CMS Plans Medicare Treatment Authorization Pilot in Six States Starting 2026

Starting January 1, 2026, Medicare will implement a prior authorization system in six states, requiring doctors to obtain approval from the Centers for Medicare & Medicaid Services (CMS) before providing certain services. This pilot aims to reduce unnecessary care and control healthcare costs, addressing the $5.8 billion spent on ineffective treatments in 2022, though concerns remain about potential delays in care, especially for high-risk patients. Concurrently, Medicaid is undergoing significant changes under legislation signed by President Donald Trump, which is projected to cut nearly $1 trillion in spending over the next decade and could result in over 11 million people losing coverage, with rural hospitals particularly vulnerable despite a $50 billion Rural Health Transformation Fund. Maryland exemplifies the broader challenges facing Medicaid as federal reforms impose caps, work requirements, and stricter eligibility rules, prompting state and local officials to reconsider service delivery and funding strategies. These shifts highlight the tension between controlling costs and maintaining access to essential healthcare, with stakeholders emphasizing the need for careful planning and coordination at all government levels.