April Obesity Coverage Watch: The State of Obesity Care Coverage

In this edition of Obesity Coverage Watch, we’re providing an overview of how coverage for obesity care is fracturing along state lines. As federal policy shifts and state budgets tighten, access to life-changing interventions is increasingly determined by geography.  

This edition tracks which states are expanding coverage, which are pulling back and what a new federal model could mean for the millions of individuals living with obesity who are caught in the middle.  

public insurance coverage of obesity medications is becoming a state-by-state story  

making strides: state governments investing in or considering expanding coverage  

• As of January 2026, 13 state Medicaid programs cover GLP-1s for obesity management, with North Carolina reinstating coverage in late 2025 after previously announcing it would eliminate access for beneficiaries.  

• Kentucky, Nevada, New Hampshire, and Louisiana are considering expanding Medicaid coverage for obesity management medications.   

• In support of Louisiana’s efforts, Millicent Gorham, CEO of the Alliance for Women’s Health & Prevention, submitted written testimony, emphasizing that:  

• “Obesity management medications are not vanity drugs. They are critical interventions for a serious chronic disease and an important tool in helping to prevent the over 200 health complications associated with obesity, including many that specifically affect women, such as breast and ovarian cancers and fertility challenges. Effectively addressing the obesity epidemic in Louisiana, where the disease impacts 13% of adult Medicaid beneficiaries, requires coverage for the full continuum of obesity care—including behavioral therapy, nutrition services, bariatric surgery and FDA-approved medications.” 

• After rolling back coverage for state employees, Ohio lawmakers have introduced legislation to restore access to critical obesity treatments.  

• Meanwhile, Wisconsin’s Group Insurance Board announced it will, for the first time, cover GLP-1 medications for obesity under the state’s employee health plan.  

concerning trends: Medicaid and employee health plan coverage on the chopping block 

• Four states—California, New Hampshire, Pennsylvania and South Carolina—ended Medicaid coverage for obesity medications this year, while Rhode Island is considering sunsetting coverage.  

• Massachusetts and Idaho recently rolled back coverage of these medications for state employees. Like the states who have rolled back Medicaid coverage, budget considerations were cited as the driving factor.  

What this means for patients: While momentum in some states is encouraging, the broader trend of disrupting care is a shortsighted and costly decision. Obesity medications aren’t vanity drugs; they are critical interventions for a serious chronic disease. 

a new access path emerges – the Centers for Medicare & Medicaid Innovation’s BALANCE Model 

While public insurance coverage at the state level remains disparate, the Trump administration has a plan to expand coverage of obesity care for Medicaid beneficiaries. 

• What it is: The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model is an initiative to increase access to select GLP-1 medications and healthy lifestyle interventions for eligible Medicaid beneficiaries.  

• Participation will be voluntary for GLP-1 manufacturers and state Medicaid agencies. The deadline for states to sign up for BALANCE is July 31, 2026. 

• The bottom line: In an increasingly fragmented coverage landscape, the BALANCE Model offers states a meaningful opportunity to provide consistent coverage of comprehensive care for some of the country’s most vulnerable populations. 

For patients, access to obesity care is more than just treatment – it’s reducing stigma, providing greater financial empowerment for women affected by the obesity wage gap and lowering long-term costs from serious associated conditions like cancer and cardiovascular disease.