A report from a member of Washington state’s congressional delegation is blasting the Trump administration for an AI pilot program she says significantly increased wait times for seniors to receive health care and has prioritized care denials over a patient’s doctor’s recommendation. 

At the beginning of 2026, the Centers for Medicare and Medicaid Services (CMS) launched the Wasteful and Inappropriate Service Reduction, or WISeR, model, which uses AI to make care coverage decisions for Medicaid patients.  

Washington is one of six states testing the new system. 

The result, said U.S. Sen. Maria Cantwell, D-Washington, is seniors waiting two to four times as long to have care authorizations determined and more rejections for coverage as Vitrix Health, the company that operates WISeR, receives financial incentives for denying rather than approving care. 

CMS announced the pilot in the fall of 2025. Federal health officials said the program’s goal is to root out fraud, waste and abuse with Medicare, the federal program that provides health coverage to people older than 65 and younger people with disabilities. 

WISeR reviews requests for some of the most costly procedures. They include epidural steroid injections for pain management, skin and tissue substitutes, less invasive treatments for spinal stenosis and osteoarthritic knees, nerve stimulation for issues like sleep apnea and incontinence, among others. 

Cantwell’s report was based on data collected by the Washington State Hospital Association from patients and providers at 16 hospitals around the state. They reported that care authorizations that previously took between one to three days are now taking 15 to 20 days to be issued. Those procedures that had two-week authorization time frames before WISeR was implemented now take four to eight weeks. 

“The WISeR Model creates new middlemen in our health care system who benefit financially by overruling doctors and denying care to Washington seniors,” according to the report. 

Providers and hospitals also report that coverage denials often lack clear rationales or are inconsistent with clinical criteria. Some have hired additional staff to appeal coverage denials. 

“Across our system, physicians are concerned about the lack of clear information and predictability surrounding the WISeR program,” said Susan Stacey, chief executive of Providence Inland Northwest in Spokane. “Uncertainty about what services may be denied and how to navigate the review process is creating operational challenges and could place additional cost pressure on providers that are already struggling. Our priority is ensuring patients can continue to receive timely, medically appropriate care while clinicians are able to spend their time focused on patients, not navigating complex administrative processes.” 

Medical provider groups and others have raised similar concerns over WISeR. The Electronic Frontier Foundation, a nonprofit digital rights group, filed a federal lawsuit against CMS in late March to force the agency to provide information on any safeguards put in place to protect patients from algorithmic bias, privacy violations and wrongful denials of care.