Insurance / Medicaid
Medicaid and GLP-1 drugs
Each state runs its own Medicaid program, so coverage of GLP-1s for weight loss depends on where you live. 14 states checked against the state's own documents so far.
AKMEVTNHWAIDMTNDMNILWIMINYRIMAORNVWYSDIAINOHPANJCTCAUTCONEMOKYWVVAMDDEAZNMKSARTNNCSCDCOKLAMSALGAHITXFL
✓ Prior-authorization path for weight management± Covered for obesity, with added limits✕ Not covered for weight loss alone○ Criteria listed only for non-obesity uses? Document found; a person still has to check it· Not verified yet
Source: each state's Medicaid documents, checked Oct 17, 2026. Click a colored state for its official wording. Weight-loss use only.
Federal background
- Each state runs its own Medicaid program within federal guidelines, so eligibility and benefits can vary widely from state to state.12
- Under CMS's voluntary BALANCE model, CMS negotiates GLP-1 prices and coverage terms with manufacturers on behalf of state Medicaid agencies that join.3
- States could choose a start date between May 1, 2026 and January 1, 2027; states that have not joined by January 1, 2027 cannot join except at CMS's discretion.45 CMS's BALANCE page, as we last checked it, does not list participating states, so we do not show any.
States checked against their own documents
This table is about weight-loss use only. We do not summarize the clinical criteria states use for other conditions.
| State | Status | What the state's document says | Document |
|---|---|---|---|
| North Carolina NC Medicaid | Prior-authorization path for weight management from 2025-12-12 | Coverage of GLP-1s for obesity was reinstated effective December 12, 2025. Wegovy is the preferred product; Zepbound and Saxenda are non-preferred.1617 | NC Medicaid bulletin, December 19, 2025 checked Oct 17, 2026 |
| Tennessee TennCare | Prior-authorization path for weight management | TennCare has a prior authorization form for weight management agents, and says its managed care plans offer support services for patients using GLP-1s for weight management.2728 | TennCare prior authorization form, Weight Management Agents (revised 08/2026), on OptumRx's TennCare site checked Oct 17, 2026 |
| Virginia Virginia Medicaid (DMAS) | Prior-authorization path for weight management | Virginia Medicaid has a service authorization form for weight-loss management that includes renewal rules for GLP-1 receptor agonists.2930 | DMAS service authorization form, Weight-Loss Management (effective 07/01/2026), hosted on the Virginia Medicaid Pharmacy Services portal checked Oct 17, 2026 |
| Michigan Michigan Medicaid | Covered for obesity, with added limits from 2026-01-01 | From January 1, 2026, coverage of GLP-1s prescribed solely for obesity is reduced; obesity requests require, among other things, a morbid obesity classification.1415 | MDHHS letter L 25-73, December 8, 2025 checked Oct 17, 2026 |
| Arizona AHCCCS | Not covered for weight loss alone | AHCCCS's fee-for-service pharmacy manual lists medications used for weight loss treatment as excluded from the outpatient pharmacy benefit.67 | AHCCCS Fee-For-Service Provider Manual, Chapter 12 (Pharmacy) checked Oct 17, 2026 |
| California Medi-Cal Rx | Not covered for weight loss alone from 2026-01-01 | Since January 1, 2026, Medi-Cal Rx no longer covers Saxenda, Wegovy or Zepbound when used for weight loss. Members under 21 can be reviewed under EPSDT.89101112 | Medi-Cal Rx alert, October 21, 2025 checked Oct 17, 2026 |
| Maryland Maryland Medicaid | Not covered for weight loss alone | Wegovy is not covered when the only reason is chronic weight management.13 | Transmittal PT 35-25, September 13, 2024 checked Oct 17, 2026 |
| New Jersey NJ FamilyCare | Not covered for weight loss alone | A Department of Human Services memo says NJ FamilyCare covers weight-loss drugs only in limited circumstances, such as FDA-approved uses other than weight loss.1819 | NJ Department of Human Services memo to the Legislature (SFY 2026) checked Oct 17, 2026 |
