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GLP-1 coverage tracker: state Medicaid and Medicare

11 state Medicaid entries and 7 Medicare entries, each with the date it takes effect, the date it was announced, and the document it comes from. Most of the 2026 movement runs one way: California, New Hampshire, Pennsylvania and South Carolina all ended Medicaid coverage of GLP-1s for obesity on January 1, 2026, and MassHealth stopped on July 1, 2026. North Carolina is the exception — it dropped coverage on October 1, 2025 and reinstated it on December 12, 2025.

Medicare did not open up. The Part D statutory exclusion for weight-loss drugs has not been repealed. What exists instead is the Medicare GLP-1 Bridge, a CMS demonstration with a $50 copay per 30-day supply that runs July 1, 2026 through December 31, 2027 and sits outside the Part D benefit. The Part D component of the BALANCE Model was postponed indefinitely, announced April 21, 2026.

Last updated 2026-09-16. Free to cite under CC BY 4.0 — please link back.

State Medicaid

Sorted by effective date, newest first. Coverage of GLP-1s for diabetes is a separate benefit and is unaffected by every row below. Two rows are documented through a managed-care plan bulletin rather than a state notice — New Hampshire and Michigan — and each names the state action it rests on. Neither is presented as a plan-only change, because the plan bulletin itself describes a statewide one.

