children’s psychiatric drugs in iowa medicaid: iowa’s own three numbers
iowa told cms three things about its children in the 2025 reporting year: 59.2 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 25th of the 50 states that reported it; 19.5 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 43rd of the 49 states that reported it; 55.1 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 9th of the 51 states that reported it.[1]
across the whole age range, iowa sits in the top quarter of the country 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 iowa sent to cms
| measure | iowa | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 59.2 | withheld | 25 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 65.0 | withheld | 24 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 62.7 | 1,783 | 23 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 19.5 | withheld | 43 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 28.6 | withheld | 44 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 25.4 | 6,254 | 44 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 48.4 | 6,254 | 43 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 26.4 | 6,254 | 44 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 55.1 | 5,465 | 9 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 62.5 | 1,612 | 6 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, iowa reported 59.2 percent — exactly the national median, and 25th of the 50 states that reported it. put the other way round, 40.8 percent of the youngest children in iowa who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 65.0 percent. across ages 1 to 17, 62.7 percent on 1,783 children, 23rd of the 51 states that reported it. it reported 60.4 the year before on the same method, so this one moved 2.3 points up — the only one of the three where that comparison holds. either side of iowa on that row: california at 62.7 and mississippi at 61.9.
the two blood tests
iowa reported that 19.5 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 43rd of the 49 states that reported it, 9.6 points below the national median of 29.1. split into halves across ages 1 to 17, glucose ran 48.4 percent and cholesterol 26.4 percent, both on 6,254 children — 43rd of the 51 states that reported it on glucose, 44th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 25.4 percent. either side of iowa on the both-tests row for ages 1 to 17: alaska at 26.3 and alabama at 23.1.
the 30-day visit after a new adhd prescription
55.1 percent, on 5,465 children aged 6 to 12 who were newly prescribed an adhd medicine in iowa — 9th of the 51 states that reported it, 7.5 points above the national median of 47.6. that leaves 44.9 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 62.5 percent had at least two more visits on 1,612 children, against a national median of 55.5 — 6th of the 49 states that reported it. either side of iowa on the 30-day row: mississippi at 55.7 and oklahoma at 54.6.
what medicaid paid for in iowa in 2024
in 2024 medicaid in iowa paid for 121,799 hydroxyzine prescriptions, $648,477 worth, and 177,801 benzodiazepine prescriptions, $9,216,366 worth — 68.5 hydroxyzine prescriptions for every 100 benzodiazepine ones. 167 of the 458 hydroxyzine rows and 944 of the 1,838 benzodiazepine rows for iowa 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 iowa’s own numbers behind them
ask which drug it is, not which class
iowa, 2024: 121,799 hydroxyzine prescriptions and 177,801 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
iowa: 59.2 percent of children aged 1 to 11, 25th of the 50 states that reported it
in 40.8 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
iowa: 19.5 percent of children aged 1 to 11 had both tests, 43rd of the 49 states that reported it
missed 80.5 percent of the time in iowa. 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
iowa: 55.1 percent, 9th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and iowa misses it 44.9 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 Iowa, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Iowa reported 59.2 percent for children aged 1 to 11, against a national median of 59.2 percent — 25th of the 50 states that reported it. For ages 12 to 17 it was 65.0 percent, and across ages 1 to 17 62.7 percent on 1,783 children.
In Iowa, do children on antipsychotics get the blood tests?
19.5 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 43rd of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 48.4 percent, cholesterol 26.4 percent, on 6,254 children.
In Iowa, how often does the 30-day ADHD follow-up visit happen?
55.1 percent of the time, on 5,465 children aged 6 to 12 newly prescribed an ADHD medicine — 9th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 62.5 percent in Iowa against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Iowa rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 59.2 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 65.0 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 62.7 on a denominator of 1,783; APM-CH both blood tests, 1 to 11: 19.5 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 28.6 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 25.4 on a denominator of 6,254; APM-CH glucose alone, 1 to 17: 48.4 on a denominator of 6,254; APM-CH cholesterol alone, 1 to 17: 26.4 on a denominator of 6,254; ADD-CH 30-day adhd follow-up, 6 to 12: 55.1 on a denominator of 5,465; ADD-CH nine-month adhd follow-up, 6 to 12: 62.5 on a denominator of 1,612. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Iowa rows, summed by product name, read 2026-09-28: hydroxyzine 121,799 prescriptions, $648,477, 167 of 458 rows suppressed; benzodiazepines 177,801 prescriptions, $9,216,366, 944 of 1,838 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