| Pennsylvania Medical Assistance | Not covered for weight loss alone from 2026-01-01 | Since January 1, 2026, Medical Assistance no longer covers GLP-1 drugs for overweight and obesity.24 | Medical Assistance Bulletin, November 24, 2025 checked Oct 17, 2026 |
| Rhode Island Rhode Island Medicaid | Not covered for weight loss alone from 2026-10-01 | Since October 1, 2026, Rhode Island Medicaid no longer covers Foundayo, Saxenda, Wegovy or Zepbound when prescribed solely for weight loss.2526 | EOHHS memo, August 5, 2026 checked Oct 17, 2026 |
| Vermont Vermont Medicaid | Not covered for weight loss alone | Vermont Medicaid's drug list says drugs used for weight loss are excluded from pharmacy coverage.31 | DVHA Preferred Drug List, updated 10/02/2026 checked Oct 17, 2026 |
| Washington Apple Health | Not covered for weight loss alone from 2026-02-01 | Since February 1, 2026, Apple Health does not cover Wegovy for weight loss.3233 | HCA medical policy 61.25.20.AA-4, effective 2/1/2026 checked Oct 17, 2026 |
| New York NYRx (Medicaid Pharmacy Program) | Criteria listed only for non-obesity uses | The NYRx drug list's criteria for Wegovy require a cardiovascular disease diagnosis, and for Zepbound an obstructive sleep apnea diagnosis.2021 | NYRx Preferred Drug Program list checked Oct 17, 2026 |
| Ohio Ohio Medicaid | Criteria listed only for non-obesity uses | Ohio's drug list places Wegovy under its criteria for GLP-1 agonists for non-obesity indications.2223 | Ohio Medicaid Unified Preferred Drug List, effective April 1, 2026 checked Oct 17, 2026 |
Not verified yet
We have not verified these states. Check with your state's Medicaid program or your plan; Medicaid.gov is the federal starting point: medicaid.gov.
Alabama · Alaska · Arkansas · Colorado · Connecticut · Delaware · District of Columbia · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Louisiana · Maine · Massachusetts · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Mexico · North Dakota · Oklahoma · Oregon · South Carolina · South Dakota · Texas · Utah · West Virginia · Wisconsin · Wyoming
For Kansas, Massachusetts, Minnesota, Mississippi and New Hampshire we found the state's document, but the state's website did not let us keep a checked copy. A person will read those documents before we add them.
Official sources for this page (33)
“Each state runs its own Medicaid program according to certain federal guidelines.”
NovoCare: Medicaid · as of Oct 17, 2026“As a result, Medicaid eligibility and benefits can vary widely from state to state.”
NovoCare: Medicaid · as of Oct 17, 2026“As part of this voluntary model, CMS will negotiate drug pricing and coverage terms with manufacturers of GLP-1 medications on behalf of state Medicaid agencies and Medicare Part D plan sponsors.”
CMS Innovation Center: BALANCE Model · as of Oct 17, 2026“States may choose to start participating in BALANCE starting on a date of their choosing between May 1, 2026, and January 1, 2027.”
CMS HPMS memo, April 21, 2026 · as of Oct 17, 2026“States that do not join the model by January 1, 2027, will not be allowed to participate in the model except at CMS discretion.”
CMS HPMS memo, April 21, 2026 · as of Oct 17, 2026“The following are excluded from coverage under the outpatient FFS pharmacy benefit:”
Arizona AHCCCS: AHCCCS Fee-For-Service Provider Manual, Chapter 12 (Pharmacy) · as of Oct 17, 2026“Medications used for weight loss treatment;”
Arizona AHCCCS: AHCCCS Fee-For-Service Provider Manual, Chapter 12 (Pharmacy) · as of Oct 17, 2026“Effective January 1, 2026, Medi-Cal Rx will no longer cover the following GLP-1 drugs when used for weight loss or weight-loss indications:”
California Medi-Cal Rx: Medi-Cal Rx alert, October 21, 2025 · as of Oct 17, 2026“For members younger than 21 years of age pursuant to the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.”
