Medicaid GLP-1 Coverage by State in 2026
Thirteen state Medicaid programs covered GLP-1s for obesity as of January 2026, down from 16 in October 2025. Every state still covers them for type 2 diabetes, and Massachusetts and Rhode Island are the latest states moving to drop weight-loss coverage.
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As of January 2026, 13 state Medicaid programs covered GLP-1 drugs for obesity treatment under fee-for-service, according to KFF — down from 16 states in October 2025 [1][4][5]. Every state Medicaid program still covers GLP-1s for type 2 diabetes, and federal rules also require coverage for cardiovascular risk reduction (Wegovy) and moderate-to-severe obstructive sleep apnea in adults with obesity (Zepbound) [1][11]. Children under 21 can receive GLP-1s when medically necessary under Medicaid’s EPSDT benefit, even in states that exclude adult obesity coverage [1][13].
The picture has kept shifting in 2026. California, New Hampshire, Pennsylvania and South Carolina ended obesity coverage on January 1, 2026 [1][2][17]. Massachusetts ended coverage of drugs prescribed solely for weight loss effective July 3, 2026 [13][14], and Rhode Island is set to end coverage for weight loss or weight management starting in October 2026 [2][17]. The sources used here have not reissued a national count after those two departures, so 13 remains the most recent published figure.
Why can states drop obesity coverage but not diabetes coverage?
Under the Medicaid Drug Rebate Program, state Medicaid programs must cover nearly all of a participating manufacturer’s FDA-approved drugs for medically accepted indications [1][5]. But a statutory exception, 42 U.S.C. 1396r-8(d)(2), lets states exclude agents used for anorexia, weight loss or weight gain. That language dates to the Omnibus Budget Reconciliation Act of 1990, which created the rebate statute [18][1].
Because of that exception, GLP-1 coverage is required for type 2 diabetes, and — following FDA approvals in March 2024 and December 2024 — for cardiovascular risk reduction (Wegovy) and for moderate-to-severe obstructive sleep apnea in adults with obesity (Zepbound) [1]. Coverage is also required for people under 21 when medically necessary under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, even where adult obesity coverage is excluded [1][13].
Medicare treats the question differently: Part D plans are barred by law from covering drugs when used for weight loss, while Medicaid rules leave the obesity decision to each state [5][17].
Which states covered GLP-1s for obesity as of January 2026?
KFF’s count of 13 state programs covering GLP-1s for obesity under fee-for-service as of January 2026 is published as a map rather than a text list [1][4][18]. Stateline reporting, drawing on KFF data, identifies the programs as Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Rhode Island, Tennessee, Utah, Virginia and Wisconsin [2]. North Carolina appears on the list because it reinstated coverage in December 2025 after dropping it in October [1][2].
Two caveats apply. Utah reported that funding for its coverage was limited to fiscal year 2026 [1]. And seven states — Connecticut, Louisiana, New Hampshire, New Mexico, North Dakota, Pennsylvania and Texas — cover one or more weight-loss drugs but no GLP-1s [1]. Because the landscape changes with budget cycles, a state’s own preferred drug list is the final word on what is covered [18].
What changed since October 2025?
A KFF survey of state Medicaid officials, conducted by Health Management Associates, found 16 state programs covering GLP-1s for obesity as of October 2025 — up from 13 in 2024 [1][11]. Since that survey, four states ended coverage effective January 1, 2026, citing budget pressure: California, New Hampshire, Pennsylvania and South Carolina [1][2][17]. Pennsylvania’s ending applies to adults 21 and older; under-21 coverage under EPSDT and coverage for other FDA indications continue [18].
North Carolina discontinued coverage of GLP-1s for obesity effective October 1, 2025, because of shortfalls in state funding, then reinstated coverage in December 2025 [3][1][2]. Michigan took a different route: starting January 1, 2026, it limited obesity-only coverage to morbid obesity — a body mass index of 40 or more — after documented failure of other appropriate weight-loss treatments, a change the state expects to save an estimated $240 million [2][4][17][18].
What did Massachusetts and Rhode Island do in 2026?
MassHealth, Massachusetts’ Medicaid program, announced in Pharmacy Facts #271 (March 12, 2026) that effective July 3, 2026, it would no longer cover drugs used for the treatment of obesity or overweight. The list includes Wegovy, Zepbound, Saxenda, Xenical, phentermine, diethylpropion, phendimetrazine and benzphetamine, and any drug used off-label for weight loss [13].