State Medicaid GLP-1 coverage changes, newest effective date first
ProgramEffectiveAnnouncedWhat changedSource
Rhode Island Medicaid10/01/202601/27/2026Gov. Dan McKee's proposed FY2027 budget would strike GLP-1s prescribed for weight loss from the Medicaid preferred drug list, with no grandfathering, keeping diabetes coverage. Projected savings $6.3 million in general revenue. Rhode Island Medicaid processed 24,971 GLP-1 prescriptions for obesity management in FY2025 (may include duplicates).Verification: This entry documents the proposal. Whether the enacted FY2027 budget kept the 2026-10-01 date is listed in openQuestions.Rhode Island Current (syndicated via Yahoo News)News source · read 2026-09-16
MassHealth (Massachusetts Medicaid)07/01/202606/27/2026Coverage ended for GLP-1s and other anti-obesity medications (Wegovy, Zepbound, Saxenda, Xenical, phentermine-based drugs) when prescribed solely for weight loss; coverage continues for other approved conditions such as type 2 diabetes. About 22,000 members affected; estimated savings about $15 million a year. Announced in January 2026 as part of Gov. Maura Healey's FY2027 budget proposal.Verification: Confirmed by The Boston Globe (2026-07-02), which adds that about 1,700 of the affected members are under 21. The MassHealth primary notice is Pharmacy Facts 271 (2026-03-12) at mass.gov, which returned HTTP 403 to fetch.Boston.comNews source · read 2026-09-16
State Medicaid programs, national count (published figure, not computed here)01/01/202601/16/202613 state Medicaid programs covered GLP-1s for obesity under fee-for-service as of January 2026, down from 16 as of October 2025 (KFF's 2025 Medicaid budget survey). Since that survey, CA, NH, PA and SC eliminated coverage and NC reinstated it after dropping it in October 2025. KFF also reports Medicaid spending on GLP-1s of almost $9 billion in 2024 (about ninefold the ~$1 billion in 2019) across more than 8 million prescriptions.Verification: The KFF page states the count but does not enumerate the 13 covering states; see openQuestions.KFFKFF source · read 2026-09-16
Pennsylvania Medicaid (Medical Assistance)01/01/202612/27/2025GLP-1 receptor agonists no longer covered for the treatment of overweight and obesity; GLP-1s remain covered for other approved indications with prior authorization. Secondary reporting (Spotlight PA, Pennsylvania Health Law Project) says the cut applies to adults 21 and older and that DHS projected roughly $380 million in savings; the bulletin text itself states no exemption.Pennsylvania Bulletin (Pennsylvania Department of Human Services)Government source · read 2026-09-16
Michigan Medicaid01/01/202612/15/2025Coverage of Wegovy, Zepbound, Saxenda and generic liraglutide for obesity restricted, not eliminated: approval now requires morbid obesity, documented failure of all other clinically appropriate weight-loss interventions, trial and failure of preferred PDL anti-obesity agents, and use only to avert the need for bariatric surgery. Basis: Michigan FY2026 budget legislation; MDHHS provider notice L 25-73.Priority Health (Michigan Medicaid health plan); corroborated by Meridian Health Plan bulletin dated 2025-12-16Health plan source · read 2026-09-16
California Medi-Cal01/01/202610/21/2025GLP-1s prescribed for weight loss removed as a covered benefit. Per KFF and the California Medical Association, Wegovy, Zepbound and Saxenda came off the Medi-Cal Rx Contract Drugs List for weight-loss indications for members 21 and older; diabetes GLP-1s unaffected, and limited PA pathways remain for MASH, cardiovascular disease and obstructive sleep apnea.Verification: Bulletin date and subject line confirmed from the PDF; drug-level detail taken from KFF (2026-01-16) and CMA because the PDF body did not extract as text.California Department of Health Care Services (Medi-Cal Rx provider bulletin)Government source · read 2026-09-16
New Hampshire Medicaid01/01/202610/14/2025GLP-1s no longer covered when prescribed solely for weight loss; coverage continues for other chronic conditions (type 2 diabetes, certain cardiovascular disease, severe sleep apnea, MASH). Underlying authority is an NH DHHS provider notification dated 2025-10-09.NH Healthy Families (Granite State Health Plan, NH Medicaid managed care plan)Health plan source · read 2026-09-16
South Carolina Medicaid (SCDHHS)01/01/2026Not establishedCoverage of GLP-1s for obesity eliminated, reversing coverage the program had added on 2024-11-01. Diabetes coverage unaffected.Verification: SC Daily Gazette reported the decision on 2025-11-17 (https://scdailygazette.com/2025/11/17/sc-medicaid-program-to-stop-covering-expensive-weight-loss-drugs-for-obesity/) but returned HTTP 403 to fetch; no SCDHHS bulletin was retrieved, so the announcement date is left null.KFFKFF source · read 2026-09-16
North Carolina Medicaid12/12/202512/19/2025Coverage of GLP-1s for obesity reinstated per the Governor's directive, reverting to the criteria in place as of 2025-09-30 (Wegovy, Zepbound, Saxenda for weight management).NC Medicaid (NC Department of Health and Human Services)Government source · read 2026-09-16
North Carolina Medicaid10/01/202509/05/2025Coverage of GLP-1s for obesity discontinued: Wegovy, Zepbound and Saxenda removed from the Preferred Drug List for weight management; Saxenda dropped for all indications; Wegovy and Zepbound limited to prior-authorized cardiovascular, MASH and sleep apnea uses. Reason given: shortfalls in state funding for an optional benefit.NC Medicaid (NC Department of Health and Human Services)Government source · read 2026-09-16
New Hampshire Medicaid (restoration attempt)No date set04/20/2026Senate Bill 455 (Sen. Sue Prentiss) would restore Medicaid coverage of GLP-1s for obesity. NH DHHS opposes it. Reported figures: $49.5M state Medicaid GLP-1 spend for FY starting 2025-07-01, falling to about $41M annually after the January cut; restoring weight-loss coverage would cost an added $24.2M per fiscal year. Driver cited: a $51M DHHS budget cut.New Hampshire Public RadioNews source · read 2026-09-16

Medicare

Sorted by effective date, newest first. Rows without an effective date record a status rather than a change — the statutory exclusion that stayed in place, and the Part D model component that was shelved.

