipsychotic, whether a child on an antipsychotic got the blood tests the label asks for, and whether a child starting an adhd medicine was seen again within a month. here are all 51, ranked, with a page for each one carrying its own figures and four questions written from them.[1]

the three measures, and how far apart the states are

APP-CH

psychosocial care first, 1 to 11

of children newly prescribed an antipsychotic, the share with documented psychosocial care as the first-line treatment.

median 59.2, mean 60.8, bottom quartile 54.1, top quartile 66.2. lowest 44.5 (North Carolina), highest 83.5 (Vermont). 50 of the 51 states got a published rate.

APM-CH

both blood tests, 1 to 11

of children on two or more antipsychotic prescriptions, the share who got a blood glucose test and a cholesterol test in the year.

median 29.1, mean 31.3, bottom quartile 23.7, top quartile 35.5. lowest 13.2 (Kansas), highest 61.5 (Montana). 49 of the 51 states got a published rate.

ADD-CH

30-day adhd follow-up, 6 to 12

of children newly prescribed an ADHD medicine, the share seen again by a prescriber within 30 days.

median 47.6, mean 47.3, bottom quartile 41.1, top quartile 53.7. lowest 30.2 (North Dakota), highest 64.2 (Maryland). 51 of the 51 states got a published rate.

every state, on all three

higher is better on all three. the rank in brackets is out of the states that received a published rate for that measure.

statepsychosocial care first
ages 1 to 11		both blood tests
ages 1 to 11		30-day adhd visit
ages 6 to 12
Alabama55.0 [37 of 50]15.4 [47 of 49]40.0 [41 of 51]
Alaska53.6 [40 of 50]17.7 [45 of 49]39.0 [44 of 51]
Arizona66.0 [15 of 50]34.2 [13 of 49]58.8 [4 of 51]
Arkansas82.0 [2 of 50]59.7 [3 of 49]54.4 [11 of 51]
California53.3 [41 of 50]28.6 [25 of 49]49.6 [19 of 51]
Colorado66.0 [15 of 50]24.0 [34 of 49]45.3 [30 of 51]
Connecticut75.3 [4 of 50]28.2 [26 of 49]47.7 [25 of 51]
Delaware60.2 [24 of 50]52.5 [6 of 49]35.3 [46 of 51]
District of Columbia81.1 [3 of 50]suppressed34.4 [48 of 51]
Florida61.6 [22 of 50]30.2 [19 of 49]46.7 [27 of 51]
Georgia55.1 [36 of 50]26.1 [31 of 49]47.5 [26 of 51]
Hawaiiunder 3018.2 [44 of 49]43.2 [36 of 51]
Idaho46.6 [47 of 50]15.3 [48 of 49]40.6 [39 of 51]
Illinois55.3 [35 of 50]26.3 [29 of 49]35.2 [47 of 51]
Indiana59.1 [27 of 50]26.6 [28 of 49]42.8 [37 of 51]
Iowa59.2 [25 of 50]19.5 [43 of 49]55.1 [9 of 51]
Kansas72.3 [8 of 50]13.2 [49 of 49]53.0 [15 of 51]
Kentucky62.7 [19 of 50]31.8 [17 of 49]53.7 [13 of 51]
Louisiana64.8 [17 of 50]21.9 [41 of 49]45.9 [29 of 51]
Maine50.4 [45 of 50]36.6 [11 of 49]57.7 [6 of 51]
Maryland73.8 [7 of 50]60.5 [2 of 49]64.2 [1 of 51]
Massachusetts69.4 [10 of 50]39.4 [8 of 49]38.4 [45 of 51]
Michigan66.1 [14 of 50]22.5 [40 of 49]51.8 [16 of 51]
Minnesota74.4 [5 of 50]suppressed39.1 [43 of 51]
Mississippi59.2 [25 of 50]21.8 [42 of 49]55.7 [8 of 51]
Missouri51.5 [44 of 50]42.8 [7 of 49]40.1 [40 of 51]
Montana68.0 [12 of 50]61.5 [1 of 49]49.1 [20 of 51]
Nebraska52.0 [43 of 50]29.8 [20 of 49]46.6 [28 of 51]
Nevada66.2 [13 of 50]23.0 [39 of 49]54.2 [12 of 51]
New Hampshire62.2 [21 of 50]32.1 [16 of 49]45.3 [30 of 51]
New Jersey44.6 [49 of 50]26.3 [29 of 49]32.1 [50 of 51]
New Mexico61.4 [23 of 50]23.4 [38 of 49]39.9 [42 of 51]
New York68.3 [11 of 50]35.5 [12 of 49]56.6 [7 of 51]
North Carolina44.5 [50 of 50]25.7 [32 of 49]51.1 [17 of 51]
North Dakota57.3 [30 of 50]36.9 [10 of 49]30.2 [51 of 51]
Ohio73.9 [6 of 50]29.6 [23 of 49]53.6 [14 of 51]
Oklahoma55.9 [33 of 50]15.9 [46 of 49]54.6 [10 of 51]
Oregon64.2 [18 of 50]27.7 [27 of 49]57.9 [5 of 51]
Pennsylvania58.5 [28 of 50]59.2 [4 of 49]48.3 [22 of 51]
Rhode Island47.4 [46 of 50]23.7 [36 of 49]48.0 [24 of 51]
South Carolina57.7 [29 of 50]29.8 [20 of 49]44.4 [33 of 51]
South Dakota56.7 [32 of 50]23.7 [36 of 49]50.0 [18 of 51]
Tennessee55.7 [34 of 50]29.6 [23 of 49]48.9 [21 of 51]
Texas46.3 [48 of 50]31.1 [18 of 49]43.9 [35 of 51]
Utah54.1 [39 of 50]23.9 [35 of 49]34.3 [49 of 51]
Vermont83.5 [1 of 50]37.1 [9 of 49]60.6 [3 of 51]
Virginia54.3 [38 of 50]29.7 [22 of 49]41.5 [38 of 51]
Washington57.2 [31 of 50]24.7 [33 of 49]44.7 [32 of 51]
West Virginia52.4 [42 of 50]58.7 [5 of 49]62.8 [2 of 51]
Wisconsin62.5 [20 of 50]32.6 [15 of 49]48.3 [22 of 51]
Wyoming71.3 [9 of 50]33.1 [14 of 49]44.3 [34 of 51]

