Relates to requiring Medicaid coverage of FDA-approved GLP-1 receptor agonist medications for obesity, metabolic disorders, and autism-related compulsive eating behaviors.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9360
SPONSOR: Santabarbara TITLE OF BILL:
An act to amend the social services law, in relation to requiring Medi-
caid coverage of FDA-approved GLP-1 receptor agonist medications for
obesity, metabolic disorders, and autism-related compulsive eating
behaviors
PURPOSE:
To mandate New York State Medicaid coverage of FDA-approved GLP-1 medi-
cations (including semaglutide, liraglutide, and similar agents) when
prescribed for the treatment of obesity, metabolic disorders, or clin-
ically documented compulsive eating behaviors related to Autism Spectrum
Disorder (ASD).
SUMMARY OF PROVISIONS:
This bill would:
1. Require NY Medicaid to cover GLP-1 receptor agonist medications for
the following medically indicated purposes:
Obesity treatment in individuals with a BMI Z 30, or Z 27 with a related
comorbidity.
Metabolic disorders, including prediabetes, Type 2 diabetes, and meta-
bolic syndrome.
Clinically verified autism-related compulsive eating behaviors, with
certification from a qualified clinician (developmental pediatrician,
neurologist, psychiatrist, psychologist, or other licensed provider).
2. Authorize and define cost-management mechanisms to ensure fiscal
responsibility, including:
Step therapy requirements, where clinically appropriate: Prior authori-
zation standards ensuring medical necessity. Income-based eligibility
prioritization for high-need, low-income Medicaid recipients.
Documentation requirements for clinician certification in autism-related
cases.
3. Require the Department of Health (DOH) to:
Develop clear rules and clinical criteria for coverage within 180 days.
Streamline prior authorization forms and timelines.
Evaluate health outcomes and potential Medicaid cost savings. Submit an
annual report to the Legislature detailing utilization, costs, and meas-
urable health outcomes.
4. Clarify that coverage applies to all FDA-approved GLP-1 medications
for obesity and metabolic indications, including emerging therapies as
approved.
JUSTIFICATION:
Obesity and metabolic disorders are among the most significant drivers
of poor health outcomes and high Medicaid spending in New York State.
GLP-1 medications have demonstrated clinically meaningful improvements
in weight loss, glycemic control, and cardiovascular health.
Recent evidence-including a major study referenced in The Wall Street
Journal-shows that semaglutide reduces the combined risk of heart
attack, stroke, or death by 57%. Preventing these events not only
improves quality of life but also significantly reduces long-term Medi-
caid expenditures.
Impact on Individuals with Autism
Autistic individuals, particularly those with limited verbal ability or
co-occurring anxiety, often struggle with:
*Compulsive eating
*Limited self-regulation
*Sensory-driven food behaviors
*Elevated risk of obesity and related chronic illness
*Families across New York report that behavioral interventions alone are
often insufficient. GLP-1 medications offer a new and evidence-based
tool to address harmful, life-limiting weight gain that can accompany
ASD. Medicaid is the primary insurer for many autistic children and
adults, making coverage essential to equitable access.
*Equity and Public Health
*Low-income and disabled New Yorkers face disproportionate barriers to:
*Healthy food access
*Specialized nutritional counseling
*Safe exercise environments
*Consistent preventive care
*GLP-1 medications help counteract structural inequities in health
outcomes. Fourteen states have already expanded Medicaid coverage for
GLP-1 medications for obesity, demonstrating both feasibility and bipar-
tisan support.
Expanding Medicaid coverage is expected to: Reduce hospitalizations
*Decrease the incidence of diabetes, hypertension, and cardiovascular
disease
*Lower long-term Medicaid spending
*Improve quality of life for high-risk populations
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
*Long-term savings are expected from:
*Reduced cardiovascular events
*Lower diabetes-related costs
*Fewer hospitalizations and emergency visits
*Decreased reliance on lifelong intensive services for disability-relat-
ed obesity
*Cost-management provisions-including step therapy, prior authorization,
and clinician certification-ensure responsible implementation.
EFFECTIVE DATE:
This act shall take effect immediately; Medicaid coverage requirements
take effect upon DOH implementing regulations within 180 days.
STATE OF NEW YORK
________________________________________________________________________
9360
2025-2026 Regular Sessions
IN ASSEMBLY
December 19, 2025
___________
Introduced by M. of A. SANTABARBARA -- read once and referred to the
Committee on Health
AN ACT to amend the social services law, in relation to requiring Medi-
caid coverage of FDA-approved GLP-1 receptor agonist medications for
obesity, metabolic disorders, and autism-related compulsive eating
behaviors
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 2 of section 365-a of the social services law
2 is amended by adding a new paragraph (oo) to read as follows:
3 (oo) (i) Federal food and drug administration approved GLP-1 receptor
4 agonist medications for the following medically indicated purposes:
5 (1) obesity treatment in individuals with a body mass index of thirty
6 or greater, or individuals with a body mass index of twenty-seven or
7 greater with a related comorbidity;
8 (2) metabolic disorders, including prediabetes, type two diabetes and
9 metabolic syndrome; and
10 (3) clinically verified autism-related compulsive eating behaviors
11 with certification from a qualified clinician, which shall include a
12 developmental pediatrician, neurologist, psychiatrist, psychologist, or
13 other licensed provider.
14 (ii) The department of health is authorized to require the following:
15 (1) step therapy protocols for such medications, where clinically
16 appropriate;
17 (2) prior authorization of such medications to ensure medical necessi-
18 ty of such medications;
19 (3) income-based eligibility prioritization for high-need, low-income
20 Medicaid recipients to receive coverage for such medications; and/or
21 (4) documentation requirements for clinician certification in cases of
22 autism-related need for such medications pursuant to clause three of
23 subparagraph (i) of this paragraph.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14216-01-5
A. 9360 2
1 (iii) The department of health shall:
2 (1) develop clear rules and clinical criteria for coverage of GLP-1
3 receptor agonist medications within one hundred eighty days of the
4 effective date of this paragraph;
5 (2) streamline prior authorization forms and timelines;
6 (3) evaluate health outcomes and potential Medicaid cost savings
7 related to the coverage of such medications; and
8 (4) submit an annual report to the legislature detailing utilization,
9 costs and measurable health outcomes related to the coverage of such
10 medications.
11 (iv) The provisions of this paragraph shall apply to GLP-1 receptor
12 agonist medications approved by the federal food and drug administration
13 on or before the effective date of this paragraph, and shall also apply
14 to emerging GLP-1 receptor agonist medications as such medications are
15 approved by the federal food and drug administration after the effective
16 date of this paragraph.
17 § 2. This act shall take effect immediately.
