children’s psychiatric drugs in washington medicaid: washington’s own three numbers
washington told cms three things about its children in the 2025 reporting year: 57.2 percent of children aged 1 to 11 newly prescribed an antipsychotic had psychosocial care documented first, 31st of the 50 states that reported it; 24.7 percent of children on two or more antipsychotics got both the glucose and the cholesterol test, 33rd of the 49 states that reported it; 44.7 percent of children aged 6 to 12 starting an adhd medicine were seen again inside 30 days, 32nd of the 51 states that reported it.[1]
across the whole age range, washington sits above the national median on psychosocial care before an antipsychotic and below the national median on the two metabolic blood tests. same state, same year, same children.
every row washington sent to cms
| measure | washington | denominator | rank | national median |
|---|---|---|---|---|
| APP-CHpsychosocial care first, 1 to 11 | 57.2 | withheld | 31 of 50 | 59.2 |
| APP-CHpsychosocial care first, 12 to 17 | 63.0 | withheld | 29 of 51 | 63.8 |
| APP-CHpsychosocial care first, 1 to 17 | 61.5 | 1,266 | 26 of 51 | 61.4 |
| APM-CHboth blood tests, 1 to 11 | 24.7 | withheld | 33 of 49 | 29.1 |
| APM-CHboth blood tests, 12 to 17 | 30.6 | withheld | 39 of 51 | 36.3 |
| APM-CHboth blood tests, 1 to 17 | 28.8 | 3,993 | 37 of 51 | 32.9 |
| APM-CHglucose alone, 1 to 17 | 54.7 | 3,993 | 23 of 51 | 54.4 |
| APM-CHcholesterol alone, 1 to 17 | 30.2 | 3,993 | 37 of 51 | 34.8 |
| ADD-CH30-day adhd follow-up, 6 to 12 | 44.7 | 5,959 | 32 of 51 | 47.6 |
| ADD-CHnine-month adhd follow-up, 6 to 12 | 52.8 | 2,206 | 31 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, washington reported 57.2 percent — 2.0 points below the national median of 59.2, and 31st of the 50 states that reported it. put the other way round, 42.8 percent of the youngest children in washington who were started on an antipsychotic had no psychosocial care documented before it. for adolescents aged 12 to 17 the figure was 63.0 percent. across ages 1 to 17, 61.5 percent on 1,266 children, 26th of the 51 states that reported it. it reported 61.1 the year before on the same method, so this one moved 0.4 points up — the only one of the three where that comparison holds. either side of washington on that row: mississippi at 61.9 and florida at 61.2.
the two blood tests
washington reported that 24.7 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 33rd of the 49 states that reported it, 4.4 points below the national median of 29.1. split into halves across ages 1 to 17, glucose ran 54.7 percent and cholesterol 30.2 percent, both on 3,993 children — 23rd of the 51 states that reported it on glucose, 37th of the 51 states that reported it on cholesterol. across ages 1 to 17 the both-tests rate was 28.8 percent. either side of washington on the both-tests row for ages 1 to 17: colorado at 30.1 and louisiana at 28.5.
the 30-day visit after a new adhd prescription
44.7 percent, on 5,959 children aged 6 to 12 who were newly prescribed an adhd medicine in washington — 32nd of the 51 states that reported it, 2.9 points below the national median of 47.6. that leaves 55.3 percent of those children with no recorded prescriber visit in the month after the medicine started. over the nine months that follow, 52.8 percent had at least two more visits on 2,206 children, against a national median of 55.5 — 31st of the 49 states that reported it. either side of washington on the 30-day row: new hampshire at 45.3 and south carolina at 44.4.
what medicaid paid for in washington in 2024
in 2024 medicaid in washington paid for 210,339 hydroxyzine prescriptions, $1,457,673 worth, and 215,527 benzodiazepine prescriptions, $1,671,929 worth — 97.6 hydroxyzine prescriptions for every 100 benzodiazepine ones. 158 of the 503 hydroxyzine rows and 935 of the 1,858 benzodiazepine rows for washington 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 washington’s own numbers behind them
ask which drug it is, not which class
washington, 2024: 210,339 hydroxyzine prescriptions and 215,527 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
washington: 57.2 percent of children aged 1 to 11, 31st of the 50 states that reported it
in 42.8 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
washington: 24.7 percent of children aged 1 to 11 had both tests, 33rd of the 49 states that reported it
missed 75.3 percent of the time in washington. 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
washington: 44.7 percent, 32nd of the 51 states that reported it
this is where a dose gets checked and a wrong fit is caught, and washington misses it 55.3 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 Washington, how many children get therapy before they get an antipsychotic?
In the 2025 reporting year Washington reported 57.2 percent for children aged 1 to 11, against a national median of 59.2 percent — 31st of the 50 states that reported it. For ages 12 to 17 it was 63.0 percent, and across ages 1 to 17 61.5 percent on 1,266 children.
In Washington, do children on antipsychotics get the blood tests?
24.7 percent of children aged 1 to 11 on two or more antipsychotic prescriptions had both tests — 33rd of the 49 states that reported it, against a national median of 29.1 percent. Across ages 1 to 17: glucose 54.7 percent, cholesterol 30.2 percent, on 3,993 children.
In Washington, how often does the 30-day ADHD follow-up visit happen?
44.7 percent of the time, on 5,959 children aged 6 to 12 newly prescribed an ADHD medicine — 32nd of the 51 states that reported it, against a national median of 47.6 percent. The nine-month measure, two further visits, was 52.8 percent in Washington against a median of 55.5.
sources
- CMS Medicaid/CHIP Child Core Set, 2025 reporting year, Washington rows, read 2026-09-28. APP-CH psychosocial care first, 1 to 11: 57.2 (denominator not publicly reported); APP-CH psychosocial care first, 12 to 17: 63.0 (denominator not publicly reported); APP-CH psychosocial care first, 1 to 17: 61.5 on a denominator of 1,266; APM-CH both blood tests, 1 to 11: 24.7 (denominator not publicly reported); APM-CH both blood tests, 12 to 17: 30.6 (denominator not publicly reported); APM-CH both blood tests, 1 to 17: 28.8 on a denominator of 3,993; APM-CH glucose alone, 1 to 17: 54.7 on a denominator of 3,993; APM-CH cholesterol alone, 1 to 17: 30.2 on a denominator of 3,993; ADD-CH 30-day adhd follow-up, 6 to 12: 44.7 on a denominator of 5,959; ADD-CH nine-month adhd follow-up, 6 to 12: 52.8 on a denominator of 2,206. Method and ranking scope: /medicaid-children. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
- CMS State Drug Utilization Data 2024, Washington rows, summed by product name, read 2026-09-28: hydroxyzine 210,339 prescriptions, $1,457,673, 158 of 503 rows suppressed; benzodiazepines 215,527 prescriptions, $1,671,929, 935 of 1,858 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