Medicare GLP-1 coverage changes, newest effective date first
ProgramEffectiveAnnouncedWhat changedSource
Medicare GLP-1 Bridge (extension)12/31/202704/21/2026Bridge extended through 2027-12-31, from an original end date of 2026-12-31, at the same time CMS said the Part D portion of the BALANCE Model would be delayed indefinitely.Verification: The extension to 2027-12-31 is also stated on the CMS BALANCE model page (last updated 2026-08-14) and the CMS GLP-1 Bridge page.KFFKFF source · read 2026-09-16
BALANCE Model negotiated price (published figure)07/01/202605/11/2026KFF reports a negotiated net price of $245 per month supply for model drugs, against a $50 per month beneficiary copay under the Medicare GLP-1 Bridge. CMS's own pages confirm negotiations with Eli Lilly and Novo Nordisk completed but do not publish the price.KFFKFF source · read 2026-09-16
Medicare GLP-1 Bridge (CMS demonstration)07/01/202612/23/2025Temporary CMS demonstration giving eligible Medicare Part D beneficiaries access to Foundayo, Wegovy (injection and tablet) and Zepbound (KwikPen only) for a $50 copay per 30-day supply, operating outside the Part D benefit's coverage and payment flow. Eligibility: 18+, and BMI >=35; or BMI >=30 with heart failure, uncontrolled hypertension or CKD stage 3a+; or BMI >=27 with pre-diabetes, prior MI, prior stroke or symptomatic PAD. People with type 2 diabetes, moderate-to-severe sleep apnea or certain liver conditions must use Part D instead.Verification: CMS page last updated 2026-08-06. End date 2027-12-31. The announcement date is the CMS BALANCE press release of 2025-12-23, which introduced the bridge demonstration.Centers for Medicare & Medicaid ServicesGovernment source · read 2026-09-16
BALANCE Model state participation (status, Medicaid)05/01/202608/14/2026As of the CMS model page last updated 2026-08-14, the model is in the 'Announced' stage and no participating state Medicaid agency is named. Drugs named in the model: all formulations of Mounjaro, Ozempic, Rybelsus, Wegovy, the KwikPen formulation of Zepbound, and Foundayo. States may begin participating May 2026 through 2027-01-01 per the State Request for Applications.Verification: CMS's 2026-03-09 Innovation Insight confirms negotiations with Eli Lilly and Novo Nordisk were completed and states/plans were invited to apply.Centers for Medicare & Medicaid ServicesGovernment source · read 2026-09-16
CMS BALANCE Model05/01/202612/23/2025CMS announced the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model, a voluntary alternative payment model under which CMS negotiates GLP-1 prices directly with manufacturers on behalf of state Medicaid agencies and Medicare Part D plans, with standardized coverage criteria and lifestyle support. Medicaid launch as early as May 2026 (model period to 2031-12-31); Part D originally January 2027. Manufacturer RFA responses and state/plan notices of intent were due 2026-01-08.Centers for Medicare & Medicaid ServicesGovernment source · read 2026-09-16
Medicare Part D statutory exclusionNo date set05/11/2026No change to the statute: Medicare Part D remains prohibited by law from covering medications used specifically for weight loss. Everything CMS has done for anti-obesity GLP-1s in 2026 sits outside the Part D benefit rather than repealing the exclusion.KFFKFF source · read 2026-09-16
CMS BALANCE Model, Medicare Part D portionNo date set04/21/2026CMS said it would not proceed with BALANCE in Medicare for 2027; the Part D portion is delayed indefinitely. The announcement came the day after the Part D application deadline of 2026-04-20.KFFKFF source · read 2026-09-16

What this tracker does not include, and why

Only state Medicaid and Medicare are tracked here. Those are the two categories where a decision is published by the government that made it, on a dated page anyone can open. Employer plans, PBM formularies and ACA Marketplace plans are excluded: they change plan by plan, most are announced to members rather than publicly, and the documents that do exist are often formulary PDFs that cannot be read or verified from outside. Tracking them at this standard is not possible, and tracking them at a lower one would put unverified rows next to verified ones.

There is also no national total on this page — no “X million people lost coverage” figure. No publisher has published one, and adding up the rows here would not produce it: state Medicaid enrollment counts, the number of enrollees who were actually using a GLP-1 for weight loss, and the overlap between programs are all different numbers. The published counts that do exist appear as their own rows, attributed to whoever published them.

