New research highlights the patchwork of Medicaid prior authorization policies across the US, revealing significant barriers for children with ADHD to access medication amid inconsistent state regulations and requirements.
Children with ADHD can face a patchwork of Medicaid rules before they can get medicine, according to new data from the Center for Public Health Law Research at Temple University. The dataset maps prior authorisation policies across Medicaid managed care plans in all 50 states and the District of Columbia and shows how often plans impose extra checks, age limits or behavioural therapy requirements before approving treatment.
The research lands against a backdrop of substantial need. CDC and HRSA data analysed for 2024 found that more than 7 million U.S. children aged 3 to 17 had an ADHD diagnosis, and about half were taking medication. MACPAC has also reported that more than 85% of children enrolled in Medicaid are in managed care, making those plans a major gatekeeper for access to treatment.
As of 1 October 2025, the Temple data found 158 Medicaid managed care plans in 31 states, including Washington, D.C., that cover ADHD medicines. Of those, 129 plans in 28 states impose prior authorisation requirements or age restrictions for children under 18. Seven plans require behavioural therapy, a referral to behavioural therapy or evidence of an upcoming appointment before medication is covered, while 14 require a prior or concurrent failure of behavioural therapy.
The findings highlight how sharply access can vary from one state to another. KFF has reported wide differences in Medicaid managed care prior authorisation timelines, with states taking different approaches to both standard and expedited decisions. State rules can also differ in the details: Texas requires prior authorisation for drugs not on its preferred drug list, while Ohio allows managed care organisations some drug utilisation controls but limits prior authorisation on certain drugs without state approval.
Researchers said the dataset is meant to help show how these rules affect children and families seeking care. Adam Herpolsheimer, a law and policy analyst at Temple’s Centre for Public Health Law Research, said the data are “a first step” towards understanding the barriers families face. The project is part of a broader look at telehealth and state laws affecting diagnosis, monitoring and treatment for ADHD and Tourette syndrome, with researchers arguing that telehealth can help reach children in areas with fewer specialists.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
