children’s psychiatric drugs in north dakota medicaid: north dakota’s own three numbers
north dakota told cms three things about its children in the 2025 reporting year: 57.3 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 30th of the 50 states that reported it; 36.9 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 10th of the 49 states that reported it; 30.2 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, the lowest of the 51 states that reported it.[1]
across the whole age range, north dakota sits above the national median on the two metabolic blood tests and in the bottom quarter of the country on the 30-day adhd follow-up. same state, same year, same children.
every row north dakota sent to cms
| measure | north dakota | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 57.3 | withheld | 30 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 62.5 | withheld | 32 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 60.4 | 359 | 32 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 36.9 | withheld | 10 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 40.7 | withheld | 17 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 39.3 | 1,031 | 14 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 57.4 | 1,031 | 14 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 40.3 | 1,031 | 15 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 30.2 | 636 | 51 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 32.7 | 422 | 48 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, north dakota reported 57.3 percent — 1.9 points below the national median of 59.2, and 30th of the 50 states that reported it. put the other way round, 42.7 percent of the youngest children in north dakota who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 62.5 percent. across ages 1 to 17, 60.4 percent on 359 children, 32nd of the 51 states that reported it. it reported 60.2 the year before on the same method, so this one moved 0.2 points up — the only one of the three where that comparison holds. either side of north dakota on that row: rhode island at 60.5 and alaska at 59.8.
the two blood tests
north dakota reported that 36.9 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 10th of the 49 states that reported it, 7.8 points above the national median of 29.1. split into halves across ages 1 to 17, glucose ran 57.4 percent and cholesterol 40.3 percent, both on 1,031 children — 14th of the 51 states that reported it on glucose, 15th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 39.3 percent. either side of north dakota on the both-tests row for ages 1 to 17: maine at 39.9 and florida at 38.8.
the 30-day visit after a new adhd prescription
30.2 percent, on 636 children aged 6 to 12 who were newly prescribed an adhd medicine in north dakota — the lowest of the 51 states that reported it, 17.4 points below the national median of 47.6. that leaves 69.8 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 32.7 percent had at least two more visits on 422 children, against a national median of 55.5 — the second-lowest of the 49 states that reported it. either side of north dakota on the 30-day row: new jersey at 32.1.
what medicaid paid for in north dakota in 2024
in 2024 medicaid in north dakota paid for 14,561 hydroxyzine prescriptions, $212,004 worth, and 25,855 benzodiazepine prescriptions, $344,830 worth — 56.3 hydroxyzine prescriptions for every 100 benzodiazepine ones. 111 of the 280 hydroxyzine rows and 596 of the 1,006 benzodiazepine rows for north dakota 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 north dakota’s own numbers behind them
ask which drug it is, not which class
north dakota, 2024: 14,561 hydroxyzine prescriptions and 25,855 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
north dakota: 57.3 percent of children aged 1 to 11, 30th of the 50 states that reported it
in 42.7 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
north dakota: 36.9 percent of children aged 1 to 11 had both tests, 10th of the 49 states that reported it
missed 63.1 percent of the time in north dakota. 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
north dakota: 30.2 percent, the lowest of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and north dakota misses it 69.8 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 North Dakota, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year North Dakota reported 57.3 percent for children aged 1 to 11, against a national median of 59.2 percent — 30th of the 50 states that reported it. For ages 12 to 17 it was 62.5 percent, and across ages 1 to 17 60.4 percent on 359 children.
In North Dakota, do children on antipsychotics get the blood tests?
36.9 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 10th of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 57.4 percent, cholesterol 40.3 percent, on 1,031 children.
In North Dakota, how often does the 30-day ADHD follow-up visit happen?
30.2 percent of the time, on 636 children aged 6 to 12 newly prescribed an ADHD medicine — the lowest of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 32.7 percent in North Dakota against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, North Dakota rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 57.3 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 62.5 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 60.4 on a denominator of 359; APM-CH both blood tests, 1 to 11: 36.9 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 40.7 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 39.3 on a denominator of 1,031; APM-CH glucose alone, 1 to 17: 57.4 on a denominator of 1,031; APM-CH cholesterol alone, 1 to 17: 40.3 on a denominator of 1,031; ADD-CH 30-day adhd follow-up, 6 to 12: 30.2 on a denominator of 636; ADD-CH nine-month adhd follow-up, 6 to 12: 32.7 on a denominator of 422. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, North Dakota rows, summed by product name, read 2026-09-28: hydroxyzine 14,561 prescriptions, $212,004, 111 of 280 rows suppressed; benzodiazepines 25,855 prescriptions, $344,830, 596 of 1,006 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