Only 13 state Medicaid programs cover GLP-1 medications for weight loss as of early 2026, down from 17 states before January 1. California, New Hampshire, Pennsylvania, and South Carolina dropped coverage citing budgetary constraints. The 13 remaining states impose strict restrictions including BMI thresholds over 30, prior authorization, and step therapy requirements. CMS introduced the BALANCE demonstration program allowing states to expand coverage through negotiated pricing beginning May 2026.

Recognizing the potential long-term benefits for enrollees’ cost of coverage, a number of state Medicaid and employee health plans initiated coverage of GLP-1s for weight loss purposes. Only Arkansas, California, Maryland, New Mexico, Pennsylvania, and Texas have introduced legislation mandating coverage in 2025 to date.