Status check: no state has been named as a BALANCE participant and Medicare coverage after 2027 remains undecided
Two coverage deadlines shape 2028 for GLP-1 patients: no state has been publicly named in Medicaid's BALANCE model, and nothing has been announced to replace Medicare's obesity drug Bridge when it ends Dec. 31, 2027 [1].
As of mid-September 2026, the two federal programs that expanded government coverage of GLP-1 drugs for obesity both have unanswered questions attached to them. CMS has not publicly named a single state Medicaid agency participating in the BALANCE Model, and the agency has announced no successor arrangement for Medicare obesity coverage when the temporary GLP-1 Bridge expires on December 31, 2027 [1].
A quick refresher on how these fit together. Medicare has been barred by law since Part D began from covering drugs used specifically for weight loss [1]. Beneficiaries can get a GLP-1 through Part D only for another FDA-approved use, such as type 2 diabetes, cardiovascular risk reduction, or sleep apnea [1]. State Medicaid programs may cover weight-loss drugs but are not required to; only 13 states did as of January 2026, down from 16 in 2025, a drop KFF links to the cost of coverage plus state budget pressure and federal funding cuts [1].
CMS's workaround was two-part. The Medicare GLP-1 Bridge, a nationwide demonstration built on Section 402 authority, runs July 1, 2026 through December 31, 2027 and offers eligible Part D enrollees a $50 monthly copay for all formulations of Foundayo (orforglipron) and Wegovy (semaglutide), plus the KwikPen formulation of Zepbound (tirzepatide) [1]. A prescriber must submit a prior authorization attesting the drug is for weight reduction and maintenance and that the patient meets one of three clinical tiers: BMI 35 or higher; BMI 30 or higher with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or BMI 27 or higher with pre-diabetes, prior heart attack, prior stroke, or symptomatic peripheral artery disease [1].
The longer-term piece, the BALANCE Model, was supposed to take over in Medicare Part D in January 2027 and run through December 2031 [1]. On April 21, 2026, CMS announced an indefinite delay of BALANCE in Part D and extended the Bridge through the end of 2027 instead [1]. BALANCE still exists on the Medicaid side, with launches on a rolling basis from May 1, 2026 to January 1, 2027, a July 31, 2026 application deadline for state Medicaid agencies, and an end date of December 31, 2031 [1]. Medicaid BALANCE criteria are broader than the Bridge, adding type 2 diabetes, noncirrhotic MASH, and obstructive sleep apnea [1].
What is not documented in the available sources is any list of states that applied or were accepted after that July 31 deadline. Nor is there any announced plan for what happens to Medicare obesity coverage on January 1, 2028. Both remain unknown rather than decided.
Congress could settle the Medicare question permanently. The Treat and Reduce Obesity Act would lift the statutory Part D exclusion. The Obesity Action Coalition reports the bill has 51 cosponsors in the House and 19 in the Senate [2]. It has not advanced.
Why it matters for patients
For a Medicare beneficiary using the Bridge, the $50 monthly copay and the coverage itself are tied to a demonstration with a hard end date of December 31, 2027 [1]. Unless CMS extends it again, revives BALANCE in Part D, or Congress changes the law, the underlying statutory prohibition on covering weight-loss drugs is still on the books [1]. That affects planning for 2028 coverage, not 2026 or 2027.
For Medicaid enrollees, whether BALANCE reaches you depends on your state opting in, and no participant list has been made public. With only 13 states covering GLP-1s for obesity as of January 2026, geography remains the biggest single factor in access [1].
One separate change is already locked in: semaglutide was selected for Medicare drug price negotiation in 2025, with a negotiated price taking effect in 2027 [1].
What happens next
Key dates from the current timeline: Medicaid BALANCE implementation was scheduled to finish rolling out by January 1, 2027; the Medicare Bridge ends December 31, 2027; Medicaid BALANCE ends December 31, 2031 [1]. Whether CMS names states, restarts BALANCE in Part D, or extends the Bridge again has not been announced.
Sources
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