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A new Medicare pilot program introducing artificial intelligence-based prior authorization has begun operating in six states, marking a significant shift in how traditional Medicare handles treatment approvals. The program, known as WISeR (Wasteful and Inappropriate Service Reduction), launched this month in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, according to a January 2026 report from KFF Health News and The New York Times.
Prior authorization has long been standard practice in Medicare Advantage plans, where private insurers review proposed treatments before agreeing to coverage. Traditional Medicare has rarely employed such requirements. Under WISeR, six technology vendors will use artificial intelligence and machine learning to evaluate authorization requests for 17 items and services that CMS has identified as higher risk of waste, fraud, and abuse.
The six-year pilot excludes emergency services and inpatient hospital care. Algorithmic denials trigger human-clinician review, and participating tech companies receive a share of the expenditures they help avert. CMS stated that vendors face financial penalties for inappropriate denials, high appeal rates, or poor performance.
David Lipschutz, co-director of the Center for Medicare Advocacy, expressed concern that participating vendors have financial incentives to deny care, given their stake in avoided costs. The CMS Innovation Center, which oversees the pilot, could expand prior authorization requirements to additional services and states without Congressional approval.
Congressional Democrats have introduced legislation to repeal WISeR. CMS plans to conduct an independent evaluation and to report annually on program outcomes. The pilot represents the latest in a series of regulatory changes affecting eldercare, including the repeal of nursing home staffing standards and the rollback of labor protections for home care workers.
