WISeR prior authorization pilot draws backlash in Medicare

By AI, Created 11:39 AM UTC, May 20, 2026, /AGP/ – Citizens’ Council for Health Freedom says a new CMS pilot is bringing prior authorization into traditional Medicare and delaying care for seniors in six states. The group argues the six-year test echoes Medicare Advantage restrictions and could expand use of AI-driven denials.

Why it matters: - Citizens’ Council for Health Freedom says the WISeR model is moving prior authorization into traditional Medicare, where seniors have expected fewer coverage hurdles than Medicare Advantage. - The group says the shift can delay or block care that Medicare beneficiaries previously received more quickly. - The issue affects about 6.4 million Medicare beneficiaries in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.

What happened: - An April 22 report presented at a U.S. Senate hearing said the CMS pilot is limiting access to a defined list of services. - U.S. Sen. Maria Cantwell, D-Wash., presented data from 16 Washington hospitals to Senate Finance Committee members. - The WISeR model began Jan. 1, 2026, and runs for six years. - Citizens’ Council for Health Freedom says the report confirms a warning the group sent in a Dec. 2, 2024 letter to then President-elect Donald Trump opposing Dr. Mehmet Oz’s nomination to lead CMS. - Twila Brase, CCHF co-founder and president, said prior authorization traps seniors in delays they paid to avoid. - Brase said the Trump administration is importing Medicare Advantage-style rationing into Original Medicare.

The details: - Washington hospitals reported procedures that once were approved in one to three days now take 15 to 20 days. - Other procedures that previously took about two weeks to approve now take four to eight weeks. - Nearly 100 patients in the University of Washington Medical System are waiting for epidural steroid injections. - More than 18,600 Washington seniors used the covered services in 2024 and are now subject to prior authorization. - Cantwell said artificial intelligence is being used as “a denial device.” - HHS Secretary Robert F. Kennedy Jr. acknowledged there are “probably kinks” in the program but defended it. - CCHF says the WISeR structure mirrors Medicare Advantage, where prior authorization is routinely used to delay or deny care. - The group cites a 2018 HHS Office of Inspector General report that found Medicare Advantage plans denied medically necessary, Medicare-approved services. - Contractors in the WISeR model, including Virtix Health, are paid based on a share of savings generated from denied claims.

Between the lines: - CCHF is tying a new CMS payment and review model to a broader fight over federal control of senior care. - The financial structure of the pilot creates an incentive to reduce claims, which raises concerns about whether cost control will outweigh timely treatment. - The group’s argument is not just about bureaucracy. It is about whether Original Medicare is becoming harder to use in ways that resemble Medicare Advantage. - Brase framed the policy as part of a larger solvency problem, saying Medicare insolvency is seven years away.

What’s next: - CCHF is calling for an end to the WISeR pilot and a return to patient-centered coverage. - Brase said seniors should have the freedom to opt out of Medicare and buy major medical insurance that puts patients and doctors in charge. - The Senate hearing data and the pilot’s early delays are likely to keep scrutiny on CMS as the program expands across the six states. - CCHF says more information is available at the organization’s website and interview requests can be sent to Alexandra de Scheel at media@cchfreedom.org.

The bottom line: - CCHF says WISeR is a warning sign that prior authorization is spreading from Medicare Advantage into traditional Medicare, with AI and financial incentives now shaping access to care for millions of seniors.