Trump administration to pilot AI for Medicare treatment approval decisions
The Trump administration announced a pilot program starting January 2026 to use artificial intelligence to approve or deny Medicare treatments in six states. Critics worry the AI-driven prior authorization system could delay or block care, causing harm, despite the administration simultaneously criticizing such practices in the private insurance sector.
What happened
The Trump administration announced a pilot program to launch in January 2026 using an artificial intelligence algorithm to decide whether to approve or deny certain medical treatments for Medicare patients. The program is designed to identify and eliminate 'low-value' services and amounts to a federal expansion of prior authorization, a process requiring approval before certain procedures, tests, and prescriptions can proceed.
Reported impact
Critics argue the program could cause delays in or denial of care, with potential for irreparable harm and even death. Patients, doctors, and lawmakers have raised concerns about the approach, particularly given prior authorization's association with care delays in the private insurance sector.
Index analysis
The pilot will affect Medicare patients and their healthcare providers in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington starting January 1, 2026, and running through 2031. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, acknowledged that prior authorization causes care to be 'significantly delayed' and 'erodes public trust in the health care system,' yet the administration is implementing an AI version of the same mechanism.
Governance controls
The announcement came in late June 2025, days after the Trump administration unveiled a voluntary effort by private health insurers to reduce their own use of prior authorization. Policy experts including Dr. Vinay Rathi and Rep. Suzan DelBene have accused the administration of sending mixed messages by criticizing prior authorization while expanding its use via AI in the Medicare program.
Classification
Sources and evidence
This record was researched and written by the Index, based on the following original reporting.