“suppressed” means the state reported and cms withheld the cell because too few children sit behind it; “under 30” means cms did not publish a rate because the denominator was under 30. neither is a zero, and in the 2025 reporting year no state failed to report any of the three measures.[1]

ranked, one measure at a time

APP-CH · psychosocial care first, 1 to 11 — national median 59.2

  1. 1Vermont83.5
  2. 2Arkansas82.0
  3. 3District of Columbia81.1
  4. 4Connecticut75.3
  5. 5Minnesota74.4
  6. 6Ohio73.9
  7. 7Maryland73.8
  8. 8Kansas72.3
  9. 9Wyoming71.3
  10. 10Massachusetts69.4
  11. 11New York68.3
  12. 12Montana68.0
  13. 13Nevada66.2
  14. 14Michigan66.1
  15. 15Arizona66.0
  16. 15Colorado66.0
  17. 17Louisiana64.8
  18. 18Oregon64.2
  19. 19Kentucky62.7
  20. 20Wisconsin62.5
  21. 21New Hampshire62.2
  22. 22Florida61.6
  23. 23New Mexico61.4
  24. 24Delaware60.2
  25. 25Iowa59.2
  26. 25Mississippi59.2
  27. 27Indiana59.1
  28. 28Pennsylvania58.5
  29. 29South Carolina57.7
  30. 30North Dakota57.3
  31. 31Washington57.2
  32. 32South Dakota56.7
  33. 33Oklahoma55.9
  34. 34Tennessee55.7
  35. 35Illinois55.3
  36. 36Georgia55.1
  37. 37Alabama55.0
  38. 38Virginia54.3
  39. 39Utah54.1
  40. 40Alaska53.6
  41. 41California53.3
  42. 42West Virginia52.4
  43. 43Nebraska52.0
  44. 44Missouri51.5
  45. 45Maine50.4
  46. 46Rhode Island47.4
  47. 47Idaho46.6
  48. 48Texas46.3
  49. 49New Jersey44.6
  50. 50North Carolina44.5

APM-CH · both blood tests, 1 to 11 — national median 29.1

  1. 1Montana61.5
  2. 2Maryland60.5
  3. 3Arkansas59.7
  4. 4Pennsylvania59.2
  5. 5West Virginia58.7
  6. 6Delaware52.5
  7. 7Missouri42.8
  8. 8Massachusetts39.4
  9. 9Vermont37.1
  10. 10North Dakota36.9
  11. 11Maine36.6
  12. 12New York35.5
  13. 13Arizona34.2
  14. 14Wyoming33.1
  15. 15Wisconsin32.6
  16. 16New Hampshire32.1
  17. 17Kentucky31.8
  18. 18Texas31.1
  19. 19Florida30.2
  20. 20Nebraska29.8
  21. 20South Carolina29.8
  22. 22Virginia29.7
  23. 23Ohio29.6
  24. 23Tennessee29.6
  25. 25California28.6
  26. 26Connecticut28.2
  27. 27Oregon27.7
  28. 28Indiana26.6
  29. 29Illinois26.3
  30. 29New Jersey26.3
  31. 31Georgia26.1
  32. 32North Carolina25.7
  33. 33Washington24.7
  34. 34Colorado24.0
  35. 35Utah23.9
  36. 36Rhode Island23.7
  37. 36South Dakota23.7
  38. 38New Mexico23.4
  39. 39Nevada23.0
  40. 40Michigan22.5
  41. 41Louisiana21.9
  42. 42Mississippi21.8
  43. 43Iowa19.5
  44. 44Hawaii18.2
  45. 45Alaska17.7
  46. 46Oklahoma15.9
  47. 47Alabama15.4
  48. 48Idaho15.3
  49. 49Kansas13.2

