Thirteen state Medicaid programs cover GLP-1s for obesity as of January, KFF finds

Thirteen state Medicaid programs covered GLP-1 drugs for obesity treatment under fee-for-service as of January 2026, while 38 states and the District of Columbia did not, according to an analysis KFF published Jan. 16, 2026 ^[1].

The same analysis reported that Medicaid filled about 1 million GLP-1 prescriptions in 2019 and more than 8 million in 2024. Gross spending on those drugs climbed from roughly $1 billion to nearly $9 billion over those years ^[1]. KFF attributes much of the recent growth to rising use of Ozempic and Wegovy (semaglutide) and Mounjaro and Zepbound (tirzepatide) ^[1].

The covering states as of January are Delaware, Kansas, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, North Carolina, Rhode Island, Tennessee, Utah, Virginia and Wisconsin ^[1]. Utah reported that funding for its benefit was limited to fiscal year 2026 ^[1].

That group shrank and reshuffled in recent months. KFF's 2025 Medicaid budget survey counted 16 states covering GLP-1s for obesity as of October 2025 ^[1]. California, New Hampshire, Pennsylvania and South Carolina have since dropped the benefit ^[1]. North Carolina ended coverage in October 2025 during a legislative budget stalemate and restored it in December 2025 ^[1]. KFF says a few other states are weighing restrictions in state fiscal year 2026 or 2027, and that fewer states are looking to expand, with cost the factor they cite most often ^[1].

Whether a state pays for these drugs for weight loss is a choice, not a requirement. Medicaid must cover nearly all FDA-approved drugs from participating manufacturers for medically accepted uses, but weight-loss agents fall into a narrow category that states may exclude ^[1]. Coverage is mandatory for diabetes, for Wegovy (semaglutide) in cardiovascular disease since March 2024, and for Zepbound (tirzepatide) in moderate to severe obstructive sleep apnea in adults with obesity since December 2024 ^[1]. Children may qualify when a doctor deems a drug medically necessary under Medicaid's Early and Periodic Screening, Diagnostic and Treatment benefit ^[1]. Medicare is barred from covering these drugs for obesity under current law ^[1].

When states do cover them for obesity, KFF says prior authorization and similar utilization controls are typical and can narrow access further ^[1].

Cost is the stated reason for the pullback. KFF writes that broader obesity drug coverage can raise Medicaid outlays, that states face tighter budgets and long-term fiscal uncertainty tied partly to federal Medicaid cuts in the 2025 reconciliation law, and that almost four in ten adults and a quarter of children enrolled in Medicaid have obesity ^[1]. Savings from lower obesity rates could take years and may not return to Medicaid if enrollees change coverage; KFF describes the evidence on savings as mixed ^[1].

Why it matters for patients

For someone on Medicaid, living in one of the 13 covering states is the clearest route to having a GLP-1 paid for as an obesity treatment. Elsewhere, an enrollee would generally need a covered diagnosis such as type 2 diabetes, cardiovascular disease or sleep apnea, or would have to meet the state's own criteria ^[1]. Prior authorization adds another step even in states that cover the drugs for weight loss ^[1].

Federal price announcements are unlikely to change what enrollees pay at the pharmacy counter. KFF notes that Medicaid members already face little or no copay for prescriptions, and that buying directly from manufacturers through TrumpRx would probably remain out of reach for people whose incomes qualify them for Medicaid. Without coverage, KFF concludes, enrollees are unlikely to get these medicines because of the out-of-pocket cost, even at reduced prices ^[1].

Other payers are restrictive too. KFF reports limited obesity coverage in ACA Marketplace plans and at most large employer firms ^[1].

What happens next

Under the BALANCE model introduced in December 2025, the CMS Innovation Center plans a five-year test intended to widen access to obesity drugs in Medicaid and Medicare by negotiating lower GLP-1 prices with manufacturers. Joining is voluntary for state Medicaid agencies, Medicare Part D plans and drugmakers, and the model pairs standardized coverage criteria with lifestyle support ^[1]. States and manufacturers were asked to signal their intent to take part by Jan. 8, 2026, and the model is expected to begin in May 2026 ^[1]. For Medicare Part D it would start in January 2027, after a separate short demonstration that opens obesity drugs to Part D enrollees beginning in July 2026 ^[1].

In November 2025 the administration announced a deal with Eli Lilly and Novo Nordisk to cut the price of their GLP-1s for Medicare, Medicaid and direct purchases through TrumpRx ^[1]. Whether those prices undercut what state Medicaid programs already pay, and whether states respond by broadening coverage, has not been determined ^[1].