children’s psychiatric drugs in california medicaid: california’s own three numbers
california told cms three things about its children in the 2025 reporting year: 53.3 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 41st of the 50 states that reported it; 28.6 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 25th of the 49 states that reported it; 49.6 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 19th of the 51 states that reported it.[1]
across the whole age range, california sits above the national median on the two metabolic blood tests and above the national median on psychosocial care before an antipsychotic. same state, same year, same children.
every row california sent to cms
| measure | california | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 53.3 | withheld | 41 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 65.6 | withheld | 21 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 62.7 | withheld | 23 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 28.6 | withheld | 25 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 40.4 | withheld | 18 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 37.2 | withheld | 19 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 57.1 | withheld | 15 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 38.4 | withheld | 20 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 49.6 | withheld | 19 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 56.5 | withheld | 21 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, california reported 53.3 percent — 5.9 points below the national median of 59.2, and 41st of the 50 states that reported it. put the other way round, 46.7 percent of the youngest children in california who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 65.6 percent. across ages 1 to 17, 62.7 percent, 23rd of the 51 states that reported it. it reported 61.7 the year before on the same method, so this one moved 1.0 points up — the only one of the three where that comparison holds. either side of california on that row: new mexico at 63.3 and iowa at 62.7.
the two blood tests
california reported that 28.6 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 25th of the 49 states that reported it, 0.5 points below the national median of 29.1. split into halves across ages 1 to 17, glucose ran 57.1 percent and cholesterol 38.4 percent — 15th of the 51 states that reported it on glucose, 20th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 37.2 percent. either side of california on the both-tests row for ages 1 to 17: vermont at 37.4 and connecticut at 36.9.
the 30-day visit after a new adhd prescription
49.6 percent — 19th of the 51 states that reported it, 2.0 points above the national median of 47.6. that leaves 50.4 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 56.5 percent had at least two more visits, against a national median of 55.5 — 21st of the 49 states that reported it. either side of california on the 30-day row: south dakota at 50.0 and montana at 49.1.
what medicaid paid for in california in 2024
in 2024 medicaid in california paid for 839,278 hydroxyzine prescriptions, $13,930,284 worth, and 1,001,614 benzodiazepine prescriptions, $35,753,045 worth — 83.8 hydroxyzine prescriptions for every 100 benzodiazepine ones. 192 of the 555 hydroxyzine rows and 939 of the 2,540 benzodiazepine rows for california 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 california’s own numbers behind them
ask which drug it is, not which class
california, 2024: 839,278 hydroxyzine prescriptions and 1,001,614 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
california: 53.3 percent of children aged 1 to 11, 41st of the 50 states that reported it
in 46.7 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
california: 28.6 percent of children aged 1 to 11 had both tests, 25th of the 49 states that reported it
missed 71.4 percent of the time in california. 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
california: 49.6 percent, 19th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and california misses it 50.4 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 California, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year California reported 53.3 percent for children aged 1 to 11, against a national median of 59.2 percent — 41st of the 50 states that reported it. For ages 12 to 17 it was 65.6 percent, and across ages 1 to 17 62.7 percent.
In California, do children on antipsychotics get the blood tests?
28.6 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 25th of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 57.1 percent, cholesterol 38.4 percent.
In California, how often does the 30-day ADHD follow-up visit happen?
49.6 percent of the time — 19th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 56.5 percent in California against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, California rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 53.3 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 65.6 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 62.7 (denominator not publicly reported); APM-CH both blood tests, 1 to 11: 28.6 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 40.4 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 37.2 (denominator not publicly reported); APM-CH glucose alone, 1 to 17: 57.1 (denominator not publicly reported); APM-CH cholesterol alone, 1 to 17: 38.4 (denominator not publicly reported); ADD-CH 30-day adhd follow-up, 6 to 12: 49.6 (denominator not publicly reported); ADD-CH nine-month adhd follow-up, 6 to 12: 56.5 (denominator not publicly reported). Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, California rows, summed by product name, read 2026-09-28: hydroxyzine 839,278 prescriptions, $13,930,284, 192 of 555 rows suppressed; benzodiazepines 1,001,614 prescriptions, $35,753,045, 939 of 2,540 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