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The Trump administration plans to launch a pilot program next year to test how artificial intelligence (AI) can be used to approve or deny medical procedures for Medicare patients. Starting January 1, 2026, the program will run through 2031 in six states: Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington. The initiative, called the Wasteful and Inappropriate Service Reduction (WISeR) Model, aims to reduce spending by identifying and denying low-value services.
The program will expand the use of prior authorization, a process that requires insurance approval before certain medical services can proceed. This practice, commonly used by private insurers, has faced criticism for causing delays and denying necessary care. The pilot will apply AI algorithms to assess procedures like skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy.
Critics, including U.S. Representatives Mark Pocan and Jan Schakowsky, have condemned the plan, arguing that it could endanger seniors' access to care. Pocan stated, "The requirement of prior authorization for traditional Medicare services will kill seniors." Schakowsky echoed these concerns, emphasizing the potential threat to millions of Medicare beneficiaries. The resolution to terminate the WISeR Model has gained support from several lawmakers and organizations, as reported by Pocan's press release.
The use of AI in health insurance is not new, but Medicare has been slow to adopt such tools. The federal government claims that the program will protect patients and Medicare funds. However, as The New York Times reports, many fear the AI-driven process could lead to denials and delays similar to those seen in Medicare Advantage plans.