COLUMBUS, Mississippi. April Hines has struggled with her weight since she was a teenager.
But over the past couple of years, her weight has dropped from 600 pounds to 385, and her blood pressure and blood sugar levels have also dropped. “I wasn’t as tired as before, and I was able to go back to church,” she said.
Hines, 46, credits her weight loss to Trulicity, part of a new class of expensive weight-loss drugs known as GLP-1, and her Medicaid coverage. “It's a blessing,” she said.
In a state where obesity rates are among the highest in the country, many health care providers were thrilled when Mississippi's Medicaid program began covering GLP-1 in 2023 for people 12 and older. Only 13 states cover the cost of obesity drugs for Medicaid enrollees, and Mississippi's Medicaid program typically has some of the rarest benefits and the most stringent eligibility rules.
Hines is one of relatively few members to take advantage of the new Medicaid benefit, which weight-loss doctors in the state say is hampered by a national drug shortage, the state's drug pre-authorization process and a lack of marketing. As of December 2024, only 2% of adults on Mississippi Medicaid who meet weight-related criteria received GLP-1, the data shows. report to the State Medicaid Drug Utilization Review Board.
“It's a little sad that so many people don't get help,” said William Rosenblatt, a family physician in Columbus who treats Hines. “These drugs target the root cause of many diseases.”
Medicaid's already meager coverage of highly touted weight-loss drugs could become more limited as federal funding for Medicaid is expected to decline following a massive tax and spending bill that President Donald Trump signed into law in July. The Congressional Budget Office has estimated that the law would reduce Medicaid spending by about $911 billion over ten years.
“The law will put quite a lot of pressure on states not to expand benefits,” said Michael Colbert, a partner at health care consulting firm Manatt. That may be especially true for these drugs, which often cost about $1,000 a month and may be used by a large percentage of Medicaid recipients, he said.
GLP-1, which have been used for many years for the treatment of type 2 diabetes have received widespread attention as a way to lose weight and reduce obesity-related conditions and their long-term costs.
But states may remain reluctant to offer expensive obesity drugs because Medicaid recipients often move in and out of coverage as their incomes change. And because the health benefits of drugs can take years to manifest (such as preventing a future heart attack), long-term financial benefits may accrue to other insurers.
Even with federal cuts set to take effect largely in 2027, states are already feeling the pinch. North Carolina Medicaid Program stopped covering drugs this month, citing high costs.
Covering weight-loss drugs poses a dilemma for the Trump administration, which has prioritized fighting chronic diseases and cutting federal spending. Secretary of Health and Human Services Robert F. Kennedy Jr. downplayed the need about medications and said more emphasis should be placed on better nutrition and more exercise.
In 2024, the Biden administration proposed that Medicare and Medicaid would cover weight-loss drugs to help tackle obesity as a public health crisis. In April, the Trump administration withdrew the Biden-era proposal, saying the programs would not cover GLP-1 weight-loss drugs.
But in August The Washington Post reported this. After all, the Trump administration was considering a five-year pilot program for Medicare and Medicaid to cover drug costs. Details have not been disclosed. When asked to comment on the report, Centers for Medicare and Medicaid Services spokesman Alex Pons told KFF Health News that all decisions undergo a cost-benefit analysis.
Meanwhile, the Trump administration included GLP-1 drugs Ozempic, Wegovy and Rybelsus on its list of 15 drugs whose prices will be negotiated with pharmaceutical manufacturers under Medicare Part D, a system created during the Biden administration amid opposition from Republicans. The results of these negotiations are expected to be announced this fall.
Most private insurers do not cover GLP-1 for weight loss, which can make the medications unaffordable for those paying out of pocket.
Further analysis provided Mississippi's Medicaid Drug Review Board shows that in the first 15 months, only about 2,900 Medicaid members age 12 and older started treatment with drug costs covered. Almost 90% of them were women, and many had high blood pressure and high cholesterol.
The analysis also found that most drug-using participants lived in south, central or northern Mississippi, rather than in the Mississippi Delta on the west side of the state, where obesity rates are highest at nearly 50%.
About 40% of adults in Mississippi are obese, according to federal data, just one percentage point behind top-ranked West Virginia.
Mississippi Medicaid spokesman Matt Westerfield told KFF Health News that in the first 15 months, the state spent $12 million to provide weight-loss drugs to 2,200 adult enrollees. He said the state approved the new drugs on the basis that treating obesity would improve the health of participants and could ultimately lead to cost savings by reducing diseases caused by obesity.
Westerfield said that while utilization was below state projections, decisions about such treatments remain up to patients and their doctors. He said the state is “raising awareness” about the drugs among health care workers, but declined to comment further.
Rosenblatt, who works for Baptist Medical Group, part of a large regional health system, says some doctors have less incentive to prescribe drugs because the government doesn't pay them to advise patients about necessary dietary changes when taking new medications.
He called the drugs “game-changing,” adding that he has seen patients lose 50 pounds or more within months of starting the medications and no longer need medications for diabetes or other conditions.
A New England Journal of Medicine Study studies published in 2021 found that participants who received GLP-1 drugs were more likely to experience significant and sustained weight loss compared to those who received a placebo.
Other recent studies have shown that these drugs help obese people reduce stress. high blood pressure and reduce your chances of heart attacks or strokes.
Mississippi is one of 10 states that have not expanded Medicaid eligibility under the 2010 Affordable Care Act to anyone whose income is below 138% of the federal poverty level, or $21,597 this year.
In Mississippi, Medicaid does not cover adults without dependent children. Parents are eligible only if their income is below 22% of the federal poverty level, or $5,863 for a family of three this year.
The state's prior authorization process requires doctors to provide the state with documented evidence that patients meet a certain level of obesity and that a treatment plan is in place. To renew a prescription, doctors must demonstrate that participants are losing weight every six months.
At the Hattiesburg Clinic, a large multidisciplinary group located in Hattiesburg, Miss., Virginia Crawford, a physician who specializes in obesity, said she was surprised that so few patients were receiving the medications. A year ago, there was a shortage of drugs that could limit the number of doctors prescribing them. And she said state pre-authorization requirements for the drug could discourage primary care doctors. Many common medications do not require progress reports or even prior authorization.
“We need to educate patients that this is an option available to them,” she said.
Lauren Scott, 40, of Laurel, Mississippi, said she lost nearly 100 pounds while taking Wegovy with the help of Medicaid.
“It’s just amazing,” she said of how the drug has dramatically reduced her appetite. “I remember going to Outback with my husband and we bought an appetizer of onion rings, a 16-ounce ribeye and a salad with extra ranch dressing. I ate a few onion rings, started eating the salad, and realized I couldn't eat it anymore.”
