children’s psychiatric drugs in massachusetts medicaid: massachusetts’s own three numbers
massachusetts told cms three things about its children in the 2025 reporting year: 69.4 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 10th of the 50 states that reported it; 39.4 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 8th of the 49 states that reported it; 38.4 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 45th of the 51 states that reported it.[1]
across the whole age range, massachusetts sits in the top quarter of the country on psychosocial care before an antipsychotic and in the bottom quarter of the country on the 30-day adhd follow-up. same state, same year, same children.
every row massachusetts sent to cms
| measure | massachusetts | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 69.4 | withheld | 10 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 72.6 | withheld | 8 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 71.7 | 1,419 | 8 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 39.4 | withheld | 8 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 41.0 | withheld | 16 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 40.6 | 5,058 | 11 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 58.7 | 5,058 | 13 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 43.0 | 5,058 | 12 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 38.4 | 7,466 | 45 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 44.5 | 2,059 | 44 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, massachusetts reported 69.4 percent — 10.2 points above the national median of 59.2, and 10th of the 50 states that reported it. put the other way round, 30.6 percent of the youngest children in massachusetts who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 72.6 percent. across ages 1 to 17, 71.7 percent on 1,419 children, 8th of the 51 states that reported it. it reported 71.0 the year before on the same method, so this one moved 0.7 points up — the only one of the three where that comparison holds. either side of massachusetts on that row: maryland at 71.8 and kansas at 71.2.
the two blood tests
massachusetts reported that 39.4 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 8th of the 49 states that reported it, 10.3 points above the national median of 29.1. split into halves across ages 1 to 17, glucose ran 58.7 percent and cholesterol 43.0 percent, both on 5,058 children — 13th of the 51 states that reported it on glucose, 12th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 40.6 percent. either side of massachusetts on the both-tests row for ages 1 to 17: new york at 41.7 and tennessee at 40.3.
the 30-day visit after a new adhd prescription
38.4 percent, on 7,466 children aged 6 to 12 who were newly prescribed an adhd medicine in massachusetts — 45th of the 51 states that reported it, 9.2 points below the national median of 47.6. that leaves 61.6 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 44.5 percent had at least two more visits on 2,059 children, against a national median of 55.5 — 44th of the 49 states that reported it. either side of massachusetts on the 30-day row: alaska at 39.0 and delaware at 35.3.
what medicaid paid for in massachusetts in 2024
in 2024 medicaid in massachusetts paid for 182,966 hydroxyzine prescriptions, $1,960,216 worth, and 463,915 benzodiazepine prescriptions, $5,182,435 worth — 39.4 hydroxyzine prescriptions for every 100 benzodiazepine ones. 158 of the 622 hydroxyzine rows and 1,019 of the 2,537 benzodiazepine rows for massachusetts 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 massachusetts’s own numbers behind them
ask which drug it is, not which class
massachusetts, 2024: 182,966 hydroxyzine prescriptions and 463,915 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
massachusetts: 69.4 percent of children aged 1 to 11, 10th of the 50 states that reported it
in 30.6 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
massachusetts: 39.4 percent of children aged 1 to 11 had both tests, 8th of the 49 states that reported it
missed 60.6 percent of the time in massachusetts. 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
massachusetts: 38.4 percent, 45th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and massachusetts misses it 61.6 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 Massachusetts, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Massachusetts reported 69.4 percent for children aged 1 to 11, against a national median of 59.2 percent — 10th of the 50 states that reported it. For ages 12 to 17 it was 72.6 percent, and across ages 1 to 17 71.7 percent on 1,419 children.
In Massachusetts, do children on antipsychotics get the blood tests?
39.4 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 8th of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 58.7 percent, cholesterol 43.0 percent, on 5,058 children.
In Massachusetts, how often does the 30-day ADHD follow-up visit happen?
38.4 percent of the time, on 7,466 children aged 6 to 12 newly prescribed an ADHD medicine — 45th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 44.5 percent in Massachusetts against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Massachusetts rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 69.4 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 72.6 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 71.7 on a denominator of 1,419; APM-CH both blood tests, 1 to 11: 39.4 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 41.0 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 40.6 on a denominator of 5,058; APM-CH glucose alone, 1 to 17: 58.7 on a denominator of 5,058; APM-CH cholesterol alone, 1 to 17: 43.0 on a denominator of 5,058; ADD-CH 30-day adhd follow-up, 6 to 12: 38.4 on a denominator of 7,466; ADD-CH nine-month adhd follow-up, 6 to 12: 44.5 on a denominator of 2,059. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Massachusetts rows, summed by product name, read 2026-09-28: hydroxyzine 182,966 prescriptions, $1,960,216, 158 of 622 rows suppressed; benzodiazepines 463,915 prescriptions, $5,182,435, 1,019 of 2,537 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