children’s psychiatric drugs in district of columbia medicaid: district of columbia’s own three numbers
district of columbia told cms three things about its children in the 2025 reporting year: 81.1 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, the third-highest of the 50 states that reported it; 10.9 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, the second-lowest of the 51 states that reported it; 34.4 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, the fourth-lowest of the 51 states that reported it.[1]
across the whole age range, district of columbia sits in the top quarter of the country 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 district of columbia sent to cms
| measure | district of columbia | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 81.1 | withheld | 3 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 77.1 | withheld | 4 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 78.5 | 247 | 3 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | suppressed | withheld | — | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 12.0 | withheld | 50 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 10.9 | 338 | 50 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 26.9 | 338 | 51 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 11.8 | 338 | 50 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 34.4 | 433 | 48 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 45.9 | 37 | 39 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, district of columbia reported 81.1 percent — 21.9 points above the national median of 59.2, and the third-highest of the 50 states that reported it. put the other way round, 18.9 percent of the youngest children in district of columbia who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 77.1 percent. across ages 1 to 17, 78.5 percent on 247 children, the third-highest of the 51 states that reported it. it reported 78.3 the year before on the same method, so this one moved 0.2 points up — the only one of the three where that comparison holds. either side of district of columbia on that row: connecticut at 78.5 and vermont at 78.2.
the two blood tests
district of columbia reported that 10.9 percent of children aged 1 to 17 on two or more antipsychotic prescriptions had both tests — the second-lowest of the 51 states that reported it, 22.0 points below the national median of 32.9. split into halves across ages 1 to 17, glucose ran 26.9 percent and cholesterol 11.8 percent, both on 338 children — the lowest of the 51 states that reported it on glucose, the second-lowest of the 51 states that reported it on cholesterol. either side of district of columbia on the both-tests row for ages 1 to 17: kansas at 15.6 and minnesota at 0.6.
the 30-day visit after a new adhd prescription
34.4 percent, on 433 children aged 6 to 12 who were newly prescribed an adhd medicine in district of columbia — the fourth-lowest of the 51 states that reported it, 13.2 points below the national median of 47.6. that leaves 65.6 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 45.9 percent had at least two more visits on 37 children, against a national median of 55.5 — 39th of the 49 states that reported it. either side of district of columbia on the 30-day row: illinois at 35.2 and utah at 34.3.
what is missing from district of columbia’s file, and why
- APM-CH both blood tests, 1 to 11: District of Columbia reported this measure for 2025, and CMS suppressed the cell: this cell is not published because the number of children behind it is small enough that publishing it could identify them. That is a withheld number, not a zero.
what medicaid paid for in district of columbia in 2024
in 2024 medicaid in district of columbia paid for 17,345 hydroxyzine prescriptions, $195,649 worth, and 18,736 benzodiazepine prescriptions, $193,240 worth — 92.6 hydroxyzine prescriptions for every 100 benzodiazepine ones. 235 of the 488 hydroxyzine rows and 901 of the 1,338 benzodiazepine rows for district of columbia 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 district of columbia’s own numbers behind them
ask which drug it is, not which class
district of columbia, 2024: 17,345 hydroxyzine prescriptions and 18,736 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
district of columbia: 81.1 percent of children aged 1 to 11, the third-highest of the 50 states that reported it
in 18.9 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
district of columbia: 10.9 percent of children aged 1 to 17 had both tests, the second-lowest of the 51 states that reported it
missed 89.1 percent of the time in district of columbia. 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
district of columbia: 34.4 percent, the fourth-lowest of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and district of columbia misses it 65.6 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 District of Columbia, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year District of Columbia reported 81.1 percent for children aged 1 to 11, against a national median of 59.2 percent — the third-highest of the 50 states that reported it. For ages 12 to 17 it was 77.1 percent, and across ages 1 to 17 78.5 percent on 247 children.
In District of Columbia, do children on antipsychotics get the blood tests?
10.9 percent of children aged 1 to 17 on two or more antipsychotic prescriptions had both tests — the second-lowest of the 51 states that reported it, against a national median of 32.9 percent. Across ages 1 to 17: glucose 26.9 percent, cholesterol 11.8 percent, on 338 children.
In District of Columbia, how often does the 30-day ADHD follow-up visit happen?
34.4 percent of the time, on 433 children aged 6 to 12 newly prescribed an ADHD medicine — the fourth-lowest of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 45.9 percent in District of Columbia against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, District of Columbia rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 81.1 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 77.1 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 78.5 on a denominator of 247; APM-CH both blood tests, 1 to 11: DS, data suppressed; APM-CH both blood tests, 12 to 17: 12.0 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 10.9 on a denominator of 338; APM-CH glucose alone, 1 to 17: 26.9 on a denominator of 338; APM-CH cholesterol alone, 1 to 17: 11.8 on a denominator of 338; ADD-CH 30-day adhd follow-up, 6 to 12: 34.4 on a denominator of 433; ADD-CH nine-month adhd follow-up, 6 to 12: 45.9 on a denominator of 37. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, District of Columbia rows, summed by product name, read 2026-09-28: hydroxyzine 17,345 prescriptions, $195,649, 235 of 488 rows suppressed; benzodiazepines 18,736 prescriptions, $193,240, 901 of 1,338 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