Thousands of low-income Californians who rely on widely prescribed weight-loss medications will lose their coverage under Medi-Cal starting Jan. 1, 2026. Health officials are urging patients to turn to diet and exercise as alternatives, but experts warn this advice may be unrealistic for those struggling with obesity.
Wilmer Cardenas of Santa Clara shared his family’s experience: his husband, Jeffer Jimenez, lost approximately 100 pounds over two years using GLP-1 drugs covered by Medi-Cal. “Of course he tried eating well and everything, but now with the medications, it’s better — a 100% change,” Cardenas said.
California joins a growing number of states restricting access to these medications due to rising costs and budget pressures. Despite recent federal negotiations aimed at lowering the price of GLP-1 drugs, states such as California and New Hampshire plan to end coverage for obesity treatment while maintaining it for other conditions like type 2 diabetes, cardiovascular disease, and chronic kidney disease.
Diana Thiara, medical director of the UC San Francisco Weight Management Program, warned of potential health consequences. “It will be quite negative for our patients,” she said, noting that data show many individuals regain weight once the drugs are discontinued.
Nationwide, several states including Michigan, Pennsylvania, Rhode Island, South Carolina, and Wisconsin are considering similar restrictions. According to the Kaiser Family Foundation, interest in covering GLP-1 drugs for obesity is waning, primarily due to cost concerns and other state budget pressures. North Carolina recently reinstated coverage after a court order despite ongoing fiscal challenges.
Federal plans to reduce the cost of GLP-1s through the TrumpRx portal may not significantly ease the financial burden. For instance, the negotiated price for Wegovy is set at $350 per month for consumers and $245 for Medicaid and Medicare, a substantial drop from the $1,350 list price. However, experts say these savings may not translate to meaningful relief for Medicaid patients, many of whom already struggle to afford the medications.
California projected that continuing coverage for GLP-1 weight-loss drugs would cost nearly $800 million annually by 2026. While Medi-Cal members under 21 will continue to have coverage for weight loss due to federal rules, most adult patients will lose access unless the drugs are deemed medically necessary for other conditions. Patients may still pay out-of-pocket or explore new, more affordable oral alternatives, such as the recently FDA-approved pill version of Wegovy.
Experts caution that relying solely on diet and exercise is often insufficient for meaningful weight loss. Kurt Hong, founding director of the Center for Clinical Nutrition at the Keck School of Medicine at USC, emphasized that obesity is a chronic condition requiring ongoing management. “Once they reach their target weight, a lot of people will try to see whether or not they can wean off. Unfortunately, when they try to get off, the weight often comes back,” he said.
For patients like the Cardenas family, the stakes are personal. Though Jimenez’s prescription is technically for diabetes, it has been crucial for weight management. “You need both,” Cardenas said. “A thousand medications, pills, natural teas, exercise programs — they don’t work like the injections.”
