children’s psychiatric drugs in alabama medicaid: alabama’s own three numbers
alabama told cms three things about its children in the 2025 reporting year: 55.0 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 37th of the 50 states that reported it; 15.4 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, the third-lowest of the 49 states that reported it; 40.0 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 41st of the 51 states that reported it.[1]
across the whole age range, alabama sits below the national median on psychosocial care before an antipsychotic and in the bottom quarter of the country on the two metabolic blood tests. same state, same year, same children.
every row alabama sent to cms
| measure | alabama | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 55.0 | withheld | 37 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 65.1 | withheld | 23 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 60.9 | 2,443 | 28 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 15.4 | withheld | 47 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 28.4 | withheld | 45 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 23.1 | 8,895 | 45 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 44.3 | 8,895 | 47 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 24.1 | 8,895 | 46 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 40.0 | 10,744 | 41 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 79.8 | 733 | 2 of 49 | 55.5 |
rank 1 is the highest rate. how the ranks and the withheld cells work.[1]
talking treatment before the antipsychotic
for the youngest children, aged 1 to 11, alabama reported 55.0 percent — 4.2 points below the national median of 59.2, and 37th of the 50 states that reported it. put the other way round, 45.0 percent of the youngest children in alabama who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 65.1 percent. across ages 1 to 17, 60.9 percent on 2,443 children, 28th of the 51 states that reported it. it reported 59.2 the year before on the same method, so this one moved 1.7 points up — the only one of the three where that comparison holds. either side of alabama on that row: florida at 61.2 and illinois at 60.7.
the two blood tests
alabama reported that 15.4 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — the third-lowest of the 49 states that reported it, 13.7 points below the national median of 29.1. split into halves across ages 1 to 17, glucose ran 44.3 percent and cholesterol 24.1 percent, both on 8,895 children — the fourth-lowest of the 51 states that reported it on glucose, 46th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 23.1 percent. either side of alabama on the both-tests row for ages 1 to 17: iowa at 25.4 and hawaii at 21.9.
the 30-day visit after a new adhd prescription
40.0 percent, on 10,744 children aged 6 to 12 who were newly prescribed an adhd medicine in alabama — 41st of the 51 states that reported it, 7.6 points below the national median of 47.6. that leaves 60.0 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 79.8 percent had at least two more visits on 733 children, against a national median of 55.5 — the second-highest of the 49 states that reported it. either side of alabama on the 30-day row: missouri at 40.1 and new mexico at 39.9.
what medicaid paid for in alabama in 2024
in 2024 medicaid in alabama paid for 86,393 hydroxyzine prescriptions, $1,766,432 worth, and 101,692 benzodiazepine prescriptions, $2,526,473 worth — 85.0 hydroxyzine prescriptions for every 100 benzodiazepine ones. 47 of the 282 hydroxyzine rows and 437 of the 1,151 benzodiazepine rows for alabama were suppressed, so both are floors.[2] our own sums of the federal file, which has no ages, so neither is a children’s number, and no rank.
four things to ask, with alabama’s own numbers behind them
ask which drug it is, not which class
alabama, 2024: 86,393 hydroxyzine prescriptions and 101,692 benzodiazepine prescriptions
hydroxyzine is an antihistamine; a benzodiazepine brings dependence and withdrawal. read the name on the bottle. why they get merged.
if an antipsychotic is being started, ask what came first
alabama: 55.0 percent of children aged 1 to 11, 37th of the 50 states that reported it
in 45.0 percent of these cases the answer is “none yet”. ask what was tried first, and ask for it in the notes.
if your child is on an antipsychotic, get the date of the bloodwork
alabama: 15.4 percent of children aged 1 to 11 had both tests, the third-lowest of the 49 states that reported it
missed 84.6 percent of the time in alabama. ask when the glucose and cholesterol test is booked, and leave with a date.
if an adhd medicine has just been started, book the 30-day visit now
alabama: 40.0 percent, 41st of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and alabama misses it 60.0 percent of the time. book it before you leave the room.
how to read any of this
self-reported, on methods that differ by state, and process not outcome.[1] method and suppression rules; the national picture.
questions people ask
In Alabama, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Alabama reported 55.0 percent for children aged 1 to 11, against a national median of 59.2 percent — 37th of the 50 states that reported it. For ages 12 to 17 it was 65.1 percent, and across ages 1 to 17 60.9 percent on 2,443 children.
In Alabama, do children on antipsychotics get the blood tests?
15.4 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — the third-lowest of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 44.3 percent, cholesterol 24.1 percent, on 8,895 children.
In Alabama, how often does the 30-day ADHD follow-up visit happen?
40.0 percent of the time, on 10,744 children aged 6 to 12 newly prescribed an ADHD medicine — 41st of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 79.8 percent in Alabama against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Alabama rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 55.0 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 65.1 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 60.9 on a denominator of 2,443; APM-CH both blood tests, 1 to 11: 15.4 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 28.4 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 23.1 on a denominator of 8,895; APM-CH glucose alone, 1 to 17: 44.3 on a denominator of 8,895; APM-CH cholesterol alone, 1 to 17: 24.1 on a denominator of 8,895; ADD-CH 30-day adhd follow-up, 6 to 12: 40.0 on a denominator of 10,744; ADD-CH nine-month adhd follow-up, 6 to 12: 79.8 on a denominator of 733. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Alabama rows, summed by product name, read 2026-09-28: hydroxyzine 86,393 prescriptions, $1,766,432, 47 of 282 rows suppressed; benzodiazepines 101,692 prescriptions, $2,526,473, 437 of 1,151 rows suppressed. Our sum, not a CMS statistic. https://data.medicaid.gov/dataset/61729e5a-7aa8-448c-8903-ba3e0cd0ea3c
all 51 states ranked · what the national numbers say
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