children’s psychiatric drugs in virginia medicaid: virginia’s own three numbers
virginia told cms three things about its children in the 2025 reporting year: 54.3 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 38th of the 50 states that reported it; 29.7 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 22nd of the 49 states that reported it; 41.5 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 38th of the 51 states that reported it.[1]
across the whole age range, virginia sits above the national median on the two metabolic blood tests and below the national median on psychosocial care before an antipsychotic. same state, same year, same children.
every row virginia sent to cms
| measure | virginia | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 54.3 | withheld | 38 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 60.8 | withheld | 37 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 58.8 | 2,707 | 39 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 29.7 | withheld | 22 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 39.2 | withheld | 21 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 36.2 | 6,933 | 22 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 56.3 | 6,933 | 18 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 37.7 | 6,933 | 22 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 41.5 | 11,376 | 38 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 52.3 | 2,727 | 32 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, virginia reported 54.3 percent — 4.9 points below the national median of 59.2, and 38th of the 50 states that reported it. put the other way round, 45.7 percent of the youngest children in virginia who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 60.8 percent. across ages 1 to 17, 58.8 percent on 2,707 children, 39th of the 51 states that reported it. it reported 57.0 the year before on the same method, so this one moved 1.8 points up — the only one of the three where that comparison holds. either side of virginia on that row: south carolina at 58.9 and nebraska at 58.3.
the two blood tests
virginia reported that 29.7 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 22nd of the 49 states that reported it, 0.6 points above the national median of 29.1. split into halves across ages 1 to 17, glucose ran 56.3 percent and cholesterol 37.7 percent, both on 6,933 children — 18th of the 51 states that reported it on glucose, 22nd of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 36.2 percent. either side of virginia on the both-tests row for ages 1 to 17: south carolina at 36.3 and north carolina at 34.9.
the 30-day visit after a new adhd prescription
41.5 percent, on 11,376 children aged 6 to 12 who were newly prescribed an adhd medicine in virginia — 38th of the 51 states that reported it, 6.1 points below the national median of 47.6. that leaves 58.5 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 52.3 percent had at least two more visits on 2,727 children, against a national median of 55.5 — 32nd of the 49 states that reported it. either side of virginia on the 30-day row: indiana at 42.8 and idaho at 40.6.
what medicaid paid for in virginia in 2024
in 2024 medicaid in virginia paid for 272,377 hydroxyzine prescriptions, $2,846,388 worth, and 352,495 benzodiazepine prescriptions, $49,103,234 worth — 77.3 hydroxyzine prescriptions for every 100 benzodiazepine ones. 220 of the 636 hydroxyzine rows and 1,133 of the 2,272 benzodiazepine rows for virginia 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 virginia’s own numbers behind them
ask which drug it is, not which class
virginia, 2024: 272,377 hydroxyzine prescriptions and 352,495 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
virginia: 54.3 percent of children aged 1 to 11, 38th of the 50 states that reported it
in 45.7 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
virginia: 29.7 percent of children aged 1 to 11 had both tests, 22nd of the 49 states that reported it
missed 70.3 percent of the time in virginia. 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
virginia: 41.5 percent, 38th of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and virginia misses it 58.5 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 Virginia, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Virginia reported 54.3 percent for children aged 1 to 11, against a national median of 59.2 percent — 38th of the 50 states that reported it. For ages 12 to 17 it was 60.8 percent, and across ages 1 to 17 58.8 percent on 2,707 children.
In Virginia, do children on antipsychotics get the blood tests?
29.7 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 22nd of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 56.3 percent, cholesterol 37.7 percent, on 6,933 children.
In Virginia, how often does the 30-day ADHD follow-up visit happen?
41.5 percent of the time, on 11,376 children aged 6 to 12 newly prescribed an ADHD medicine — 38th of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 52.3 percent in Virginia against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Virginia rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 54.3 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 60.8 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 58.8 on a denominator of 2,707; APM-CH both blood tests, 1 to 11: 29.7 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 39.2 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 36.2 on a denominator of 6,933; APM-CH glucose alone, 1 to 17: 56.3 on a denominator of 6,933; APM-CH cholesterol alone, 1 to 17: 37.7 on a denominator of 6,933; ADD-CH 30-day adhd follow-up, 6 to 12: 41.5 on a denominator of 11,376; ADD-CH nine-month adhd follow-up, 6 to 12: 52.3 on a denominator of 2,727. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Virginia rows, summed by product name, read 2026-09-28: hydroxyzine 272,377 prescriptions, $2,846,388, 220 of 636 rows suppressed; benzodiazepines 352,495 prescriptions, $49,103,234, 1,133 of 2,272 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