children’s psychiatric drugs in missouri medicaid: missouri’s own three numbers
missouri told cms three things about its children in the 2025 reporting year: 51.5 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 44th of the 50 states that reported it; 42.8 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 7th of the 49 states that reported it; 40.1 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 40th of the 51 states that reported it.[1]
across the whole age range, missouri sits in the top quarter of the country on the two metabolic blood tests and in the bottom quarter of the country on psychosocial care before an antipsychotic. same state, same year, same children.
every row missouri sent to cms
| measure | missouri | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 51.5 | withheld | 44 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 54.5 | withheld | 44 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 53.6 | 4,589 | 44 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 42.8 | withheld | 7 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 42.5 | withheld | 12 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 42.6 | 9,266 | 9 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 63.0 | 9,266 | 7 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 43.2 | 9,266 | 10 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 40.1 | 12,729 | 40 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 45.1 | 4,734 | 43 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, missouri reported 51.5 percent — 7.7 points below the national median of 59.2, and 44th of the 50 states that reported it. put the other way round, 48.5 percent of the youngest children in missouri who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 54.5 percent. across ages 1 to 17, 53.6 percent on 4,589 children, 44th of the 51 states that reported it. it reported 51.9 the year before on the same method, so this one moved 1.7 points up — the only one of the three where that comparison holds. either side of missouri on that row: hawaii at 54.9 and south dakota at 53.6.
the two blood tests
missouri reported that 42.8 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 7th of the 49 states that reported it, 13.7 points above the national median of 29.1. split into halves across ages 1 to 17, glucose ran 63.0 percent and cholesterol 43.2 percent, both on 9,266 children — 7th of the 51 states that reported it on glucose, 10th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 42.6 percent. either side of missouri on the both-tests row for ages 1 to 17: arizona at 45.8 and new york at 41.7.
the 30-day visit after a new adhd prescription
40.1 percent, on 12,729 children aged 6 to 12 who were newly prescribed an adhd medicine in missouri — 40th of the 51 states that reported it, 7.5 points below the national median of 47.6. that leaves 59.9 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 45.1 percent had at least two more visits on 4,734 children, against a national median of 55.5 — 43rd of the 49 states that reported it. either side of missouri on the 30-day row: idaho at 40.6 and alabama at 40.0.
what medicaid paid for in missouri in 2024
in 2024 medicaid in missouri paid for 240,482 hydroxyzine prescriptions, $3,720,466 worth, and 178,118 benzodiazepine prescriptions, $2,977,559 worth — 135.0 hydroxyzine prescriptions for every 100 benzodiazepine ones. 75 of the 367 hydroxyzine rows and 441 of the 1,398 benzodiazepine rows for missouri 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 missouri’s own numbers behind them
ask which drug it is, not which class
missouri, 2024: 240,482 hydroxyzine prescriptions and 178,118 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
missouri: 51.5 percent of children aged 1 to 11, 44th of the 50 states that reported it
in 48.5 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
missouri: 42.8 percent of children aged 1 to 11 had both tests, 7th of the 49 states that reported it
missed 57.2 percent of the time in missouri. 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
missouri: 40.1 percent, 40th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and missouri misses it 59.9 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 Missouri, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Missouri reported 51.5 percent for children aged 1 to 11, against a national median of 59.2 percent — 44th of the 50 states that reported it. For ages 12 to 17 it was 54.5 percent, and across ages 1 to 17 53.6 percent on 4,589 children.
In Missouri, do children on antipsychotics get the blood tests?
42.8 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 7th of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 63.0 percent, cholesterol 43.2 percent, on 9,266 children.
In Missouri, how often does the 30-day ADHD follow-up visit happen?
40.1 percent of the time, on 12,729 children aged 6 to 12 newly prescribed an ADHD medicine — 40th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 45.1 percent in Missouri against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Missouri rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 51.5 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 54.5 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 53.6 on a denominator of 4,589; APM-CH both blood tests, 1 to 11: 42.8 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 42.5 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 42.6 on a denominator of 9,266; APM-CH glucose alone, 1 to 17: 63.0 on a denominator of 9,266; APM-CH cholesterol alone, 1 to 17: 43.2 on a denominator of 9,266; ADD-CH 30-day adhd follow-up, 6 to 12: 40.1 on a denominator of 12,729; ADD-CH nine-month adhd follow-up, 6 to 12: 45.1 on a denominator of 4,734. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Missouri rows, summed by product name, read 2026-09-28: hydroxyzine 240,482 prescriptions, $3,720,466, 75 of 367 rows suppressed; benzodiazepines 178,118 prescriptions, $2,977,559, 441 of 1,398 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