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House Appropriations Committee Blocks Funding for Medicare AI Prior-Authorization Pilot
A key House committee voted on Tuesday to end the Wasteful and Inappropriate Service Reduction (WISeR) pilot, a program that adds artificial‑intelligence‑backed prior authorization to certain traditional Medicare services. The vote came as part of a unanimous amendment to the 2027 HHS spending bill that would prohibit the use of federal funds to implement WISeR or any other model that applies prior authorization to fee‑for‑service Medicare.
The WISeR pilot was announced by the Centers for Medicare & Medicaid Services (CMS) last summer as a six‑year effort to curb fraud and wasteful spending in Medicare. Under the program, CMS contracts with private companies to apply AI‑enabled prior authorization to services considered vulnerable to inappropriate use, such as skin and tissue substitutes and epidural steroid injections for pain management. The pilot began in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—in January 2026.
Democrats and patient advocates have criticized the pilot, arguing that it delays care for seniors and adds administrative burdens on providers. The House Appropriations Committee’s amendment reflects that concern. Rep. Robert Aderholt, R‑Alabama, who chairs the subcommittee that oversees HHS, described the amendment as “bipartisan” during the markup on the legislation. Rep. Lois Frankel, D‑Florida, said the amendment resulted from her collaboration with Rep. Andy Harris, R‑Maryland. “I think we all agree. Medicare was built on a simple promise that after a lifetime of work Americans should be able to get the healthcare they have earned,” she said. “And prior authorization by artificial intelligence is putting the judgement of doctors and the needs of patients behind.”
The amendment will still need to pass the full House and the Senate before it becomes law. It is one of several recent actions aimed at curbing the use of AI in Medicare prior authorization. In May, House and Senate Democrats introduced resolutions that would use a congressional tool to overturn agency actions and roll back the pilot.
Late last year, House Democrats filed a bill to repeal the WISeR model, but the legislation has not advanced. The new amendment therefore represents a significant step toward limiting the program’s expansion. If enacted, it would prevent CMS from allocating federal funds to WISeR or any similar prior‑authorization initiative in traditional Medicare.
The pilot’s impact on seniors and providers remains a point of contention. While CMS maintains that the AI component is intended to reduce unnecessary services, critics point to early reports of high denial rates and delays in care. The amendment signals that lawmakers are taking those concerns seriously.
The outcome of the amendment will shape the future of AI‑driven utilization management in Medicare. If passed, it would halt the current pilot and halt any future AI‑based prior‑authorization models in fee‑for‑service Medicare, potentially preserving the current workflow for providers and the access that seniors rely on. The measure’s passage would also signal a broader shift in congressional oversight of federal health‑care initiatives that rely on algorithmic decision‑making.
At present, the WISeR pilot continues to operate in the six states where it was launched, and CMS is still collecting data on its performance. The House Appropriations Committee’s action adds a new layer of scrutiny that could ultimately limit the program’s reach and influence how AI is integrated into Medicare services.
The next steps will involve the full House and Senate reviewing the amendment. If approved, the amendment would become part of the 2027 HHS appropriations bill, effectively barring federal funding for WISeR and similar prior‑authorization models in traditional Medicare. The decision will have implications for Medicare beneficiaries, providers, and the broader debate over the role of artificial intelligence in health‑care decision‑making.
The WISeR pilot was announced by the Centers for Medicare & Medicaid Services (CMS) last summer as a six‑year effort to curb fraud and wasteful spending in Medicare. Under the program, CMS contracts with private companies to apply AI‑enabled prior authorization to services considered vulnerable to inappropriate use, such as skin and tissue substitutes and epidural steroid injections for pain management. The pilot began in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—in January 2026.
Democrats and patient advocates have criticized the pilot, arguing that it delays care for seniors and adds administrative burdens on providers. The House Appropriations Committee’s amendment reflects that concern. Rep. Robert Aderholt, R‑Alabama, who chairs the subcommittee that oversees HHS, described the amendment as “bipartisan” during the markup on the legislation. Rep. Lois Frankel, D‑Florida, said the amendment resulted from her collaboration with Rep. Andy Harris, R‑Maryland. “I think we all agree. Medicare was built on a simple promise that after a lifetime of work Americans should be able to get the healthcare they have earned,” she said. “And prior authorization by artificial intelligence is putting the judgement of doctors and the needs of patients behind.”
The amendment will still need to pass the full House and the Senate before it becomes law. It is one of several recent actions aimed at curbing the use of AI in Medicare prior authorization. In May, House and Senate Democrats introduced resolutions that would use a congressional tool to overturn agency actions and roll back the pilot.
Late last year, House Democrats filed a bill to repeal the WISeR model, but the legislation has not advanced. The new amendment therefore represents a significant step toward limiting the program’s expansion. If enacted, it would prevent CMS from allocating federal funds to WISeR or any similar prior‑authorization initiative in traditional Medicare.
The pilot’s impact on seniors and providers remains a point of contention. While CMS maintains that the AI component is intended to reduce unnecessary services, critics point to early reports of high denial rates and delays in care. The amendment signals that lawmakers are taking those concerns seriously.
The outcome of the amendment will shape the future of AI‑driven utilization management in Medicare. If passed, it would halt the current pilot and halt any future AI‑based prior‑authorization models in fee‑for‑service Medicare, potentially preserving the current workflow for providers and the access that seniors rely on. The measure’s passage would also signal a broader shift in congressional oversight of federal health‑care initiatives that rely on algorithmic decision‑making.
At present, the WISeR pilot continues to operate in the six states where it was launched, and CMS is still collecting data on its performance. The House Appropriations Committee’s action adds a new layer of scrutiny that could ultimately limit the program’s reach and influence how AI is integrated into Medicare services.
The next steps will involve the full House and Senate reviewing the amendment. If approved, the amendment would become part of the 2027 HHS appropriations bill, effectively barring federal funding for WISeR and similar prior‑authorization models in traditional Medicare. The decision will have implications for Medicare beneficiaries, providers, and the broader debate over the role of artificial intelligence in health‑care decision‑making.
