Gillibrand Pushes to End Medicare AI Reviews
Original Medicare enrollees in six states are affected by a pilot that uses artificial intelligence to review certain coverage requests.
Updated on Nov. 2, 2026 in Senior Health
Live Poll
Should artificial intelligence be allowed to help decide Medicare coverage for patients?
Senator Kirsten Gillibrand, ranking member of the Senate Aging Committee, is calling for an end to the Medicare WISeR pilot, which uses artificial intelligence in coverage reviews for selected Original Medicare services. The pilot operates in six states and is scheduled to run through December 31, 2031, so the changes would affect Original Medicare enrollees in those states.
Why it matters
The pilot tests whether AI-assisted prior authorization can be used to review certain Original Medicare services before they are provided, which directly affects how seniors and their doctors get approval for care. Gillibrand's push comes after Senate Republicans blocked an earlier resolution to end the program in July, so the debate over AI in coverage decisions remains unresolved.
The available record is the program's design and the legislative history: the WISeR pilot covers six states and is set to run through 2031, and Senate Republicans blocked Gillibrand's May resolution to end it in July. Gillibrand cites reports of substantial declines in Medicare services, but the extraction does not include the underlying figures or any independent evaluation of those declines.
The players
Kirsten Gillibrand
A New York Democratic senator who serves as ranking member of the Senate Aging Committee and has pressed for oversight of Medicare coverage decisions.
Senate Republicans
The Republican majority bloc in the U.S. Senate that blocked Gillibrand's resolution to end the WISeR pilot in July.
Centers for Medicare & Medicaid Services
The federal agency that administers Medicare, including Original Medicare coverage rules and the WISeR pilot.
The details
WISeR applies to selected Original Medicare services, including certain skin and tissue substitutes, electrical nerve stimulator implants and knee arthroscopy procedures. Providers can request prior authorization, which is a coverage review before the service is delivered, or have claims reviewed after treatment but before payment. Emergency services, inpatient-only services and services that would pose substantial risks if delayed are excluded. Gillibrand argues that paying participating technology companies for spending they avoid creates an incentive to deny care.
Timeline
January 1, 2026: WISeR pilot begins operating.
May 2026: Gillibrand introduces a resolution to end the pilot.
July 2026: Senate Republicans block the resolution.
October 30, 2026: Gillibrand issues a statement calling for the pilot's end.
December 31, 2031: The pilot is scheduled to end.
Health Landscape
WISeR adds artificial intelligence to the prior authorization process, which has historically required human review of coverage requests before services are delivered. The pilot's limited six-state scope and exclusion of Medicare Advantage mean it is a targeted test rather than a nationwide change to how Original Medicare reviews care.
If you have Original Medicare in one of the six pilot states, a service such as knee arthroscopy or a nerve stimulator implant may go through an AI-assisted review, so it is reasonable to ask your doctor whether prior authorization is needed. Questions about whether a particular treatment is medically necessary are best discussed directly with your physician.
The takeaway
The WISeR pilot is a live test of AI in Medicare coverage decisions, and its outcome will shape how prior authorization works for Original Medicare services. If your care falls under one of the covered services, ask your doctor whether a review is required before treatment.
What happens next
The WISeR pilot is scheduled to run through December 31, 2031, so its operation and any further legislative attempts to end it will continue to be tracked over that period.
Further reading
For more on how coverage rules affect older adults, see Senior Health.
Live Poll
Should artificial intelligence be allowed to help decide Medicare coverage for patients?
