Medicaid is a joint public health insurance program providing medical coverage to low-income adults, children, and people with disabilities. It is administered jointly by the federal government and individual states, creating significant variation in benefits across the country. The core answer to whether Medicaid covers gym memberships is generally no, as fitness programs are not a standard, federally mandated benefit. Coverage for a gym membership or fitness program is entirely dependent on the specific state and the type of plan a recipient is enrolled in.
The General Rule and State Variation
Standard Medicaid benefits cover services deemed medically necessary, such as hospital stays, doctor visits, prescription drugs, and certain preventive screenings. Gym memberships and general fitness programs fall outside this definition, typically being classified as non-essential or wellness-related services. Because they are not required federal benefits, states are not obligated to include them in their basic Medicaid offerings.
This structure means the coverage landscape is highly fragmented, allowing states flexibility to expand benefits beyond the federal minimum requirements. A state may use special federal waivers or dedicated state funds to offer non-traditional benefits aimed at disease prevention and health promotion. For instance, some state programs may offer a Preventive Health Assistance allowance that can be used toward a gym membership or weight management fees for eligible members.
State-level decisions often reflect a balance between promoting long-term health and managing program costs. Preventative services like fitness access can reduce future medical expenses, leading some states to invest in population health beyond acute care.
Coverage Through Managed Care Organizations
The primary way a Medicaid recipient may gain access to a gym membership is through a Managed Care Organization (MCO). Most states contract with these private insurance companies to administer Medicaid benefits, and the majority of recipients are enrolled in an MCO plan. MCOs must cover all standard Medicaid services, but they are also permitted to offer extra perks known as “Value-Added Services” (VAS) or “Expanded Benefits.”
These value-added benefits are used by MCOs to attract and retain members while also encouraging overall wellness and preventative care. Fitness-related VAS often include gym discounts, an annual stipend for membership fees, or full access to national fitness network programs like One Pass or Renew Active. The availability and scope of these fitness perks are determined by the MCO, though the state must approve the MCO’s offerings.
The benefit details vary significantly between MCOs, even within the same state. For example, one plan might offer a $150 annual fitness voucher, while another might provide a no-cost membership to a network of gyms.
The fitness benefits are usually included at no extra cost to the member, as they are factored into the MCO’s total contract with the state. MCOs often change their Value-Added Services annually, so recipients must check their current plan details frequently to see what specific fitness coverage is available.
Eligibility and Enrollment Requirements
Accessing a fitness benefit begins with confirming enrollment in an MCO plan that offers the perk. If enrolled in a standard, fee-for-service Medicaid program, access is unlikely unless the state offers a separate wellness program. MCO members should locate the plan’s Summary of Benefits document, often available on the organization’s website or in the member handbook.
Recipients can also call the member services phone number on the back of their Medicaid card to inquire directly about fitness benefits. When a benefit is confirmed, requirements to activate it may include completing an annual wellness exam or a health risk assessment. Some programs may also require the member to use an in-network gym or obtain a doctor’s recommendation for physical activity.
If the MCO partners with a national fitness network, the member may need to obtain a special ID number, such as a Fitness ID or confirmation code, from the MCO before enrolling. This code verifies eligibility at the gym. These steps ensure the member meets administrative requirements to utilize the non-standard benefit.