Trump Admin's New AI Program Will Determine Medicare Eligibility

Inside an American Hospital — Source: adamkaz / Getty

Donald Trump has long sold his supporters the dream of “Making America Great Again”, but when you examine what he actually means with the slogan, it often translates into making everyday life more expensive, more complicated, and less humane. Nowhere is this more evident than in the realm of public services.

The latest example arrived this week with the Centers for Medicare and Medicaid Services (CMS) announcing a new pilot program that will reportedly begin next year, in six states, the Wasteful and Inappropriate Service Reduction (WISeR) Model, a so-called “innovation” that will use artificial intelligence to decide whether Medicare beneficiaries actually deserve the care their doctors recommend.

The WISeR Model will test whether “enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes” for services labeled as vulnerable to “fraud, waste, and abuse.” In other words, instead of your physician determining the care you need, an algorithm could decide whether Medicare will pay for it.

In a press release on the agency’s website, CMS notes that its new program will “arget Wasteful, Inappropriate Services in Original Medicare”:

“The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars.”

Traditionally, folks enjoying public benefits with the original Medicare program would not need to worry about this process, but those using Medicare Advantage seem to encounter it all the time. Prior authorization is the process whereby medical providers are required to check with insurance companies before providing certain types of care. As a way to rectify the confusion, recipients who are receiving original Medicare will still be subjected to prior authorization through the pilot program.

CMS insists the initiative will ensure patients receive “safe, effective, and necessary care.” But buried beneath the bureaucratic double talk is the reality that an AI tool, operated by companies with financial incentives to deny claims, will wield authority over decisions that should rest between patient and doctor.

For patients, especially seniors, the implications are devastating. Navigating prior authorization is difficult for even the most health-literate among us. For older adults — many of whom live with cognitive decline, chronic conditions, or limited access to advocacy — the barriers are insurmountable.

The statistics from Medicare Advantage are telling. In 2023 alone, 3.2 million prior authorization requests were denied, with only 11.7% of those denials appealed—even though the majority of appeals resulted in reversals. This means that coverage is often rationed not by outright denial, but through administrative exhaustion. Patients, already facing health crises, simply give up rather than spending time battling insurers.

Research shows that less affluent patients are less likely to appeal, and Black and Hispanic Medicaid patients are less likely to win appeals, even when they try. The system is inequitable by design. Extending this bureaucratic gauntlet into traditional Medicare will only magnify the disparities in access to care.

Critics have already dubbed the program “AI death panels”, as lawsuits filed against UnitedHealth, Cigna, and Humana challenge the deployment. Lawsuits accuse these companies of deploying algorithms to deny necessary care regardless of physician judgment, after internal data showed denial rates as high as 90%, later overturned on appeal.

CMS Director Dr. Mehmet Oz insists the program is about “crushing fraud, waste, and abuse,”; but the real-world outcome will be delays in treatment, increased physician burnout from endless paperwork, and seniors left in limbo while an AI system decides if their care is “appropriate.”

Trump’s plan to inject AI into Medicare decision-making is less about innovation and more about rationing care through red tape. It represents a dangerous shift in public health policy that prioritizes cost-cutting over compassion and corporations over human judgment.

For the roughly 33 million Americans who rely on traditional Medicare, the stakes are enormous. This is not simply about rooting out “waste.” It’s about whether our most vulnerable citizens, seniors, the sick, the poor, will be forced to fight machines for the care their doctors know they need.

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Virtual Insanity: Trump Administration Launching Program That Will Use AI To Determine Medicare Eligibility was originally published on newsone.com