ADD-CH · 30-day adhd follow-up, 6 to 12 — national median 47.6

  1. 1Maryland64.2
  2. 2West Virginia62.8
  3. 3Vermont60.6
  4. 4Arizona58.8
  5. 5Oregon57.9
  6. 6Maine57.7
  7. 7New York56.6
  8. 8Mississippi55.7
  9. 9Iowa55.1
  10. 10Oklahoma54.6
  11. 11Arkansas54.4
  12. 12Nevada54.2
  13. 13Kentucky53.7
  14. 14Ohio53.6
  15. 15Kansas53.0
  16. 16Michigan51.8
  17. 17North Carolina51.1
  18. 18South Dakota50.0
  19. 19California49.6
  20. 20Montana49.1
  21. 21Tennessee48.9
  22. 22Pennsylvania48.3
  23. 22Wisconsin48.3
  24. 24Rhode Island48.0
  25. 25Connecticut47.7
  26. 26Georgia47.5
  27. 27Florida46.7
  28. 28Nebraska46.6
  29. 29Louisiana45.9
  30. 30Colorado45.3
  31. 30New Hampshire45.3
  32. 32Washington44.7
  33. 33South Carolina44.4
  34. 34Wyoming44.3
  35. 35Texas43.9
  36. 36Hawaii43.2
  37. 37Indiana42.8
  38. 38Virginia41.5
  39. 39Idaho40.6
  40. 40Missouri40.1
  41. 41Alabama40.0
  42. 42New Mexico39.9
  43. 43Minnesota39.1
  44. 44Alaska39.0
  45. 45Massachusetts38.4
  46. 46Delaware35.3
  47. 47Illinois35.2
  48. 48District of Columbia34.4
  49. 49Utah34.3
  50. 50New Jersey32.1
  51. 51North Dakota30.2

every reporting break we found

between the 2024 and 2025 reporting years, every reporting state in the country moved the metabolic-monitoring and adhd-follow-up measures from administrative claims to electronic clinical data systems. the first-line psychosocial care measure stayed on claims everywhere. so no metabolic or adhd figure is comparable to its own prior year in any state, and where one of them moved a long way the instrument changed underneath it.[2]

we compared all 501 cells that have a rate in both years. the median change is 1.8 points and the ninetieth percentile is 7.5. eight cells moved 20 points or more, and the largest move below that line is 17.7, so the threshold sits in a real gap rather than being chosen to suit an argument. these eight are the series that visibly snapped:

statemeasure20242025change
Minnesotaboth blood tests, 12 to 1736.80.8-36.0
Minnesotacholesterol alone, 1 to 1736.40.8-35.6
Minnesotaboth blood tests, 1 to 1735.30.6-34.7
West Virginia30-day adhd follow-up, 6 to 1232.162.8+30.7
Kansascholesterol alone, 1 to 1743.715.9-27.8
Kansasboth blood tests, 1 to 1743.215.6-27.6
West Virginianine-month adhd follow-up, 6 to 1235.662.5+26.9
Kansasglucose alone, 1 to 1757.935.9-22.0

minnesota is the clearest case: its cholesterol rate falls from 36.4 to 0.8 while its glucose rate moves from 53.9 to 54.4. a state does not stop drawing cholesterol on children in a year while continuing to draw glucose from the same arm. that is a reporting break, and it is treated as one here and on minnesota’s own page. kansas moves the same way on all three of the metabolic rows it reported in both years, and west virginia moves the other way on both adhd rows — up 30.7 and 26.9 points, which lands it second of the 51 states on the 30-day measure and sixth of the 49 on the nine-month one. none of these eight is quoted anywhere on this site as a change in care.

what these numbers are not

they are state-reported, on differing methods, and they count process rather than outcome: whether a service was documented, a test done, a visit held. none of them records whether a child got better. most denominators are withheld — cms publishes the rate without the count on every age-split row. “states” here counts the district of columbia as a state, which is what cms does in its own reporting column; cms’s published median also counts puerto rico, which has no page here. and none of it comes from an advocacy group’s figures.

the drug utilization sums on the state pages are ours, not cms’s, and the file behind them has no age, no diagnosis and no prescriber field, so nothing derived from it is a children’s number.[3] the national picture, the hydroxyzine explainer, where fda approval for young children exists, and the argument in both directions are on the parent page.

all 51 pages

Alabama · Alaska · Arizona · Arkansas · California · Colorado · Connecticut · Delaware · District of Columbia · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Louisiana · Maine · Maryland · Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Jersey · New Mexico · New York · North Carolina · North Dakota · Ohio · Oklahoma · Oregon · Pennsylvania · Rhode Island · South Carolina · South Dakota · Tennessee · Texas · Utah · Vermont · Virginia · Washington · West Virginia · Wisconsin · Wyoming

questions people ask

Which state does best on getting children therapy before an antipsychotic?