MassHealth continues to cover GLP-1s with prior authorization for other medically accepted indications: a BMI over 27 with established cardiovascular disease to reduce major adverse cardiovascular events (MACE) risk, metabolic dysfunction-associated steatohepatitis (MASH), and a BMI of 30 or more with moderate-to-severe obstructive sleep apnea. Requests for members under 21 are reviewed for medical necessity under EPSDT [13][14]. About 22,000 members were affected, roughly 1,700 of them under 21, and the change is expected to save about $15 million. Prior authorizations submitted before February 17, 2026 were end-dated July 2, 2026 and must be resubmitted for coverage beyond July 3, 2026 [14][13].
Rhode Island is the next departure. Its governor proposed removing the coverage, as reported in April 2026, and Medicaid coverage of GLP-1s for weight loss or weight management ends starting in October 2026 [2][17]. Meanwhile, Louisiana lawmakers were debating in April 2026 whether to add coverage for enrollees with a comorbidity such as prediabetes, hypertension or cardiovascular disease [2].
What GLP-1s does Medicaid cover in every state?
Every state covers GLP-1s for type 2 diabetes — Ozempic, Mounjaro, Trulicity, Victoza, Rybelsus and others — usually with prior authorization [11][18][16]. Coverage for the other required indications follows the FDA labels.
North Carolina’s September 2025 bulletin shows how a state carves the required indications out of an obesity exclusion: effective October 1, 2025, Wegovy remained covered with prior authorization to reduce cardiovascular death, heart attack and stroke in obese adults with cardiovascular disease, and for noncirrhotic MASH with moderate to advanced fibrosis (stages F2 to F3). Zepbound remained covered for moderate-to-severe obstructive sleep apnea in adults with obesity. Saxenda was dropped for all indications, while phentermine, diethylpropion and phendimetrazine stayed on the preferred drug list without prior approval [3].
Some states cover Zepbound only for sleep apnea. West Virginia treats weight-loss agents as a benefit exclusion but covers Zepbound for obstructive sleep apnea in adults with obesity. Louisiana’s criteria cover adults 18 and older with moderate-to-severe sleep apnea, a BMI of 30 or more and an apnea-hypopnea index of 15 or more, without diabetes; approvals run six months, and continuation requires at least 5% weight loss [18].
One warning applies everywhere: writing a diabetes diagnosis that a patient does not have in order to obtain coverage is fraud [18].
How much does Medicaid spend on GLP-1s?
Medicaid prescriptions for GLP-1s grew about sevenfold, from about 1 million in 2019 to over 8 million in 2024 — 8.4 million prescriptions in 2024. Gross spending grew about ninefold, from about $1 billion in 2019 to almost $9 billion in 2024 — $8.6 billion — with gross spending per prescription reaching $1,000 in 2024 [1][5].
| Measure | 2019 | 2024 |
|---|---|---|
| GLP-1 prescriptions | about 1 million | 8.4 million |
| Gross spending | about $1 billion | $8.6 billion |
| Share of Medicaid prescriptions | about 0% | about 1% |
| Share of gross Medicaid drug spending | 1% | over 8% |
These figures are gross, before rebates, and include GLP-1s prescribed for diabetes as well as obesity — they are not obesity-only spending and not what an enrollee pays [1]. Novo Nordisk has reported that rebates and other fees, across all payers, accounted for about 40% of the cost of Ozempic and Wegovy [1].
GLP-1s still made up only about 1% of Medicaid prescriptions in 2024, up from about 0% in 2019, but they accounted for over 8% of gross Medicaid prescription drug spending in 2024, up from 1% in 2019 [1]. The pressure is unlikely to ease: almost four in ten adults and a quarter of children on Medicaid have obesity, and the Medicaid cuts in the 2025 federal reconciliation law have tightened state budgets [1][2].
What restrictions apply where coverage exists?
Where states cover GLP-1s for obesity, the drugs are typically subject to prior authorization and other utilization controls [1][4]. Common criteria include a BMI threshold, documented comorbidities, a documented diet and exercise attempt, and prescriber qualifications; some states apply step therapy through liraglutide [18][17].
California’s Medi-Cal Rx offers a historical example of quantity limits: a July 2024 bulletin restricted Wegovy and Saxenda to one carton per dispensing and one dispensing every 28 days — four Wegovy pens or five Saxenda pens. California ended obesity coverage on January 1, 2026, so the limit illustrates the kind of controls states use rather than current California coverage [10][1][18].
Managed care adds another layer. A managed care plan’s formulary can differ from the state fee-for-service list [17][18]. Federal Medicaid managed care rules set outer limits on prior authorization decisions — 72 hours for expedited requests and 14 calendar days for standard requests — and appeal windows run 30 to 60 days depending on the state [17][18].
