Massachusetts and Rhode Island are considering dropping GLP-1 drugs for obesity treatment from their Medicaid programs, continuing a trend of states that have stopped coverage of these expensive medications. 

Thirteen state Medicaid programs are covering GLP-1 drugs for the treatment of obesity this year, down from 16 last year. 

Medicaid programs in California, New Hampshire, Pennsylvania and South Carolina have eliminated coverage of the drugs for weight loss, because the expense strained state budgets. 

In Massachusetts, the governor’s proposed fiscal 2028 budget would not fund the state’s Medicaid program, MassHealth, to cover GLP-1 medications for weight loss alone, though the state would continue covering the drugs for diabetes and other conditions. The legislature is still debating the state budget. 

Rhode Island’s governor also has proposed removing GLP-1 coverage from the state’s Medicaid program for weight loss treatment. 

North Carolina reinstated such coverage in mid-December after having dropped it in October. 

Medicaid programs in Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia and Wisconsin also cover the drugs for obesity treatment, according to KFF, a health policy research group. 

But some states, such as Michigan, have restricted eligibility for these medications to morbidly obesity patients rather than those who are overweight or obese. The move is expected to save the state an estimated $240 million. 

Meanwhile, lawmakers in Louisiana are debating whether to allow Medicaid to cover GLP-1s for obesity treatment if enrollees have another chronic condition, or comorbidity, such as prediabetes, hypertension or cardiovascular disease.  

The medications generally have been too expensive for people without insurance. In February, one of the largest producers of these drugs, Novo Nordisk, announced it would reduce their list prices to $675 per month in 2027. 

Gross spending on Medicaid prescriptions for GLP-1s — for diabetes as well as for weight loss — has increased from around $1 billion in 2019 to almost $9 billion in 2024 as demand for these drugs has risen, according to KFF. 

At the same time almost 40% of adults and a quarter of children with Medicaid have obesity and may benefit from having access to the drugs, according to KFF. 

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

In the eight states that expanded Medicaid after 2018, the number of people receiving prescriptions for the opioid addiction treatment medication buprenorphine increased dramatically, according to a paper that researchers will present next month.

The states that expanded Medicaid before that period also saw gains, but they were generally smaller. That’s because other changes, aside from Medicaid expansion, made buprenorphine easier to get after 2018.

The researchers found that among all patients — those covered by Medicaid, other insurers and the uninsured — the number of buprenorphine prescriptions increased in the eight most recent Medicaid expansion states (Idaho, Maine, Missouri, North Carolina, Oklahoma, South Dakota, Utah and Virginia) by more than 21% between 2019 and 2023. Maine, Oklahoma and Virginia saw the most dramatic increases.

Among the states that expanded Medicaid in 2018 or before, Kentucky, Vermont and West Virginia experienced the largest boosts. The study, published in February in JAMA Network Open, was conducted by researchers from Rutgers University and Indiana University, based on pharmacy claims data from retailers across the country.

Stephen Crystal, director of the Center for Health Services Research at Rutgers University and one of the authors, explained that buprenorphine became more accessible after 2018 as the federal government loosened various prescribing rules, including allowing prescribing via telehealth.

“Longer-term tracking shows that expansion, whether early or later, provides essential financial access and supports the growth of a provider network that improves population-level treatment rates,” Crystal told Stateline.

Experts warn that looming Medicaid cuts could cut off buprenorphine access to thousands of patients. The broad tax and spending law President Donald Trump signed last summer is projected to cut federal Medicaid spending by an estimated $886.8 billion over the next decade, largely because new work requirements will push people off the rolls, according to estimates by the Congressional Budget Office. CBO estimates that it could increase the number of people without health insurance by 7.5 million in 2034.

Opioid overdose deaths in the U.S. peaked during the COVID-19 pandemic, reaching a high of 81,806 deaths in 2022. They’ve fallen sharply since then, to 79,358 in 2023 and 54,045 in 2024.

Medicaid is  the largest payer of opioid use disorder treatment, and in 2023 it covered nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, said Robin Rudowitz, a senior vice president at KFF, a health policy research group.

“Having health insurance is the main way for people to have consistent access to health care services, and also particularly for Medicaid, as most people are low income, and it provides protections against financial burdens,” Rudowitz said.

“And for (opioid use disorder) specifically, research shows that when people discontinue treatment, mortality risk increases. And for discontinuation of Medicaid, specifically, when coverage lapses, mortality rate increases.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.