California Medi-Cal Rx: Medi-Cal Rx alert, October 21, 2025 · as of Oct 17, 2026“Saxenda® (liraglutide)”
California Medi-Cal Rx: Medi-Cal Rx alert, October 21, 2025 · as of Oct 17, 2026“Wegovy® (semaglutide)”
California Medi-Cal Rx: Medi-Cal Rx alert, October 21, 2025 · as of Oct 17, 2026“Zepbound® (tirzepatide)”
California Medi-Cal Rx: Medi-Cal Rx alert, October 21, 2025 · as of Oct 17, 2026“Wegovy will not be covered when the sole indication is for chronic weight management”
Maryland Maryland Medicaid: Transmittal PT 35-25, September 13, 2024 · as of Oct 17, 2026“Coverage of GLP-1 medications when prescribed solely to treat obesity, including requests for continuation, will be reduced.”
Michigan Michigan Medicaid: MDHHS letter L 25-73, December 8, 2025 · as of Oct 17, 2026“Patient must be classified as morbidly obese”
Michigan Michigan Medicaid: MDHHS letter L 25-73, December 8, 2025 · as of Oct 17, 2026“NC Medicaid coverage for GLP-1s for the treatment of obesity is being reinstated effective Dec. 12, 2025.”
North Carolina NC Medicaid: NC Medicaid bulletin, December 19, 2025 · as of Oct 17, 2026“Wegovy is a Preferred Product. Zepbound and Saxenda are Non-Preferred Products.”
North Carolina NC Medicaid: NC Medicaid bulletin, December 19, 2025 · as of Oct 17, 2026“NJ FamilyCare already provides coverage of drugs indicated for weight loss in certain limited circumstances.”
“These include when drugs (including Glucagon-like peptide-1 agonists or GLP-1s) are prescribed for FDA-approved indications other than weight loss.”
“semaglutide (Wegovy®) LIFETIME QUANTITY LIMIT: • Two treatment attempts per lifetime • Confirm diagnosis of cardiovascular disease”
New York NYRx (Medicaid Pharmacy Program): NYRx Preferred Drug Program list · as of Oct 17, 2026“tirzepatide (Zepbound®) LIFETIME QUANTITY LIMIT: • Two treatment attempts per lifetime • Confirm diagnosis of obstructive sleep apnea (OSA)”
New York NYRx (Medicaid Pharmacy Program): NYRx Preferred Drug Program list · as of Oct 17, 2026“GLP-1 AGONISTS FOR NON-OBESITY INDICATIONS”
“WEGOVY PA INJ, TAB”
“effective January 1, 2026, coverage will end for drugs containing a glucagon-like peptide-1 (GLP-1) receptor agonist for the treatment of overweight and obesity for Medical Assistance (MA) beneficiaries.”
Pennsylvania Medical Assistance: Medical Assistance Bulletin, November 24, 2025 · as of Oct 17, 2026“beginning October 1, 2026, Rhode Island Medicaid will no longer cover certain GLP-1 receptor agonists when they are prescribed solely for weight loss.”
Rhode Island Rhode Island Medicaid: EOHHS memo, August 5, 2026 · as of Oct 17, 2026“Foundayo (Orforglipron) Saxenda (Liraglutide) Wegovy (Semaglutide) Zepbound (Tirzepatide)”
Rhode Island Rhode Island Medicaid: EOHHS memo, August 5, 2026 · as of Oct 17, 2026“Weight Management Agents”
“Each of TennCare's three Managed Care Organizations (MCOs) are offering wraparound services to support patients utilizing GLP-1 Agonists for weight management.”
“WEIGHT-LOSS MANAGEMENT”
“GLP-1 Receptor Agonists – If the member achieves a weight loss of ≥ 5% reduction in body weight compared to the most recent authorization, an additional 6-month SA may be granted.”
“Drugs used for weight loss, drugs used to promote fertility, and drugs used for cosmetic purposes or hair growth are excluded from coverage under the Vermont Medicaid Pharmacy program.”
Vermont Vermont Medicaid: DVHA Preferred Drug List, updated 10/02/2026 · as of Oct 17, 2026“Semaglutide injection or tablet (Wegovy®) is not covered by Apple Health for weight loss”
Washington Apple Health: HCA medical policy 61.25.20.AA-4, effective 2/1/2026 · as of Oct 17, 2026“Effective Date: 2/1/2026”
Washington Apple Health: HCA medical policy 61.25.20.AA-4, effective 2/1/2026 · as of Oct 17, 2026