PHILADELPHIA, September 10, 2026 — New data published by the Center for Public Health Law Research (CPHLR) at Temple University Beasley School of Law offers an in-depth look at prior authorization policies applying to children under the age of 18 in Medicaid managed care plans. It captures details of Medicaid managed care policies for the 50 U.S. states and the District of Columbia, describing policies around access to ADHD medications as of October 1, 2025, including prior authorization and age requirements and prerequisites of non-medication alternatives.
According to 2024 data analyzed by the Centers for Disease Control and Prevention Health Resources and Services Administration (HRSA), 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.
Data from the Medicaid and CHIP Payment and Access Commission (MACPAC) 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.
As of October 1, 2025, 158 Medicaid managed care plans across 31 states (including the District of Columbia) provide coverage for ADHD medications, according to the new data on LawAtlas. Within those managed care plans, 129 plans impose prior authorization requirements or age restrictions for ADHD medications prescribed to children under the age of 18 years old.
“These data are a first step in providing us with a better understanding of the barriers and access children face around the country,” said Adam Herpolsheimer, JD, a law and policy analyst at the Center for Public Health Law Research. “Because each state approaches its managed care policies differently, it’s important to continue evaluating the ways these policies disparately affect American children and their families seeking support for ADHD.”
Other results from this research include:
Pharmacy benefits for pediatric ADHD medications are included within 158 Medicaid managed care plans in the United States.
Across 28 states, 129 managed care plans impose prior authorization or age restrictions for ADHD medications prescribed to children younger than 18 years old.
Seven managed care plans require concurrent behavioral therapy, a referral to behavioral therapy, or proof of an impending appointment for behavioral therapy in order for medication to be covered.
Fourteen managed care plans require a prior trial and/or concurrent failure of behavioral therapy in order for medication to be approved.
Diagnosis and treatment for ADHD can involve frequent interactions with the healthcare system and medical professionals and may include psychosocial treatment or pharmacological treatment, or both. Telehealth can increase access to specialty care in communities with shortages of healthcare professionals, including rural areas. A policy brief by CPHLR researchers released alongside this dataset considers state telehealth laws as they govern the use of telehealth for ADHD or Tourette syndrome diagnosis, monitoring, or treatment. The policy brief summarizes the legal landscape and evidence and offers a research agenda and policy options for future consideration. It contributes towards a more holistic understanding of how laws act as facilitators or barriers to supports and treatment for children with neurodevelopmental conditions.
The dataset was created using scientific legal mapping methods that support the creation of high quality, scientific legal data for research and practice. The data may be explored and downloaded for free on LawAtlas.org.
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.
The Center for Public Health Law Research at Temple University Beasley School of Law creates and advances research on the health effects of laws and policies. Learn more at phlr.temple.edu.