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Understanding and Addressing Antipsychotic Prescribing Practices for Medicaid-enrolled Children

Statement of Problem

Children enrolled in Medicaid, and particularly those in foster care, are more likely to be prescribed psychotropic medications than privately insured children. 

In 2016, the Pennsylvania Department of Human Services (DHS) announced several new initiatives to reduce the use of psychotropic medications among Medicaid-enrolled youth in the state, including the release of new prescribing guidelines for physicians. These initiatives were informed by research PolicyLab did in collaboration with DHS to review psychotropic prescribing in the Pennsylvania Medicaid program, with a focus on antipsychotic medications and prescribing trends to youth in foster care. 

While interim reporting from Pennsylvania’s Medicaid program shows initial declines in prescription rates of antipsychotics, we lack a nuanced understanding of how prescribing practices and diagnoses shifted following implementation of these state initiatives and the impacts of the COVID-19 pandemic on mental/behavioral health care access.


Next Steps

We continue to share findings from our foundational work with stakeholders at the city, state, and federal levels, and we’re also undertaking new projects with our Medicaid partners in the Commonwealth to understand how 2015 changes to Pennsylvania’s prescribing guidelines and the COVID-19 pandemic impacted trends in psychotropic prescribing, mental/behavioral health diagnoses, and mental/behavioral health care utilization among Medicaid-enrolled youth in the state. 

In our current work, we aim to describe 2016-2021 trends in:

  • Psychotropic medication prescription rates by medication class, as well as trends in cross-class polypharmacy 
  • The average number of annual and monthly mental/behavioral health care encounters by setting (outpatient, inpatient, ED, telehealth) across patient demographic groups (age, race/ethnicity, sex, and Medicaid payor region)
  • High-risk opioid use metrics and substance use disorder diagnoses among children with comorbid mental health diagnoses and/or psychotropic prescriptions

The findings from these studies will inform targeted quality improvement efforts to strengthen prescribing and monitoring guidelines within the Pennsylvania Medicaid program, with a focus on improving equity in mental health care access and outcomes for youth in Pennsylvania.  

This project page was last updated in October 2022.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Understanding and Addressing Antipsychotic Prescribing Practices for Medicaid-enrolled Children [Online]. [Accessed: plug in date accessed here].