Pediatric ADHD Medication Prior Authorization Policies in Medicaid Managed Care Plans

About this dataset:

According to 2024 data analyzed by the Centers for Disease Control and Prevention (CDC) using the Health & Resources Administration (HRSA)’s National Survey of Children’s Health (NSCH), more than 7 million (11.7%) US children 3-17 years old had a current attention-deficit/hyperactivity disorder (ADHD) diagnosis, with approximately half taking ADHD medication. States vary widely in the number of children with an ADHD diagnosis (from 6% to 17%), with even greater variation in medication treatment estimates (38% to 72%). Some state Medicaid programs have implemented policies to manage the use of ADHD medications and guide physicians toward best practices for ADHD treatment in children.  

Data from the Medicaid and CHIP Payment and Access Commission show that over 85% of children enrolled in Medicaid are covered by managed care plans. As a key delivery system, managed care plans play a role in determining how Medicaid policies governing access to ADHD medications operate. These policies can often include prior authorization requirements for prescription medication that restrict approvals to patients of a certain age or require additional provider involvement before approval for payment is granted.  

This cross-sectional dataset captures prior authorization requirements and age restrictions for ADHD medications prescribed to children under age 18 across Medicaid managed care plans in all 50 states and the District of Columbia as of October 1, 2025. 

Tips for Navigating this Dataset  

This dataset contains parallel records to capture each state’s distinct Medicaid managed care plans. States with multiple plans are indicated on the map and table with an asterisk. To view individual plan information, select the state in the map or table view. From there, each individual plan is uniquely identified by the plan name. For example, selecting Florida will display multiple plan-specific records, including Aetna Better Health of Florida and Florida Community Care.   

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,249,998.00 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.