The Trump administration initiated a Medicare pilot program set to begin January 1, 2026, in six states. Titled the Wasteful and Inappropriate Service Reduction Model (WISeR), it will use artificial intelligence to help approve or deny certain services to reduce spending.
Operating in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, the pilot program is scheduled to run through 2031 unless altered by subsequent congressional or administrative policy changes. The WISeR model specifically targets three procedures for AI-driven prior-authorization reviews: skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for osteoarthritis. This initiative introduces AI-based reviews into the traditional Medicare system, a domain where such technology was previously confined mostly to private insurance plans. According to the program’s design, the recommendations generated by the AI system will be subject to a final review by qualified human clinicians before a decision is rendered on a service.
The stated objective of the program, according to the Centers for Medicare and Medicaid Services (CMS), is to curb fraud, waste, and potential patient harm by identifying and denying services considered unnecessary or of low clinical benefit. This approach has generated significant criticism from medical professionals and healthcare experts. A primary concern is that the algorithms could disproportionately flag and lead to the denial of high-cost treatments that are medically necessary for patients. Experts also warn about the possibility of the AI system rejecting treatments that a patient’s own doctor has recommended, raising questions about the role of automated systems in clinical decision-making.
Formal opposition has been voiced by several organizations, including the American Medical Association (AMA). The AMA opposes the pilot and has called for its modification, citing its own surveys that revealed an increase in care denials by private insurance companies already utilizing similar AI systems. Joining the opposition are various advocacy groups and some lawmakers. These groups argue that delegating coverage decisions to AI-driven platforms could ultimately harm patients and create new barriers that worsen access to essential healthcare services across the affected states.
