Trump Administration's AI Prior-Authorization Program for Medicare Denies More Care Than It Approves, Leaves Patients in Pain

Since January 2026, a Trump administration pilot program called WISeR has used AI to approve or deny Medicare prior-authorization requests in six states — a layer of bureaucracy that never previously existed for Medicare patients. Documents obtained by the Electronic Frontier Foundation through litigation paint a grim picture: one vendor auto-approved everything at launch because its technology wasn't ready, another couldn't distinguish between Medicare Part A and Part B for months, and a third denied 53 percent of the 6,096 requests it reviewed in its first weeks. At least one authorization request sat pending for 83 days. Vendors were supposed to respond within 72 hours.

The program's payment structure compounds the problem: contractors earn 25 percent of the estimated cost of every claim they deny, and the financial penalty for wrongly denying care — a deduction of 5 to 10 percent of that bonus — is small enough that CMS's own Office of the Actuary noted in a memo that "model participants will have an incentive to deny as many claims as possible." When Sen. Patty Murray asked Trump's HHS deputy secretary nominee whether contractors make more money by denying care, he said no. The CMS documents say otherwise. Meanwhile, an Ohio provider wrote in all capitals in a survey that they had watched three patients cry at the bedside waiting for spine surgery authorizations that never came, calling the program "a disgrace to the human race." The administration plans to expand WISeR to oncology and air ambulance transport.