By Sera Ramadan, M.D. | September 5, 2026
Removing GLP-1 coverage from Medi-Cal at the start of 2026 was the wrong call, medically and fiscally.
The state projected GLP-1 coverage would cost nearly $800 million annually. Meanwhile, California already spends an estimated $89.5 billion per year treating obesity and its downstream illnesses. If eliminating a treatment saves millions while guaranteeing billions in avoidable spending, that is not fiscal responsibility. It is cost-shifting onto the sickest patients.
The equity argument is just as clear. For the 1.4 million LGBTQ+ Californians on Medi-Cal, this coverage gap compounds existing barriers: limited access to affirming providers, higher rates of poverty, and chronic exposure to stressors that directly affect metabolic health. In Los Angeles County, obesity affects cisgender lesbians at twice the rate of cisgender gay men (42% versus 21%). Lesbian women experience higher rates of obesity, hypertension, and diabetes than heterosexual women, the product of layered social determinants that medicine alone cannot fix, but should not make worse.
For transgender women, hormone replacement therapy increases fat mass and insulin resistance, raising the risk of obesity and Type 2 diabetes. GLP-1s address these metabolic effects directly and safely. And for patients living with HIV, nearly one-third of whom in California rely on Medi-Cal, GLP-1s offer an option that does not interact adversely with antiretroviral therapy, a significant concern for a population already managing complex drug regimens.
The benefits extend beyond weight and metabolic disease. Early but compelling data shows GLP-1s reduce addictive behaviors by modulating the brain’s dopamine reward pathways. In a small randomized trial, patients with opioid use disorder saw a 40% reduction in cravings over three weeks. Separate observational data found GLP-1 use was associated with a 50% reduction in recurrent alcohol use disorder diagnoses. In a population already facing disproportionate rates of substance use, removing access to a medication with this kind of signal is a missed opportunity at best.
California has the clinical evidence, the policy infrastructure, and the stated commitment to health equity to do better than this. Reinstating GLP-1 coverage in Medi-Cal is the logical extension of treating obesity as the serious, chronic disease it is.
Dr. Sera Ramadan, Glendale
Dr. Sera Ramadan is the founder and medical director of Los Angeles Primary Care, and is board-certified in internal medicine and obesity medicine.