Does Medicaid Cover Ozempic for Weight Loss? State-by-State 2026

Whether Medicaid covers Ozempic, Wegovy or Zepbound for weight loss depends entirely on the state. Federal law lets each state decide whether to cover drugs used for weight loss, and as of January 2026, only 13 state Medicaid fee-for-service programs covered GLP-1s for obesity treatment, down from 16 in October 2025 ^[1][2]. The picture is different for other uses: every state Medicaid program must cover GLP-1s when they are prescribed for type 2 diabetes, cardiovascular disease (Wegovy) or moderate-to-severe obstructive sleep apnea (Zepbound) ^[1][2].

The reason is the Medicaid Drug Rebate Program. Under that program, states must cover nearly all of a participating manufacturer’s FDA-approved drugs for medically accepted indications, but weight-loss agents sit in a small group of drugs that states are allowed to exclude ^[1][2]. So a prescription written for obesity alone is a state option, while the same drug prescribed for a required indication must be covered. Medicare is stricter still: it is barred by law from covering drugs used for weight loss, and Part D covers GLP-1s only for other FDA-approved indications ^[1][2].

This page is coverage-policy information, not medical, legal or benefits advice. For an answer about a specific case, the state Medicaid agency and the prescriber are the right places to ask.

Which uses are mandatory for Medicaid and which are optional?

The covered indication on the prescription is what drives the coverage rule, not the drug itself ^[1][2].

Use	Medicaid coverage rule
Type 2 diabetes	Required in every state [1]
Cardiovascular disease (Wegovy, FDA approval March 2024)	Required in every state [1]
Moderate-to-severe obstructive sleep apnea in adults with obesity (Zepbound, FDA approval December 2024)	Required in every state [1]
Obesity or weight loss alone	Optional; each state decides [1][2]
Children, when deemed medically necessary	Required under the EPSDT benefit [1]

EPSDT is Medicaid’s Early and Periodic Screening, Diagnostic and Treatment benefit. Under it, coverage is required for children when it is deemed medically necessary, even in states that exclude weight-loss drugs for adults ^[1].

Which states cover GLP-1s for weight loss in 2026?

Thirteen state Medicaid programs covered GLP-1s for obesity treatment under fee-for-service as of January 2026, according to KFF ^[1][2]. KFF’s 2025 Medicaid budget survey had counted 16 states as of October 2025 ^[1][2].

Stateline, citing KFF, named these states as covering GLP-1s for obesity treatment in 2026: Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia, Wisconsin and North Carolina, with Massachusetts and Rhode Island also covering but proposing to drop the benefit ^[5].

A second compilation, from MultiState Associates on StateVitals using April 2026 data, agrees on most states but conflicts on two: it lists Maryland as covering and Missouri as not covering ^[4]. The two lists also disagree on the starting count — MultiState says 17 states offered coverage before January 1, 2026, while KFF’s survey counted 16 as of October 2025 ^[4][1]. Neither source resolves the Maryland and Missouri discrepancy, so enrollees in those states should confirm directly with the state agency.

Two other notes on reading these lists. First, KFF’s 13-state count covers fee-for-service programs only; Medicaid managed care plans may follow different rules ^[1]. Second, some covering states have narrowed eligibility rather than dropping coverage — Michigan restricted it to morbid obesity, a move expected to save an estimated $240 million ^[5].

Which states dropped coverage, and when did it take effect?

Four states eliminated Medicaid coverage of GLP-1s for obesity treatment effective January 1, 2026: California, New Hampshire, Pennsylvania and South Carolina ^[1][4][5]. KFF says the cuts likely reflect recent state budget challenges and the significant costs associated with coverage ^[1][5], and the MultiState compilation reports that the states’ stated justification was budgetary constraints ^[4]. KFF also points to the broader fiscal environment, including the federal Medicaid cuts in the 2025 reconciliation law, as pressure behind the re-evaluations ^[1][5].

