children’s psychiatric drugs in hawaii medicaid: hawaii’s own three numbers
hawaii told cms three things about its children in the 2025 reporting year: no publishable rate for psychosocial care before an antipsychotic in children aged 1 to 11; 18.2 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 44th of the 49 states that reported it; 43.2 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 36th of the 51 states that reported it.[1]
across the whole age range, hawaii sits below the national median on the 30-day adhd follow-up and in the bottom quarter of the country on the two metabolic blood tests. same state, same year, same children.
every row hawaii sent to cms
| measure | hawaii | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | under 30 | withheld | — | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 55.1 | withheld | 43 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 54.9 | 102 | 43 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 18.2 | withheld | 44 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 23.0 | withheld | 46 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 21.9 | 301 | 46 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 51.5 | 301 | 35 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 24.3 | 301 | 45 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 43.2 | 461 | 36 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 55.6 | 133 | 24 of 49 | 55.5 |
rank 1 is the highest rate. how the ranks and the withheld cells work.[1]
talking treatment before the antipsychotic
cms did not publish a rate for hawaii here because fewer than 30 children were in the denominator. too few children to count is not the same as none, and it is not a zero. for adolescents aged 12 to 17 the figure was 55.1 percent. across ages 1 to 17, 54.9 percent on 102 children, 43rd of the 51 states that reported it. it reported 46.7 the year before on the same method, so this one moved 8.2 points up — the only one of the three where that comparison holds. either side of hawaii on that row: oklahoma at 55.7 and missouri at 53.6.
the two blood tests
hawaii reported that 18.2 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 44th of the 49 states that reported it, 10.9 points below the national median of 29.1. split into halves across ages 1 to 17, glucose ran 51.5 percent and cholesterol 24.3 percent, both on 301 children — 35th of the 51 states that reported it on glucose, 45th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 21.9 percent. either side of hawaii on the both-tests row for ages 1 to 17: alabama at 23.1 and oklahoma at 19.9.
the 30-day visit after a new adhd prescription
43.2 percent, on 461 children aged 6 to 12 who were newly prescribed an adhd medicine in hawaii — 36th of the 51 states that reported it, 4.4 points below the national median of 47.6. that leaves 56.8 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 55.6 percent had at least two more visits on 133 children, against a national median of 55.5 — 24th of the 49 states that reported it. either side of hawaii on the 30-day row: texas at 43.9 and indiana at 42.8.
what is missing from hawaii’s file, and why
- APP-CH psychosocial care first, 1 to 11: CMS did not publish a rate for Hawaii here because fewer than 30 children were in the denominator. Too few children to count is not the same as none, and it is not a zero.
what medicaid paid for in hawaii in 2024
in 2024 medicaid in hawaii paid for 15,563 hydroxyzine prescriptions, $79,579 worth, and 38,834 benzodiazepine prescriptions, $244,323 worth — 40.1 hydroxyzine prescriptions for every 100 benzodiazepine ones. 90 of the 202 hydroxyzine rows and 458 of the 854 benzodiazepine rows for hawaii 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 hawaii’s own numbers behind them
ask which drug it is, not which class
hawaii, 2024: 15,563 hydroxyzine prescriptions and 38,834 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
hawaii: no publishable rate for ages 1 to 11; 54.9 percent across ages 1 to 17
the youngest band is withheld here; the wider age range is not. 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
hawaii: 18.2 percent of children aged 1 to 11 had both tests, 44th of the 49 states that reported it
missed 81.8 percent of the time in hawaii. 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
hawaii: 43.2 percent, 36th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and hawaii misses it 56.8 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 Hawaii, how many children get therapy before they get an antipsychotic?
CMS did not publish a rate for Hawaii here because fewer than 30 children were in the denominator. Too few children to count is not the same as none, and it is not a zero. Across ages 1 to 17 Hawaii reported 54.9 percent.
In Hawaii, do children on antipsychotics get the blood tests?
18.2 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 44th of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 51.5 percent, cholesterol 24.3 percent, on 301 children.
In Hawaii, how often does the 30-day ADHD follow-up visit happen?
43.2 percent of the time, on 461 children aged 6 to 12 newly prescribed an ADHD medicine — 36th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 55.6 percent in Hawaii against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Hawaii rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: #, denominator under 30; APP-CH psychosocial care first, 12 to 17: 55.1 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 54.9 on a denominator of 102; APM-CH both blood tests, 1 to 11: 18.2 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 23.0 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 21.9 on a denominator of 301; APM-CH glucose alone, 1 to 17: 51.5 on a denominator of 301; APM-CH cholesterol alone, 1 to 17: 24.3 on a denominator of 301; ADD-CH 30-day adhd follow-up, 6 to 12: 43.2 on a denominator of 461; ADD-CH nine-month adhd follow-up, 6 to 12: 55.6 on a denominator of 133. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Hawaii rows, summed by product name, read 2026-09-28: hydroxyzine 15,563 prescriptions, $79,579, 90 of 202 rows suppressed; benzodiazepines 38,834 prescriptions, $244,323, 458 of 854 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