Method

Each row records one dated public announcement. The effective date is when the change takes or took effect; the announcement date is the date of the cited document. Where a date could not be established from a named source it is shown as not established rather than estimated — South Carolina's announcement date is blank for that reason. Where a primary document could not be read, the row says so in its verification note and names what the detail rests on instead: the Medi-Cal bulletin PDF did not extract as text, and the MassHealth primary notice returned an error, so those rows lean on KFF and on news publishers respectively.

Every row carries a source label. A row marked KFF is KFF's reporting, not a government document — that includes the count of state programs still covering GLP-1s for obesity, the $245 negotiated model price, and the indefinite Part D postponement. A row marked Government links to CMS or a state agency. Rows are re-verified monthly; the source URLs were last read on 2026-09-16.

One note from outside the tracked categories, for context only, both self-labeled as surveys: the Business Group on Health 2027 Employer Healthcare Strategy Survey (released August 25, 2026, 127 employers) reported employer coverage of GLP-1s for weight management falling from 72% in 2025 to 60% in 2026, and KFF's analysis of 2024 ACA Marketplace formularies found Wegovy covered by 1% of Marketplace drug plans against 82% for Ozempic. Both are survey and formulary analysis, not government policy, and neither is tracked in the tables above. Business Group on Health, via HCAMag · KFF

Sources

  1. Pennsylvania Bulletin (Pennsylvania Department of Human Services) — Pennsylvania Medicaid (Medical Assistance), 2025-12-27 (Government, read 2026-09-16)
  2. California Department of Health Care Services (Medi-Cal Rx provider bulletin) — California Medi-Cal, 2025-10-21 (Government, read 2026-09-16)
  3. NH Healthy Families (Granite State Health Plan, NH Medicaid managed care plan) — New Hampshire Medicaid, 2025-10-14 (Health plan, read 2026-09-16)
  4. New Hampshire Public Radio — New Hampshire Medicaid (restoration attempt), 2026-04-20 (News, read 2026-09-16)
  5. KFF — South Carolina Medicaid (SCDHHS) (KFF, read 2026-09-16)
  6. NC Medicaid (NC Department of Health and Human Services) — North Carolina Medicaid, 2025-09-05 (Government, read 2026-09-16)
  7. NC Medicaid (NC Department of Health and Human Services) — North Carolina Medicaid, 2025-12-19 (Government, read 2026-09-16)
  8. Priority Health (Michigan Medicaid health plan); corroborated by Meridian Health Plan bulletin dated 2025-12-16 — Michigan Medicaid, 2025-12-15 (Health plan, read 2026-09-16)
  9. Boston.com — MassHealth (Massachusetts Medicaid), 2026-06-27 (News, read 2026-09-16)
  10. Rhode Island Current (syndicated via Yahoo News) — Rhode Island Medicaid, 2026-01-27 (News, read 2026-09-16)
  11. KFF — State Medicaid programs, national count (published figure, not computed here), 2026-01-16 (KFF, read 2026-09-16)
  12. KFF — Medicare Part D statutory exclusion, 2026-05-11 (KFF, read 2026-09-16)
  13. Centers for Medicare & Medicaid Services — Medicare GLP-1 Bridge (CMS demonstration), 2025-12-23 (Government, read 2026-09-16)
  14. KFF — Medicare GLP-1 Bridge (extension), 2026-04-21 (KFF, read 2026-09-16)
  15. Centers for Medicare & Medicaid Services — CMS BALANCE Model, 2025-12-23 (Government, read 2026-09-16)
  16. KFF — CMS BALANCE Model, Medicare Part D portion, 2026-04-21 (KFF, read 2026-09-16)
  17. KFF — BALANCE Model negotiated price (published figure), 2026-05-11 (KFF, read 2026-09-16)
  18. Centers for Medicare & Medicaid Services — BALANCE Model state participation (status, Medicaid), 2026-08-14 (Government, read 2026-09-16)

How to cite this tracker

Free to reuse under CC BY 4.0; a link back to this page is the attribution we ask for. For a date or a source document on deadline, email [email protected].

WeighedHealth Editorial. “GLP-1 Coverage Tracker: State Medicaid and Medicare.” WeighedHealth, 2026-09-16. https://weighedhealth.com/research/glp1-coverage-tracker

See our methodology.