North Carolina took a different path. It ended GLP-1 coverage in October 2025 amid a legislative budget stalemate, then reinstated it in December 2025, which is what brought the national count back to 13 as of January 2026 ^[1][4][5].

Two more states may be next. In Massachusetts, the governor’s proposed fiscal 2028 budget would not fund MassHealth coverage of GLP-1s for weight loss alone, while continuing to cover the drugs for diabetes and other conditions; the legislature was still debating the budget as of late April 2026 ^[5]. Rhode Island’s governor has also proposed removing Medicaid coverage of GLP-1s for weight loss ^[5].

One thing to keep separate: decisions about state employee health plans are not Medicaid policy. Colorado, North Carolina and West Virginia removed GLP-1 weight-loss coverage from their state employee health plans, which is distinct from their Medicaid programs ^[4]. Colorado’s Medicaid program does not cover GLP-1s for weight loss ^[4].

Louisiana is moving the other direction: lawmakers there were debating in April 2026 whether to allow Medicaid coverage of GLP-1s for obesity when an enrollee has a comorbidity such as prediabetes, hypertension or cardiovascular disease ^[5].

What restrictions apply in states that do cover these drugs?

Coverage does not mean open access. States that cover GLP-1s for obesity typically apply utilization controls such as prior authorization, which can further limit access ^[1].

According to the MultiState compilation, common criteria in covering states include ^[4]:

• A body mass index (BMI) over 30, or in some states a BMI over 27 with obesity-related comorbidities
• Step therapy, meaning documented failure of diet and exercise programs or cheaper medications first
• Prescriber documentation that the enrollee participated in and did not achieve clinically meaningful weight loss through those prerequisite programs

These criteria come from a secondary compilation, not from KFF’s own survey, so the exact thresholds vary by state and should be verified with the state’s Medicaid program ^[4].

How much is Medicaid spending on GLP-1s?

Gross Medicaid spending on GLP-1s — for all covered uses, not just weight loss — has climbed sharply ^[2]:

Year	Medicaid gross GLP-1 spending
2019	$999 million [2]
2020	$1.5 billion [2]
2021	$2.5 billion [2]
2022	$4.1 billion [2]
2023	$6.9 billion [2]
2024	$8.6 billion [2]

In 2024, Medicaid covered 8.4 million GLP-1 prescriptions with $8.6 billion in gross spending ^[2]. Stateline frames the same trend as growth from about $1 billion in 2019 to almost $9 billion in 2024 ^[5]. For comparison, Medicare in 2024 saw 21.8 million claims and $27.5 billion in gross GLP-1 spending ^[2].

These are gross figures, before rebates. Net spending is lower because Medicaid receives manufacturer rebates, and those net prices are not public ^[2].

The growth has been driven mainly by Ozempic and Wegovy (semaglutide) and Mounjaro and Zepbound (tirzepatide) ^[1]. The demand side is large: almost four in ten adults and a quarter of children with Medicaid have obesity ^[1][5]. KFF notes that possible long-term savings from reduced chronic disease are mixed in the evidence, may take many years, and may not accrue to Medicaid at all if enrollees change coverage — so states may not be factoring long-term savings into their decisions ^[1].

Do the new federal price deals help Medicaid enrollees?

In November 2025, the Trump administration announced a deal with Eli Lilly and Novo Nordisk to lower GLP-1 prices for Medicare, Medicaid and cash payers through the TrumpRx platform ^[1][6][7]. Under the deal, prices for currently available injectable GLP-1s would fall to about $245 per month for the government in Medicare and Medicaid ^[6][7][9]. Weight-loss pills in development were priced at $149 per month to the government and to cash payers ^[6]. Medicare beneficiaries’ out-of-pocket costs are capped at $50 per month ^[6][7].

For Medicaid enrollees specifically, the deal changes little. KFF points out that these announcements do not affect costs for Medicaid enrollees, who already pay little or no prescription drug copays, and that TrumpRx cash prices would likely still be prohibitive for people who must have low incomes to qualify for Medicaid ^[1]. The core problem is coverage, not price: unless Medicaid covers the drug, enrollees are unlikely to have access to it even at lower prices ^[1].

