As demand for GLP-1 medications continues to surge across the United States, a growing number of states are reevaluating whether they can afford to cover these drugs for obesity treatment under Medicaid. Recent proposals in Massachusetts and Rhode Island highlight a broader national trend: balancing access to innovative but expensive therapies with the realities of state budgets.
A shrinking list of states offering coverage
Just a year ago, 16 state Medicaid programs covered GLP-1 medications specifically for weight loss. That number has now dropped to 13. States like California, New Hampshire, Pennsylvania, and South Carolina have already eliminated this benefit, citing unsustainable costs.
GLP-1 drugs, originally developed for diabetes management, have gained widespread attention for their effectiveness in promoting weight loss. However, their high price tag has made them a significant financial burden for publicly funded programs like Medicaid.
Proposed changes in Massachusetts and Rhode Island
In Massachusetts, Governor Maura Healey’s proposed fiscal 2028 budget would remove coverage of GLP-1 drugs for weight loss under MassHealth, the state’s Medicaid program. Importantly, coverage would remain intact for patients using these medications to treat diabetes or other medical conditions. The proposal is still under legislative review, leaving room for potential revisions.
Similarly, Rhode Island’s governor has proposed eliminating Medicaid coverage for GLP-1 medications when prescribed solely for obesity treatment. These decisions reflect a growing concern among policymakers: how to prioritize limited healthcare dollars while still addressing widespread chronic conditions.
Despite these cutbacks, several states continue to provide coverage for GLP-1 drugs for obesity. These include Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia, and Wisconsin.
However, even among these states, access is often limited. For example, Michigan has restricted eligibility to patients with morbid obesity, excluding those who are overweight or moderately obese. This policy adjustment alone is projected to save the state an estimated $240 million, illustrating the scale of financial pressure these medications create.
Louisiana’s ongoing debate
In Louisiana, lawmakers are considering a middle-ground approach. Rather than offering broad coverage, the state may allow Medicaid to cover GLP-1 medications for obesity only when patients also have a related chronic condition, such as prediabetes, hypertension, or cardiovascular disease.
This strategy aims to target patients at the highest risk while controlling costs, but it also raises questions about equity and early intervention. Should treatment be limited to those already experiencing complications, or should it be expanded to prevent them?
The cost challenge
The financial strain driving these decisions is substantial. Medicaid spending on GLP-1 prescriptions (covering both diabetes and weight loss) has skyrocketed from about $1 billion in 2019 to nearly $9 billion in 2024, according to KFF.
For those without insurance, affordability remains a major barrier. In response, Novo Nordisk announced plans to lower the list price of its GLP-1 medications to $675 per month by 2027. While this reduction may improve access, it is still a significant expense for many patients and for state-funded programs.
High need, limited access
The debate over GLP-1 coverage comes at a time when obesity rates remain high. Nearly 40% of adults and about 25% of children enrolled in Medicaid have obesity, suggesting a large population could potentially benefit from these medications. Yet, as states tighten coverage, a pattern emerges: Innovative treatments are becoming more effective and more popular, but not necessarily more accessible.
The kids are also affected
As Philadelphia’s WHYY reported, the Children’s Hospital of Philadelphia (CHOP) did some research about the coverage specifically for children:
CHOP researchers found that only a fraction of eligible kids ultimately get a GLP-1 prescription. Even after they do, families struggle with cost and insurance coverage issues that make it hard for their children to stay on the medication.
Side effects and gaps in follow-up care are also causing disruptions in medication use, according to CHOP’s findings, recently published in the journal Pediatrics.
Looking ahead
The future of GLP-1 coverage under Medicaid is far from settled. As more states weigh the costs and benefits, policies will likely continue to evolve, creating a patchwork system where access depends heavily on geography.
For patients, providers, and policymakers alike, the challenge is clear: how to expand access to life-changing treatments without overwhelming already stretched healthcare budgets. Whether through pricing reforms, eligibility adjustments, or alternative treatment strategies, the decisions made today will shape obesity care for years to come.
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Source: “Philly pediatricians are using GLP-1 drugs to treat childhood obesity, but cost can be a major barrier, CHOP doctors find,” WHYY, 5/4/26
Source: “Only 13 States’s Medicaid Still Cover GLP-1 Drugs to Treat Obesity, and More Are Dropping Out,” FlaglerLive.com, 4/30/26
Source: “Rhode Island considers ending Medicaid coverage of GLP-1 drugs for weight loss,” Rhode Island Current, 6/10/25
Source: “Louisiana Medicaid might add coverage for popular obesity treatment drugs,” Louisiana Illuminator, 4/16/26
Source: “Medicaid Coverage of and Spending on GLP-1s,” KFF, 1/16/26
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