AI and Medicare in WA

Risks, Possible Delays, and How We Can Respond

By the Healthcare Team of WSI

Washington residents are about to face a major change in how Medicare approves certain procedures. Starting January 1, 2026, a six-year federal pilot program called the Wasteful and Inappropriate Services Reduction (WISeR) Model will use AI-assisted prior authorization for outpatient treatments, including knee arthroscopy, steroid injections, and other common procedures. Washington is one of six states selected for this pilot. While AI will assist licensed clinicians, there is a real risk that algorithms, combined with contractor incentives, could delay or deny necessary care for Medicare receipients.

For communities in Washington, this could mean longer waits for treatment, more paperwork, and greater stress for those managing chronic conditions or mobility issues. Fixed-income residents could also face increased financial burdens if procedures are delayed or denied. Healthcare providers may be caught in a web of new administrative demands, potentially impacting the quality and timeliness of care.

What can we as citizens do? First, fight like hell. Make a lot of noise. Call your representatives. Call the media. Post on social media. In addition, we can educate residents about their rights to appeal denials, help track and report delays, and pressure Center for Medicare and Medicaid Services for transparency and oversight on approval rates and AI decision-making. Mobilizing public awareness and engaging with local healthcare providers will be critical to ensure that patient voices are heard before this pilot expands to other conditions or other states.