What is the BALANCE model, and has any state joined?
Introduced in December 2025, BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) is a five-year CMS Innovation Center model that is voluntary for state Medicaid programs, Medicare Part D plans and manufacturers. It features negotiated net prices, standardized coverage criteria and a manufacturer-funded lifestyle program [1][5][16]. The covered products are all formulations of Mounjaro, Ozempic, Rybelsus and Wegovy; the KwikPen formulation of Zepbound; and Foundayo [16].
The timeline: manufacturers faced an application deadline of January 8, 2026; the model launches for state Medicaid agencies on May 1, 2026, with rolling implementation through January 1, 2027; states face a July 31, 2026 application deadline; and the model ends December 31, 2031 [5]. On the Medicare side, CMS announced on April 21, 2026 an indefinite delay of BALANCE in Part D and an extension of the separate Medicare GLP-1 Bridge, which runs July 1, 2026 through December 31, 2027 at $50 per month for eligible beneficiaries [5][16][18].
As of mid-August 2026, CMS’s own model page names no participating state and lists the number of participants as not applicable [16]. No state’s participation has been publicly confirmed in the sources used here.
Will lower BALANCE prices change enrollee access?
It is unclear. KFF notes it is not known how the negotiated prices compare with the net prices states already pay after rebates, and states face tighter budgets [1]. For enrollees themselves, the price deals change little: Medicaid enrollees already pay little or no copays for prescription drugs, and buying directly from manufacturers through TrumpRx would likely still be prohibitive at Medicaid incomes [1].
The policy direction also shifted in April 2025, when the Trump administration dropped a Biden-era proposal that would have required state Medicaid programs to cover obesity drugs [1][11]. Separately, Novo Nordisk announced a list price cut to $675 per month taking effect in 2027 [2].
Do ACA Marketplace plans cover Wegovy?
Rarely. A Leverage|Axiaci review of the 300 carriers offering 2026 Marketplace plans, funded by the Robert Wood Johnson Foundation, found 26 carriers covering GLP-1s for obesity treatment, concentrated in nine states: California, North Dakota, New York, Vermont, Pennsylvania, West Virginia, Rhode Island, Delaware and Georgia. In California and North Dakota, all carriers offer plans that cover the drugs [6][7].
| State | Carriers covering GLP-1s for obesity (2026) |
|---|---|
| California | 14 |
| North Dakota | 3 |
| New York | 3 |
| Pennsylvania | 1 |
| West Virginia | 1 |
| Rhode Island | 1 |
| Vermont | 1 |
| Delaware | 1 |
| Georgia | 1 |
The barriers are steep: all but four carriers limit coverage to morbid obesity, a BMI of 40 or above, and all require three to nine months of documented diet and exercise plus proof the enrollee could not lose weight. Enrollment in plans with GLP-1 obesity coverage fell from 3.6 million in 2024 to 2.8 million in 2026 [6][7]. A separate KFF analysis of 2024 federal Marketplace formularies found Wegovy on just 1% of plans, compared with Ozempic on 82%, and every plan covering an obesity GLP-1 required prior authorization [8].
North Dakota took a distinctive path. A bill that would have required Medicaid coverage, HB 1451, failed; instead, the state changed its essential health benefit benchmark, approved by CMS in August 2023 and effective for plans beginning January 1, 2025, requiring individual and small-group plans to cover GLP-1 and GIP drugs for the prevention of diabetes and treatment of insulin resistance, metabolic syndrome or morbid obesity [9][11]. State legislatures remain active: NCSL has tracked 66 bills in 25 states since 2022, Colorado insurers must offer optional anti-obesity coverage starting in 2027, and an Alabama law enacted in 2026 orders Medicaid to evaluate the cost of covering the drugs [4][17].
How do I check my own state’s rules?
Start with the documents. Search your state Medicaid program’s preferred drug list and prior authorization criteria for “Wegovy,” “Zepbound,” “tirzepatide” and “semaglutide,” and check the date on the document — these lists change quarterly and have changed repeatedly in 2026 [18][16].
Then confirm by phone. Call the number on your Medicaid card or your managed care plan’s member services line and ask whether GLP-1s are covered for weight management, what the prior authorization criteria are, and whether the state has joined the BALANCE model [16][18].
If coverage is denied or unclear, ask your prescriber whether a documented diagnosis of diabetes, cardiovascular disease, sleep apnea or MASH applies to you — that changes the coverage question entirely — and ask about the appeals process [16]. Do not stop a prescribed medication because coverage information is unclear [16].
Sources
- KFF. Medicaid Coverage of and Spending on GLP-1s. January 16, 2026.
