In a few months, Washingtonians on Medicare could see additional hurdles when it comes to getting approval for their procedures and care. . 

That’s because the Trump Administration is exploring the use of prior authorizations to assess whether medical services are necessary for a patient. If it isn’t, the procedures may not be covered.

Prior authorization is a common practice in the insurance industry but not in Medicare. The U.S. Centers for Medicare and Medicaid Services says the tool will help weed out waste and fraud. And it says it will use AI to help make eligibility decisions. 

Washington is one of six states that will pilot the program, starting in January.

GUEST: Darius Tahir - Correspondent for KFF News

RELATED LINKS: 


AI Will Soon Have a Say in Approving or Denying Medicare Treatments


Health Care  AI reviews rolling out for Medicare in WA for some procedures
WISeR (Wasteful and Inappropriate Service Reduction) Model

Thank you to the supporters of KUOW, you help make this show possible! If you want to help out, go to kuow.org/donate/soundsidenotes

Soundside is a production of KUOW in Seattle, a proud member of the NPR Network.

In a few months, Washingtonians on Medicare could see additional hurdles when it comes to getting approval for their procedures and care. .&nbsp;
That&rsquo;s because the Trump Administration is exploring the use of prior authorizations to assess whether medical services are necessary for a patient. If it isn&rsquo;t, the procedures may not be covered.
Prior authorization is a common practice in the insurance industry but not in Medicare. The U.S. Centers for Medicare and Medicaid Services says the tool will help weed out waste and fraud. And it says it will use AI to help make eligibility decisions.&nbsp;
Washington is one of six states that will pilot the program, starting in January.
GUEST: <a href="https://kffhealthnews.org/news/author/darius-tahir/">Darius Tahir</a> - <a href="https://www.kff.org/person/darius-tahir/">Correspondent for KFF News</a>
RELATED LINKS:&nbsp;
<ul>
<li>
<a href="https://kffhealthnews.org/news/article/ai-medicare-prior-authorization-trump-pilot-program-wiser/">AI Will Soon Have a Say in Approving or Denying Medicare Treatments</a>
</li>
<li>
<a href="https://washingtonstatestandard.com/2025/09/25/ai-reviews-rolling-out-for-medicare-in-wa-for-some-procedures/">Health Care&nbsp; AI reviews rolling out for Medicare in WA for some procedures</a>
</li>
<li><a href="https://www.cms.gov/priorities/innovation/innovation-models/wiser">WISeR (Wasteful and Inappropriate Service Reduction) Model</a></li>
</ul>
Thank you to the supporters of KUOW, you help make this show possible! If you want to help out, go to <a href="http://kuow.org/donate/soundsidenotes">kuow.org/donate/soundsidenotes</a>
Soundside&nbsp;is a production of KUOW in Seattle, a proud member of the NPR Network.

Soundside

The federal government is planning a new program to approve Medicare claims. Washington is one of six states that will pilot the program, which relies on AI, starting Jan. 1st.

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