Vermont, at 83.5 percent of children aged 1 to 11 with documented first-line psychosocial care in the 2025 reporting year. North Carolina reported the lowest, 44.5 percent. The national median across the 51 states that received a published rate was 59.2 percent. Across the full age range of 1 to 17, Minnesota reported the highest rate in the country at 79.3 percent and North Carolina the lowest at 46.1 percent.

Which state does worst on the metabolic blood tests for children on antipsychotics?

For children aged 1 to 11 on two or more antipsychotic prescriptions, Kansas reported the lowest both-tests rate at 13.2 percent and Montana the highest at 61.5 percent, against a national median of 29.1 percent. Across ages 1 to 17, Minnesota's published figure is 0.6 percent, but that is a broken series rather than a finding: Minnesota reported 35.3 percent the year before and its glucose rate barely moved, and every state changed the instrument behind this measure between the two years. West Virginia reported the highest at 59.7 percent.

Why are some states missing a number instead of showing a zero?

Because a missing number and a zero are different things. In the 2025 reporting year all 50 states and the District of Columbia reported all three measures, so nothing here is a refusal to report. Five cells are still blank: CMS suppressed the both-tests rate for children aged 1 to 11 in Minnesota and the District of Columbia, and the nine-month ADHD rate in Montana and Wyoming, under its cell-size suppression policy; and it did not publish a rate for psychosocial care in children aged 1 to 11 in Hawaii because fewer than 30 children were in the denominator. CMS also withholds the denominator on every age-split row, publishing the rate without the count.

Can these numbers be compared between states?

Only carefully. The Child Core Set is state-reported and states use different methods and data systems, cells below the suppression threshold are withheld, and most denominators are not published. Between the 2024 and 2025 reporting years every reporting state moved the metabolic-monitoring and ADHD-follow-up measures from administrative claims to electronic clinical data systems, so neither measure is comparable to its own prior year in any state. The ranks here are positions in a field of differing methods, not a league table of care.

sources

  1. CMS Medicaid/CHIP Child Core Set, 2025 reporting year, downloaded and read 2026-09-28: APP-CH (first-line psychosocial care for children and adolescents on antipsychotics), APM-CH (metabolic monitoring for children and adolescents on antipsychotics) and ADD-CH (follow-up care for children prescribed ADHD medication). Only rows flagged "Rate Used in Calculating State Mean and Median = Yes" are used. Source line on every row: "Mathematica analysis of the Quality Measure Reporting (QMR) system reports for the 2025 Core Set as of April 28, 2026." Ranks on these pages are computed over the 50 states and the District of Columbia that received a published rate for each measure; CMS's published mean, median and quartiles additionally include Puerto Rico, which reports all three measures. Guam and the U.S. Virgin Islands appear in the file and reported none of the three. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
  2. CMS Medicaid/CHIP Child Core Set, 2024 reporting year, downloaded and read 2026-09-28. Used only to detect reporting breaks. Every reporting state moved APM-CH and ADD-CH from "Administrative" to "Electronic Clinical Data Systems (ECDS)" between the 2024 and 2025 reporting years (the District of Columbia to Electronic Health Records for ADD-CH; Florida and Maryland to EHR and ECDS); APP-CH stayed "Administrative" in every state. Median absolute year-over-year change across the 501 comparable cells: 1.8 points; ninetieth percentile 7.5 points; largest move below the 20-point threshold used here: 17.7 points. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
  3. CMS State Drug Utilization Data 2024 (sdud2024_updatedJuly2026.csv, 5,308,407 rows, downloaded 2026-09-28). Our own sums by product name across the reporting states and territories, all ages: hydroxyzine 8,675,297 prescriptions and $105,553,404 reimbursed; the benzodiazepine class 11,753,095 prescriptions and $321,772,863. The file has no age, no diagnosis and no prescriber field. Not a CMS-published statistic, and not a children's number. https://data.medicaid.gov/dataset/61729e5a-7aa8-448c-8903-ba3e0cd0ea3c

nothing here is a reason to start, stop or change a child’s medication. it is a set of questions to bring to the person who prescribes it.

adam