Medicare to test AI in prior authorizations for six states starting Jan 2026.

Starting January 2026, Medicare will launch a six-state pilot program using artificial intelligence to determine prior authorization for certain services like skin substitutes, nerve stimulator implants, and knee surgeries, aiming to reduce wasteful care and fraud. The initiative, running through 2031, expands a practice common in private insurance but historically limited in traditional Medicare. While officials say AI decisions will be reviewed by humans and exclude emergency or time-sensitive care, critics warn the move contradicts the administration’s push to reduce prior authorization delays in private plans and could harm patient access. Public opinion strongly opposes prior authorization, with about 75% of Americans viewing it as a major problem.