The Medicaid and CHIP Payment and Access Commission (MACPAC) voted on May 7, 2026, to recommend new federal and state policies addressing artificial intelligence in prior authorization. The proposals aim to boost transparency and human oversight in automated pre-approvals for care, as regulators currently face limited visibility into how managed care plans utilize these tools within the safety-net insurance program.

Specifically, MACPAC suggested that the Centers for Medicare & Medicaid Services (CMS) issue guidance requiring a human with appropriate expertise to review all automated care denials for medical necessity. The commission also recommended regulatory updates to ensure that denials in fee-for-service Medicaid are issued by personnel with relevant medical, behavioral, or long-term care backgrounds.

Additionally, MACPAC proposed that CMS guide states on utilizing existing regulatory authority to oversee insurers' automation. The group also advised state Medicaid agencies to update health plan contracts, requiring disclosure of how AI is used in coverage and authorization decisions. Commissioners noted that these transparency tools are essential for monitoring potential risks like inaccurate coding and data bias.

The Medicaid and CHIP Payment and Access Commission (MACPAC) voted on May 7, 2026, to recommend new federal and state policies addressing artificial intelligence in prior authorization. The proposals aim to boost transparency and human oversight in automated pre-approvals for care, as regulators currently face limited visibility into how managed care plans utilize these tools within the safety-net insurance program.

Specifically, MACPAC suggested that the Centers for Medicare & Medicaid Services (CMS) issue guidance requiring a human with appropriate expertise to review all automated care denials for medical necessity. The commission also recommended regulatory updates to ensure that denials in fee-for-service Medicaid are issued by personnel with relevant medical, behavioral, or long-term care backgrounds.

Additionally, MACPAC proposed that CMS guide states on utilizing existing regulatory authority to oversee insurers' automation. The group also advised state Medicaid agencies to update health plan contracts, requiring disclosure of how AI is used in coverage and authorization decisions. Commissioners noted that these transparency tools are essential for monitoring potential risks like inaccurate coding and data bias.