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California Medicaid

Does California Medicaid cover Wegovy?

No. California Medicaid's policies on file exclude Wegovy for weight loss on Medicaid plans.

Policy document

  • Medicaid: Not covered. Effective January 1, 2026, Wegovy is no longer eligible for coverage for weight loss or weight loss-related...

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (1 plan type)

Applies to Medicaid plans.

Not covered

Effective January 1, 2026, Wegovy is no longer eligible for coverage for weight loss or weight loss-related indications.

Exceptions

  • under_21_epsdt: Effective January 1, 2026, PA requests submitted for weight loss or weight loss-related indications will be reviewed for medical necessity for members younger than 21 years of age pursuant to the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.

Policy note: Removal from coverage effective January 1, 2026. EPSDT exception applies for members under age 21.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12 A GLP-1 Coverage Considerations · View policy document (PDF)

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Full requirements: Wegovy for Heart Disease Risk Reduction (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Non-weight-loss indication (e.g., cardiovascular disease) — PA required, reviewed for medical necessity

All of:

  • PA request submitted for non-weight-loss-related cardiovascular disease indication
  • Medical necessity review required

Documentation to bring

  • PA request for cardiovascular disease or other non-weight-loss indication
  • Documentation supporting medical necessity

Policy note: Document states 'PA requests submitted for non-weight loss-related indications, such as cardiovascular disease, will be reviewed for coverage consideration based on medical necessity.' No specific clinical criteria are defined in this document; medical necessity review is indicated. PA is required.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12 A GLP-1 Coverage Considerations · View policy document (PDF)

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Full requirements: Wegovy for Liver Disease (MASH) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

MASH without cirrhosis — no PA required with correct diagnosis code

All of:

  • Noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) diagnosis
  • Claim submitted with ICD-10-CM diagnosis code K76.0 and/or K75.8

Documentation to bring

  • ICD-10-CM diagnosis code K76.0 (Fatty (change of) liver, not elsewhere classified) and/or K75.8 (Other specified inflammatory liver diseases) submitted on claim

Not covered when

  • Cirrhotic MASH not addressed; document specifies noncirrhotic MASH only

Policy note: Effective April 1, 2026. No PA required when claim is submitted with the appropriate ICD-10-CM diagnosis code (K76.0 and/or K75.8). Claims without the appropriate code will deny with Reject Code 80. Document does not specify detailed clinical criteria (fibrosis stage, confirmation methods, etc.) beyond the diagnosis code requirement.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12 A GLP-1 Coverage Considerations · View policy document (PDF)

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If weight loss isn't covered on your plan

California Medicaid has separate Wegovy policies that don't depend on that benefit:

Questions people ask
Does California Medicaid cover Wegovy?
No. California Medicaid's policies on file exclude Wegovy for weight loss on Medicaid plans.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under California Medicaid: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Elevance Health, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Molina Healthcare, Alabama Medicaid, Clover Health, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

Summary of California Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.