Kids covered by Medicaid are given antipsychotics four times as often as children whose parents have private insurance, and Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, The New York Times reports.

The findings were published last summer on the Health Affairs web site, but an FDA advisory committee met last week to consider antipsychotic risks for kids and recommendations for new warnings. Some 300,000 kids under age 18 - whether covered by Medicaid or private insurance - now use these meds. And Medicaid medical directors from 16 states is looking at ways to reduce prescriptions of antipsychotic drugs among Medicaid children (see background here).

At issue, of course, is why children from poor families receive with meds and whether they actually need them? Are mental or emotional problems in poor families more likely to result in prescriptions? We know that Medicaid generally pays less for counseling than private insurers.

“It’s easier for patients, and it’s easier for docs,” Derek Suite, a psychiatrist in the Bronx whose pediatric cases include children and adolescents covered by Medicaid and who sometimes prescribes antipsychotics, tells the Times. “But the question is, ‘What are you prescribing it for?’ That’s where it gets a little fuzzy.”

And the Times notes that this is a potentially expensive problem. If health care reform expands Medicaid coverage by 15 million people, which would amount to a 43 percent increase, more kids are likely to wind up on antipsychotics. The meds may be cheaper than counseling, but are Medicaid’s biggest drug expenditure, costing the program $7.9 billion in 2006, the most recent year for which the data is available, the Times writes.

The data indicated that more than 4 percent of patients ages six to 17 in Medicaid fee-for-service programs received antipsychotics, compared with less than 1 percent of privately insured children and adolescents, according to the paper. More recent data through 2007 indicates that the disparity has remained, Stephen Crystal, a Rutgers professor who led the study, tells the paper.