Medicare Update: Warning Over AI Delays Issued by Democrat

A Democratic U.S. senator is warning that a new Medicare pilot program using artificial intelligence to approve medical care is causing weeks‑long delays for seniors seeking treatment, raising alarms about patient safety and access to care.

Senator Maria Cantwell of Washington has called on the Department of Health and Human Services (HHS) to overhaul the Wasteful and Inappropriate Service Reduction (WISeR) Model, an AI‑driven prior authorization program launched earlier this year in six states.

The program allows private contractors to use artificial intelligence to review whether certain Medicare procedures should be approved before care is delivered.

"CMS has structured the WISeR model in a way that financially rewards contractors for delaying or denying care," Cantwell wrote in a letter to Health and Human Services Secretary Robert F. Kennedy Jr. "A misaligned incentive structure that claims to boost efficiency but risks restricting access for vulnerable seniors."

Why It Matters

The WISeR pilot marks a significant shift in how traditional Medicare operates, expanding prior authorization requirements into a program that historically allowed doctors to decide when care was medically necessary without insurer approval.

Early data suggest that adding AI‑driven review has slowed access to care rather than streamlined it, with seniors waiting weeks longer for treatments that were previously approved within days or a couple of weeks.

What To Know

Traditional Medicare has historically required little to no prior authorization for most services, unlike Medicare Advantage plans, which commonly require insurer approval before treatment. Under the WISeR pilot, that changed for 13 specific services deemed vulnerable to waste, fraud, or overuse by the Centers for Medicare and Medicaid Services (CMS).

Those services, which include epidural steroid injections, skin and tissue substitutes, and other outpatient procedures, now require providers in participating states to submit claims through an AI‑supported system before treatment can proceed.

"This is, in many ways, the slow privatization of a public program. You're allowing AI systems to help determine what procedures are ‘necessary,'" Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek. "And when you look at the incentive structure, it tells you everything you need to know."

The pilot began January 1 and applies to Medicare beneficiaries in Arizona, Washington, Texas, Ohio, Oklahoma, and New Jersey.

Cantwell said the program is not meeting CMS's own benchmarks. While the agency committed to responding to routine claims within 72 hours and urgent claims within 24 hours, providers in Washington reported waiting 15 to 20 days for authorization decisions, many of which were denied without clear explanations.

"AI is being used as a denial device for the CMS system. And it’s apparently had some problems where it’s not taking a few days to find out whether you’re going to get covered or not-it’s basically taking weeks to find out that you’re denied, on things that never were a prior denial before," Cantwell told Kennedy at a hearing of the Senate Finance Committee this week.

"We have hospitals calling me about this, I have doctors calling me about this, I have patients calling me about this. So, I would appreciate if you take a look at it,” she said.

In response, Kennedy said: "That kind of delay is unacceptable, and we will work with you on it."

According to a report compiled from data by the Washington State Hospital Association, procedures that previously took about two weeks to approve are now taking four to eight weeks under the AI‑driven model. Hospitals also reported that patients were frequently forced to reschedule appointments multiple times while waiting for approval, potentially prolonging pain and allowing underlying conditions to worsen.

For seniors reliant on Medicare, those delays can translate into prolonged discomfort and even postponed surgeries.

At the University of Washington Medical System, providers reported average wait times of 15 to 20 days for responses to prior authorization requests, far exceeding CMS standards, with nearly 100 patients waiting at one point for pain‑management procedures included in the pilot.

While much of the early data Cantwell highlighted comes from Washington state, Arizona is also participating in the WISeR pilot, and patients there have expressed similar concerns.

"Delays for some beneficiaries have lasted for weeks, weeks that can prove costly in terms of putting off procedures for both the patient and the facility they’ve chosen," Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek. "Pilot programs are meant to test out features and fix potential issues prior to them expanding, so the hope is these initial problems can be fixed before more states are added."

In her letter sent to Kennedy, Cantwell outlined several demands, including enforcing the promised 72‑hour response time for standard claims and 24‑hour responses for urgent cases

She also pushed for a requirement that any denial include a written explanation by a human reviewer, not AI alone.

"The scary thing about AI is that if we really think we’re going to put AI in charge of deciding [care] instead of doctors, I think we’re going to have some real problems," Cantwell said.

What Happens Next

The Department of Health and Human Services has acknowledged the reported delays, with Kennedy calling them "unacceptable" during congressional testimony and pledging to work with lawmakers to address problems in the pilot.

However, HHS has continued to defend its goal of reducing waste in Medicare.

For now, the WISeR model remains in effect across all six participating states, meaning millions of traditional Medicare beneficiaries continue to be affected.

"This should absolutely raise concerns," Thompson said. "Private companies are now sitting on massive amounts of taxpayer data and taxpayer dollars, all under the umbrella of contractual obligations. And when profit is tied to limiting care, the risk becomes very real."

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This story was originally published April 29, 2026 at 12:22 PM.