children’s psychiatric drugs in montana medicaid: montana’s own three numbers
montana told cms three things about its children in the 2025 reporting year: 68.0 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 12th of the 50 states that reported it; 61.5 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, the highest of the 49 states that reported it; 49.1 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 20th of the 51 states that reported it.[1]
across the whole age range, montana sits in the top quarter of the country on the two metabolic blood tests and above the national median on the 30-day adhd follow-up. same state, same year, same children.
every row montana sent to cms
| measure | montana | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 68.0 | withheld | 12 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 70.1 | withheld | 14 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 69.7 | 346 | 13 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 61.5 | withheld | 1 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 48.4 | withheld | 8 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 51.9 | 1,342 | 5 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 69.4 | 1,342 | 5 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 52.5 | 1,342 | 6 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 49.1 | withheld | 20 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | suppressed | withheld | — | 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, montana reported 68.0 percent — 8.8 points above the national median of 59.2, and 12th of the 50 states that reported it. put the other way round, 32.0 percent of the youngest children in montana who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 70.1 percent. across ages 1 to 17, 69.7 percent on 346 children, 13th of the 51 states that reported it. it reported 67.1 the year before on the same method, so this one moved 2.6 points up — the only one of the three where that comparison holds. either side of montana on that row: wyoming at 70.9 and arizona at 69.5.
the two blood tests
montana reported that 61.5 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — the highest of the 49 states that reported it, 32.4 points above the national median of 29.1. split into halves across ages 1 to 17, glucose ran 69.4 percent and cholesterol 52.5 percent, both on 1,342 children — the fifth-highest of the 51 states that reported it on glucose, 6th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 51.9 percent. either side of montana on the both-tests row for ages 1 to 17: pennsylvania at 56.3 and delaware at 51.3.
the 30-day visit after a new adhd prescription
49.1 percent — 20th of the 51 states that reported it, 1.5 points above the national median of 47.6. that leaves 50.9 percent of those children with no recorded prescriber visit in the month after the medicine started. Montana reported this measure for 2025, and CMS suppressed the cell: the nine-month continuation rate 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. either side of montana on the 30-day row: california at 49.6 and tennessee at 48.9.
what is missing from montana’s file, and why
- ADD-CH nine-month adhd follow-up, 6 to 12: Montana 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 montana in 2024
in 2024 medicaid in montana paid for 39,908 hydroxyzine prescriptions, $593,741 worth, and 54,913 benzodiazepine prescriptions, $792,257 worth — 72.7 hydroxyzine prescriptions for every 100 benzodiazepine ones. 107 of the 302 hydroxyzine rows and 557 of the 1,131 benzodiazepine rows for montana 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 montana’s own numbers behind them
ask which drug it is, not which class
montana, 2024: 39,908 hydroxyzine prescriptions and 54,913 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
montana: 68.0 percent of children aged 1 to 11, 12th of the 50 states that reported it
in 32.0 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
montana: 61.5 percent of children aged 1 to 11 had both tests, the highest of the 49 states that reported it
missed 38.5 percent of the time in montana. 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
montana: 49.1 percent, 20th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and montana misses it 50.9 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 Montana, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Montana reported 68.0 percent for children aged 1 to 11, against a national median of 59.2 percent — 12th of the 50 states that reported it. For ages 12 to 17 it was 70.1 percent, and across ages 1 to 17 69.7 percent on 346 children.
In Montana, do children on antipsychotics get the blood tests?
61.5 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — the highest of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 69.4 percent, cholesterol 52.5 percent, on 1,342 children.
In Montana, how often does the 30-day ADHD follow-up visit happen?
49.1 percent of the time — 20th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was not published for Montana.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Montana rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 68.0 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 70.1 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 69.7 on a denominator of 346; APM-CH both blood tests, 1 to 11: 61.5 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 48.4 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 51.9 on a denominator of 1,342; APM-CH glucose alone, 1 to 17: 69.4 on a denominator of 1,342; APM-CH cholesterol alone, 1 to 17: 52.5 on a denominator of 1,342; ADD-CH 30-day adhd follow-up, 6 to 12: 49.1 (denominator not publicly reported); ADD-CH nine-month adhd follow-up, 6 to 12: DS, data suppressed. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Montana rows, summed by product name, read 2026-09-28: hydroxyzine 39,908 prescriptions, $593,741, 107 of 302 rows suppressed; benzodiazepines 54,913 prescriptions, $792,257, 557 of 1,131 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