Ohio Medicare Patients Now Need AI Approval for Certain Procedures

New federal pilot program in Ohio uses artificial intelligence to review and approve some Medicare procedures.

Published on Feb. 11, 2026

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Ohio is one of six states participating in a new federal pilot program that uses artificial intelligence (AI) to help decide whether certain medical procedures should be approved for Medicare patients. The Wasteful and Inappropriate Service Reduction (WISeR) Model began in January 2026, and requires some Medicare patients in Ohio to get prior approval from an AI system before moving forward with about a dozen outpatient procedures. While supporters say the AI could help cut down on unnecessary care, doctors and patient advocates are concerned about potential delays in treatment and the growing use of prior authorization.

Why it matters

This pilot program highlights the increasing role of technology, specifically AI, in healthcare decision-making. While the goal is to reduce wasteful spending, there are concerns that the automated process could lead to mistakes and delays in care, especially for complex patients. The outcome of this program in Ohio could shape how much influence AI has over Medicare patients' care in the future.

The details

Under the new WISeR Model, some Medicare patients in Ohio will have to get prior approval from an AI system before they can undergo about a dozen outpatient procedures. The AI, run by private companies hired by the federal government, will review the requests and look for patterns that suggest a procedure may be overused or doesn't match typical clinical guidelines. Ohio Medicare officials say human doctors will still make the final decisions, but the AI will conduct the initial screening. Doctors in Ohio say even short delays can affect patients, as it could mean people stay in pain longer or their condition worsens before they get treated. Patient advocates also worry that some seniors may assume a denial is final and not pursue an appeal.

  • The WISeR Model began in January 2026.
  • The pilot program is currently underway in Ohio and five other states.

The players

WISeR Model

A new federal pilot program that uses artificial intelligence to help decide whether certain medical procedures should be approved for Medicare patients.

Todd Baker

CEO of the Ohio State Medical Association, who expresses concerns that the new prior authorization process could add administrative hassle and burden for doctors and patients.

Jay Rayl

Runs Medicare Made Simple, a Medicare insurance agency in Cleveland, and believes the prior authorization process using AI could help control costs as long as humans remain involved in final decisions.

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What they’re saying

“Anytime you add a layer into the process of having to get approval to deliver care to someone, that can slow down the process. It has the potential to add layers of administrative hassle, burden.”

— Todd Baker, CEO, Ohio State Medical Association (Ideastream Public Media)

“I think that overall, when you really start looking at the kind of things that Medicare is starting to look at doing some authorizations with, it's something that people do need to adjust to a little bit. It doesn't typically become a huge problem.”

— Jay Rayl, Owner, Medicare Made Simple (Ideastream Public Media)

What’s next

The new WISeR Model will continue to be implemented in Ohio and the other five pilot states, with ongoing monitoring and evaluation of its impact on patient care and Medicare costs.

The takeaway

This pilot program highlights the growing influence of artificial intelligence in healthcare decision-making, raising concerns about the potential for delays, mistakes, and reduced access to care, even as supporters argue it could help control unnecessary spending. The outcome in Ohio could shape the future role of AI in Medicare patients' care.