# Can an algorithm deny your care?

> Who is allowed to use AI to approve or refuse treatment coverage, and what human check is required?

Federal health agencies are expanding AI in Medicare review while AI labs sell prior-authorisation tools to insurers. States are responding with laws requiring a licensed clinician to make every denial, setting up a clash with federal efforts to pre-empt state AI rules.

## Stops
1. **4 Dec 2025: HHS publishes department-wide AI strategy built on a 'OneHHS' platform** (Development) HHS commits to AI across CMS and other agencies. [page](https://wheresthe.ai/d/us-hhs-ai-strategy-onehhs-2025-12/) · [source](https://www.hhs.gov/press-room/hhs-unveils-ai-strategy-to-transform-agency-operations.html)
2. **1 Jan 2026: Medicare starts WISeR, an AI-assisted prior-authorisation pilot in six states** (Development) Traditional Medicare begins AI-assisted prior authorisation, with vendors paid from savings. [page](https://wheresthe.ai/d/us-cms-wiser-ai-prior-auth-2026-01/) · [source](https://www.cms.gov/files/document/wiser-fact-sheet.pdf)
3. **11 Jan 2026: Anthropic launches Claude for Healthcare with HIPAA-ready tools for providers and payers** (Development) Frontier labs package prior-authorisation and claims-appeal tools for payers and providers. [page](https://wheresthe.ai/d/anthropic-claude-for-healthcare-2026-01/) · [source](https://www.anthropic.com/news/healthcare-life-sciences)
4. **17 May 2024: Colorado AI Act (SB 24-205)** (Rule) Colorado's general AI Act already treats health-care decisions as consequential. [page](https://wheresthe.ai/rule/us-co-sb24-205-colorado-ai-act/) · [source](https://leg.colorado.gov/bills/sb24-205)
5. **23 Mar 2026: Washington law says only a licensed clinician can deny prior-authorisation requests** (Development) Washington and six other states require a human clinician behind every AI-assisted denial. [page](https://wheresthe.ai/d/us-wa-sb5395-prior-auth-ai-2026-03/) · [source](https://app.leg.wa.gov/billsummary?BillNumber=5395&Year=2025)
6. **22 Sep 2025: CCPA ADMT regulations** (Rule) California's automated decision-making rules add notice and opt-out duties. [page](https://wheresthe.ai/rule/us-ca-ccpa-admt-regulations-2025/) · [source](https://cppa.ca.gov/regulations/ccpa_updates.html)
7. **11 Dec 2025: State AI law preemption EO** (Rule) Federal pressure to pre-empt state AI laws could test these state protections. [page](https://wheresthe.ai/rule/us-eo-14365-national-ai-policy-framework-2025/) · [source](https://www.federalregister.gov/documents/2025/12/16/2025-23092/ensuring-a-national-policy-framework-for-artificial-intelligence)

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