What is the BALANCE model, and when does it reach Medicaid?

BALANCE — Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth — is a voluntary CMS Innovation Center model announced on December 23, 2025 ^[6][8]. It runs under Section 1115A of the Social Security Act as a five-year model, and participation is voluntary for manufacturers, state Medicaid agencies and Medicare Part D plans ^[1][8].

Under the model, CMS negotiates directly with manufacturers on behalf of states and Part D plans. Negotiation areas include guaranteed net prices, out-of-pocket cost limits, standardized coverage criteria across participating state Medicaid programs, and requirements to pair the drugs with lifestyle and nutrition interventions ^[7][8].

The timeline for the Medicaid side ^[2]:

Date	Milestone
January 8, 2026	Deadline for manufacturers to apply [1][2][7]
January 12 – February 5, 2026	Pre-implementation period for CMS and manufacturers [2]
May 1, 2026 – January 1, 2027	Medicaid launch window; states join on a rolling basis [2][8]
July 31, 2026	Deadline for state Medicaid agencies to apply [2]
December 31, 2031	BALANCE ends for state Medicaid agencies [2]

The drugs included are all formulations of Mounjaro, Ozempic, Rybelsus and Wegovy, the KwikPen formulation of Zepbound, and Foundayo, for both currently covered indications and weight management ^[8]. To be eligible, a manufacturer’s product must show at least a 9.5% average body-weight reduction at an FDA-approved dose in a randomized clinical trial ^[8]. Medicaid beneficiaries receiving GLP-1s for weight management under the model would get a manufacturer-provided lifestyle support program at no cost ^[8].

One caution from CMS itself: the model does not guarantee coverage for any individual — patients would be subject to qualifications set in the negotiations, including prior authorization requirements ^[8]. And no participating states have been publicly named. As of the CMS model page’s last update on August 14, 2026, the stage is listed as “Announced” and the number of participants as “N/A” ^[8].

A June 4, 2026 Health Affairs Forefront piece by Kenneth E. Thorpe and Kirsten Axelsen describes BALANCE as postponed indefinitely in Medicare while remaining open for Medicaid state participation until July 2026, and urges CMS rulemaking or action by Congress to remove the Part D weight-loss exclusion ^[9].

What happened to BALANCE in Medicare, and what is the GLP-1 Bridge?

The Medicare half of BALANCE has stalled. April 20, 2026 was the deadline for Part D sponsors to apply to the model, and on April 21, 2026, CMS announced an indefinite delay of BALANCE in Medicare Part D along with an extension of the separate Medicare GLP-1 Bridge; KFF’s brief was updated May 11, 2026 to reflect this ^[2]. The Part D arm of BALANCE had originally been scheduled to run from January 2027 to December 2031 ^[2].

The Medicare GLP-1 Bridge is a different mechanism. It was originally scheduled for July 1 through December 31, 2026, and now runs through December 31, 2027 ^[2][8]. It is a nationwide demonstration built on Section 402 demonstration authority and is separate from Part D coverage — sponsors do not have to opt in and bear no financial risk for their enrollees’ costs under it ^[2]. Eligible Medicare beneficiaries pay $50 for a month’s supply under the demonstration ^[6][7].

The contrast matters for readers comparing programs: Medicare now has a nationwide pathway for obesity drugs through the Bridge, while Medicaid coverage for weight loss still depends on which state an enrollee lives in ^[2][1].

Could lower prices change the state math?

Possibly, but it is not yet clear. Novo Nordisk announced in February 2026 that it would cut US list prices to $675 per month in 2027 ^[5]. Separately, semaglutide — the active ingredient in Ozempic, Wegovy and Rybelsus — was selected for Medicare drug price negotiation in 2025, with the negotiated price taking effect in 2027 ^[2].

KFF notes it is unclear how these new lower prices compare with the net prices state Medicaid programs already pay after rebates, since rebate-adjusted prices are confidential ^[1]. How states respond amid tightening budgets also remains unclear ^[1].

