03/12/2026
A read worth sharing.
🚨 A startling revelation has surfaced from newly obtained Freedom of Information Act data: Medicaid, the federal-state program designed to provide healthcare to America's most vulnerable populations, is funding the widespread off-label prescribing of powerful psychiatric medications to nearly 3 million children across 32 states—at a cost of $1.78 billion in a single year.
Among them are 270,000 children under the age of five, an age group for which no psychiatric drug class carries FDA approval.
In a meticulous investigation published on Substack, clinical psychologist Dr. Roger McFillin examines these figures (primarily from 2023, with Texas data from 2022) and describes a troubling pattern: a high-volume "prescription assembly line" that prioritizes rapid medication over comprehensive evaluation, informed consent, or exploration of underlying social determinants such as poverty, trauma, family instability, hunger, or grief.
Among the most concerning findings:
• In Oregon, psychiatric drugs were prescribed to 37.7% of Medicaid-enrolled children (total enrollment exceeding 700,000), with antipsychotics ranking as the leading class overall—and for children under five—despite their well-documented risks of permanent involuntary movement disorders (tardive dyskinesia), sudden cardiac death, severe metabolic disruption, profound weight gain, insulin resistance, and type 2 diabetes.
• Across most reporting states, anti-anxiety medications (including benzodiazepines, which carry warnings against use beyond two weeks even in adults due to rapid dependence and severe withdrawal) were the most commonly prescribed class for children under five.
• High-volume prescribing is evident in prescriber-level data from Illinois, where one clinical nurse specialist prescribed psychiatric medications to nearly 4,000 Medicaid-enrolled children in a single year, generating over $203,711 in Medicaid reimbursements for ADHD drugs alone—equivalent to more than 15 children per working day, a pace that precludes meaningful clinical assessment or follow-up.
These prescriptions frequently occur in extremely brief encounters—sometimes as short as eight minutes—where clinicians rarely probe root causes or discuss FDA black-box warnings (e.g., increased suicidality with antidepressants in youth), addiction risks comparable to strong opioids with stimulants, or long-term neurological and sexual dysfunction.
True informed consent appears absent, and non-pharmacological interventions are seldom prioritized.
The practice disproportionately affects the nation's poorest and most disadvantaged children—those in foster care, single-parent households, rural communities with limited access to specialists, or immigrant families facing language and resource barriers—who have the least capacity to obtain second opinions or challenge the prevailing model.
Dr. McFillin frames this not as isolated malpractice, but as a systemic failure enabled by financial incentives: Medicaid generously reimburses short "medication management" visits and covers drug costs, creating referral pipelines (including school-based screenings) that feed high-volume prescribing without mandatory outcome tracking or accountability for adverse events.
The Citizens Commission on Human Rights, which obtained the FOIA data, has outlined targeted reforms:
1. Require signed acknowledgment of FDA Medication Guides (plain-language risk information) as a condition of Medicaid reimbursement for psychiatric prescriptions, with penalties for non-compliance.
2. Direct CMS to publicly identify, audit, and investigate high-volume prescribers—especially those treating children under five off-label—and halt funding for unjustifiable patterns.
3. Convene an independent, conflict-free expert panel to rigorously reassess pediatric risks using FDA trial data, post-marketing surveillance, and adverse-event reports.
4. Establish a mandatory, enforceable federal database for tracking adverse drug reactions in Medicaid-enrolled children.
Taxpayers are footing the bill for an enterprise that may cause lifelong harm to developing brains and bodies.
These children deserve more than chemical containment: they need safety, stable caregiving, adequate nutrition, trauma-informed support, and time to be heard.