Ozempic and Wegovy Coming to Medicaid in 2026 — How Low-Income Families Can Access GLP-1 Drugs

For millions of low-income Americans on Medicaid who struggle with obesity, diabetes, or heart disease, a major barrier may be falling in 2026: GLP-1 medications like Ozempic and Wegovy — which can cost over $1,000 per month without insurance — are coming to Medicaid coverage through a new federal program launching as early as May 2026.

What Happened
The Centers for Medicare and Medicaid Services (CMS) announced the BALANCE Model — Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth — a new voluntary program enabling state Medicaid agencies to cover GLP-1 medications used for weight management and metabolic health improvement. The program launches in Medicaid as early as May 2026.

What Are GLP-1 Medications?
GLP-1 receptor agonists were originally developed to treat type 2 diabetes but have shown significant effectiveness for weight loss and cardiovascular risk reduction. Well-known options include:

Ozempic / Wegovy (semaglutide) — Novo Nordisk
Zepbound / Mounjaro (tirzepatide) — Eli Lilly
Victoza / Saxenda (liraglutide) — Novo Nordisk
Clinical studies show these medications can produce 15–20% weight loss over 12–16 months, along with improvements in blood sugar and cardiovascular outcomes.

What This Means for Medicaid Recipients
Low or no cost access: Medicaid enrollees in participating states may access GLP-1 medications with standard cost-sharing (often $0 or very low copays)
Lifestyle support included: The model pairs medication with nutrition counseling and behavioral health resources
Voluntary for states: Each state decides whether to participate — check your state’s Medicaid agency
Who May Qualify
Body mass index (BMI) of 30 or higher, or BMI of 27 or higher with a weight-related condition
Type 2 diabetes, cardiovascular disease, or other qualifying metabolic conditions
Enrolled in a participating state Medicaid plan
How to Access GLP-1 Coverage Starting May 2026
Check if your state is participating — contact your state Medicaid agency or visit medicaid.gov
Talk to your doctor — confirm you have a qualifying condition
Request a prior authorization — your doctor submits documentation to your Medicaid plan
Enroll in lifestyle support programming — required under the BALANCE Model
🏥 Not on Medicaid Yet? Check If You Qualify
A family of four earning under approximately $40,000/year may qualify for Medicaid in most states. eHealth can help you check eligibility and find the right plan — free of charge.

Check Medicaid Eligibility →
Frequently Asked Questions
My state doesn’t participate. Can I still get GLP-1 medications?
You may still get them for diabetes treatment under existing Medicaid coverage. Check with your state Medicaid agency for weight management coverage.

Are there side effects?
GLP-1 medications can cause nausea, vomiting, and diarrhea especially when starting. Discuss all risks with your doctor before starting.

When will Medicare cover GLP-1 for weight loss?
The BALANCE Model includes a Medicare Part D component launching January 2027.

Source: Centers for Medicare and Medicaid Services — cms.gov. Updated March 16, 2026.