children’s psychiatric drugs in texas medicaid: texas’s own three numbers
texas told cms three things about its children in the 2025 reporting year: 46.3 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, the third-lowest of the 50 states that reported it; 31.1 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 18th of the 49 states that reported it; 43.9 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 35th of the 51 states that reported it.[1]
across the whole age range, texas sits above the national median 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 texas sent to cms
| measure | texas | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 46.3 | withheld | 48 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 51.1 | withheld | 47 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 49.3 | 13,185 | 49 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 31.1 | withheld | 18 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 41.8 | withheld | 13 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 37.7 | 34,460 | 16 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 54.9 | 34,460 | 21 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 38.7 | 34,460 | 19 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 43.9 | 46,379 | 35 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 55.3 | 8,291 | 25 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, texas reported 46.3 percent — 12.9 points below the national median of 59.2, and the third-lowest of the 50 states that reported it. put the other way round, 53.7 percent of the youngest children in texas who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 51.1 percent. across ages 1 to 17, 49.3 percent on 13,185 children, the third-lowest of the 51 states that reported it. it reported 44.2 the year before on the same method, so this one moved 5.1 points up — the only one of the three where that comparison holds. either side of texas on that row: idaho at 50.1 and new jersey at 48.0.
the two blood tests
texas reported that 31.1 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 18th of the 49 states that reported it, 2.0 points above the national median of 29.1. split into halves across ages 1 to 17, glucose ran 54.9 percent and cholesterol 38.7 percent, both on 34,460 children — 21st of the 51 states that reported it on glucose, 19th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 37.7 percent. either side of texas on the both-tests row for ages 1 to 17: florida at 38.8 and new hampshire at 37.4.
the 30-day visit after a new adhd prescription
43.9 percent, on 46,379 children aged 6 to 12 who were newly prescribed an adhd medicine in texas — 35th of the 51 states that reported it, 3.7 points below the national median of 47.6. that leaves 56.1 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 55.3 percent had at least two more visits on 8,291 children, against a national median of 55.5 — 25th of the 49 states that reported it. either side of texas on the 30-day row: wyoming at 44.3 and hawaii at 43.2.
what medicaid paid for in texas in 2024
in 2024 medicaid in texas paid for 315,357 hydroxyzine prescriptions, $3,327,401 worth, and 298,370 benzodiazepine prescriptions, $17,048,782 worth — 105.7 hydroxyzine prescriptions for every 100 benzodiazepine ones. 196 of the 534 hydroxyzine rows and 822 of the 1,906 benzodiazepine rows for texas 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 texas’s own numbers behind them
ask which drug it is, not which class
texas, 2024: 315,357 hydroxyzine prescriptions and 298,370 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
texas: 46.3 percent of children aged 1 to 11, the third-lowest of the 50 states that reported it
in 53.7 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
texas: 31.1 percent of children aged 1 to 11 had both tests, 18th of the 49 states that reported it
missed 68.9 percent of the time in texas. 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
texas: 43.9 percent, 35th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and texas misses it 56.1 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 Texas, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Texas reported 46.3 percent for children aged 1 to 11, against a national median of 59.2 percent — the third-lowest of the 50 states that reported it. For ages 12 to 17 it was 51.1 percent, and across ages 1 to 17 49.3 percent on 13,185 children.
In Texas, do children on antipsychotics get the blood tests?
31.1 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 18th of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 54.9 percent, cholesterol 38.7 percent, on 34,460 children.
In Texas, how often does the 30-day ADHD follow-up visit happen?
43.9 percent of the time, on 46,379 children aged 6 to 12 newly prescribed an ADHD medicine — 35th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 55.3 percent in Texas against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Texas rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 46.3 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 51.1 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 49.3 on a denominator of 13,185; APM-CH both blood tests, 1 to 11: 31.1 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 41.8 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 37.7 on a denominator of 34,460; APM-CH glucose alone, 1 to 17: 54.9 on a denominator of 34,460; APM-CH cholesterol alone, 1 to 17: 38.7 on a denominator of 34,460; ADD-CH 30-day adhd follow-up, 6 to 12: 43.9 on a denominator of 46,379; ADD-CH nine-month adhd follow-up, 6 to 12: 55.3 on a denominator of 8,291. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Texas rows, summed by product name, read 2026-09-28: hydroxyzine 315,357 prescriptions, $3,327,401, 196 of 534 rows suppressed; benzodiazepines 298,370 prescriptions, $17,048,782, 822 of 1,906 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