Story perspectives

New AI Model Could Limit Medicare Services Starting 2026

12/26/2025

Summary

Story summary

The Centers for Medicare & Medicaid Services will implement the Wasteful and Inappropriate Service Reduction (WISeR) model on January 1, 2026, in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—requiring prior authorization for 17 health services using artificial intelligence.
Critics warn artificial intelligence could raise denial rates for necessary care.
The program aims to curb spending by targeting low-value services, with voluntary provider participation, and could influence Medicare policy.

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Story summary

The Centers for Medicare & Medicaid Services will implement the Wasteful and Inappropriate Service Reduction (WISeR) model on January 1, 2026, in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—requiring prior authorization for 17 health services using artificial intelligence.
Critics warn artificial intelligence could raise denial rates for necessary care.
The program aims to curb spending by targeting low-value services, with voluntary provider participation, and could influence Medicare policy.