Affordability remains a barrier outside Medicaid: in KFF polling, 56% of GLP-1 users said the drugs were difficult to afford, including one in four who said they were “very difficult” to afford ^[2].

What is happening in state legislatures?

Arkansas shows both sides of the trend. Its Medicaid program does not cover GLP-1s for obesity ^[7]. During the 2025 legislative session, Rep. Aaron Pilkington introduced House Bill 1332, which would have required Arkansas Medicaid to evaluate and document the cost of obesity-related conditions among enrollees and required health insurers to offer optional anti-obesity drug coverage; the bill failed to advance out of a Senate committee ^[7]. On the employer side, the Arkansas Division of Employee Benefits explored GLP-1 weight-loss coverage in 2023 and declined it, with a projected annual cost of $83 million assuming only 10% of eligible members used the drugs ^[7].

What can a Medicaid enrollee do right now?

A few practical steps follow from the coverage rules:

• Check the state’s Medicaid preferred drug list or Medicaid Rx bulletin. These lists change with budget cycles, as the January 2026 cuts show ^[1].
• Pay attention to the indication on the prescription. Coverage for diabetes, cardiovascular disease and sleep apnea is required; weight loss alone is not ^[1][2].
• Ask about the prior authorization pathway and the BMI and step-therapy criteria the state applies ^[1][4].
• For anyone under 21, the EPSDT benefit requires coverage when deemed medically necessary ^[1].
• Remember that the widely cited 13-state count covers fee-for-service; a Medicaid managed care plan may have a different formulary ^[1].

What to watch next

Several open questions will shape the rest of 2026 and beyond:

• Whether CMS publicly names any participating BALANCE state; the participants field was still “N/A” as of the August 14, 2026 page update ^[8].
• Whether Massachusetts and Rhode Island finalize the proposed cuts in their budgets ^[5].
• Whether the Medicare GLP-1 Bridge is extended or replaced after December 31, 2027 ^[2][8].
• Whether CMS rulemaking or Congress removes the statutory weight-loss exclusion, as Thorpe and Axelsen urged in June 2026 ^[9].

Sources

1. KFF. Medicaid Coverage of and Spending on GLP-1s. January 16, 2026.
2. KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. May 11, 2026.
3. Medical Daily. The Federal Deal to Cut Medicaid Prices on Weight Loss Drugs Still Names No Participating States.
4. StateVitals. Does Medicaid Cover GLP-1 Drugs? A State-by-State Guide (2026 Update). May 1, 2026.
5. Stateline. More states consider dropping GLP-1 weight loss drugs from Medicaid. April 30, 2026.
6. Reuters. US health agency unveils weight-loss drug coverage model. December 23, 2025.
7. ACHI. Trump Administration Announces New Voluntary Payment Model for Weight-Loss Drugs. January 6, 2026.
8. Centers for Medicare & Medicaid Services. BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model.
9. Health Affairs. After BALANCE: Why Voluntary Coverage For Obesity Drugs Failed And What Comes Next. June 4, 2026.
10. CalMatters. California moves to expand access to GLP-1 weight-loss drugs. August 2026.
11. CalMatters Digital Democracy. SB 1089: Preventive Treatment Health Care Act.
12. LegiScan. Bill Text: CA SB1089, 2025-2026 Regular Session, Introduced.
13. Colorado General Assembly. SB26-066: Regulation of Compounded Weight-Loss Medication. 2026 Regular Session.
14. The Baltimore Sun. Facebook post on Senate Minority Leader Steve Hershey’s remarks.
15. CNBC. Medicare will start covering obesity drugs for the first time. Here’s what patients should know. June 30, 2026.
16. Medscape. Novo Nordisk to Halve US List Price Of Wegovy From 2027. February 24, 2026.
17. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity & Metabolism. August 2022.
18. JAMA. Journal article.
19. Centers for Medicare & Medicaid Services. Fact Sheet: Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027. June 2023.