- Stateline. More states consider dropping GLP-1 weight loss drugs from Medicaid. April 30, 2026.
- NC Medicaid. NC Medicaid to Change Coverage for GLP-1 Weight Management Medications. September 5, 2025.
- National Conference of State Legislatures. GLP-1s: Cost, Coverage and State Policy Trends. March 23, 2026.
- KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. May 11, 2026.
- Axiaci. Marketplace Coverage Shrinks as Barriers Expand in 2026.
- Becker’s Payer Issues. GLP-1 coverage under ACA plans continues to decline: 6 notes. December 2, 2025.
- KFF. Costly GLP-1 Drugs are Rarely Covered for Weight Loss by Marketplace Plans. June 12, 2024.
- North Dakota Insurance Department. Feds approve new benefits for North Dakota ACA plans. September 5, 2023.
- Medi-Cal Rx. Reminder: Quantity Limit Restrictions for Anti-Obesity Preparations. July 24, 2024.
- North Dakota Monitor. States retreat from covering drugs for weight loss but not North Dakota. November 30, 2025.
- MultiState. GLP-1 Weight Loss Drugs: Coverage Under Medicaid and Other Health Plans. March 17, 2025.
- MassHealth. Pharmacy Facts: MassHealth Changes to Management of Anti-Obesity Medications. March 12, 2026.
- The Boston Globe. MassHealth drops GLP-1 coverage for obesity Friday. July 2, 2026.
- Facebook. Public Sector Healthcare Roundtable post on state GLP-1 coverage.
- Medical Daily. The Federal Deal to Cut Medicaid Prices on Weight Loss Drugs Still Names No Participating States.
- healthinsurance.org. Does health insurance cover GLP-1 medications for weight loss?
- FormBlends. Does Medicaid Cover Zepbound? 2026 State by State Rules. September 5, 2026.
Frequently asked questions
Does Medicaid cover Ozempic for type 2 diabetes in every state?
Yes. Every state Medicaid program covers GLP-1s for type 2 diabetes, including Ozempic, Mounjaro, Trulicity, Victoza and Rybelsus, usually with prior authorization. Federal law requires coverage for medically accepted indications other than obesity; only the weight-loss use is optional for states.
Does Medicaid cover Wegovy for weight loss?
Only in some states. KFF counted 13 state Medicaid programs covering GLP-1s for obesity under fee-for-service as of January 2026, down from 16 in October 2025 after California, New Hampshire, Pennsylvania and South Carolina ended coverage. Where covered, prior authorization is typical.
Which states cover Zepbound through Medicaid?
Zepbound for obesity falls under the same optional benefit as Wegovy, so coverage depends on the state. Some states, including West Virginia and Louisiana, cover Zepbound only for moderate-to-severe obstructive sleep apnea in adults with obesity, with six-month approvals and a 5% weight-loss requirement for continuation.
Can children on Medicaid get GLP-1s through EPSDT in a state that excludes adult coverage?
Yes. Medicaid's EPSDT benefit requires coverage for people under 21 when medically necessary, even in states that exclude adult obesity coverage. MassHealth, for example, ended adult weight-loss coverage on July 3, 2026 but still reviews under-21 requests for medical necessity under EPSDT.
What did MassHealth stop covering in July 2026?
Effective July 3, 2026, MassHealth stopped covering drugs used for obesity or overweight, including Wegovy, Zepbound, Saxenda, Xenical, phentermine, diethylpropion, phendimetrazine and benzphetamine. About 22,000 members were affected. Coverage continues with prior authorization for cardiovascular risk, MASH and sleep apnea indications.
When does Rhode Island Medicaid stop covering GLP-1s for weight loss?
Rhode Island's Medicaid coverage of GLP-1s for weight loss or weight management ends starting in October 2026, after the governor proposed removing the benefit. The sources used here give October 2026 as the start of the ending, not a confirmed October 1 date.
What is the BALANCE model, and has any state joined?
BALANCE is a voluntary five-year CMS Innovation Center model, introduced in December 2025, that negotiates lower GLP-1 prices with manufacturers for state Medicaid programs and Part D plans, with standardized coverage criteria and a manufacturer-funded lifestyle program. As of mid-August 2026, CMS's model page names no participating state.
Do ACA Marketplace plans cover Wegovy?
Rarely. Of 300 carriers offering 2026 Marketplace plans, 26 cover GLP-1s for obesity, in nine states. All but four require a BMI of 40 or above, and all require three to nine months of documented diet and exercise. A KFF analysis found Wegovy on just 1% of 2024 federal Marketplace plans.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.