Medicare Policy Changes Affect Staffing, AI, and Pilot Programs

Recent federal actions have altered requirements and pilot programs affecting Medicare and Medicaid, including changes to nursing home staffing and the use of artificial intelligence in care authorization.

The Department of Health and Human Services published an interim final rule on December 3, 2025, that rescinded previously established minimum staffing requirements for nursing homes participating in Medicare and Medicaid. The rule takes effect on February 2, 2026, and follows earlier court decisions that vacated the staffing mandate in Texas and Iowa, as well as legislative delays on implementation.

The original staffing requirements had called for a registered nurse to be present at all times and set a minimum of about 3.47 to 3.48 hours of direct care per resident each day. These mandates were first delayed by legislation and then formally removed by the recent HHS action.

In a separate development, the Centers for Medicare & Medicaid Services issued a final rule for Medicare Advantage plans for contract year 2026. This rule did not include several provisions from the earlier proposal, such as requirements for health equity analysis, specific guardrails on artificial intelligence use, or coverage for anti-obesity medications.

What the numbers show

• The rescinded staffing rule required 3.47–3.48 hours of direct care per resident daily
• The interim final rule rescinding staffing requirements was published December 3, 2025
• The WISeR pilot is scheduled to operate for six years starting January 1, 2026

Senator Kirsten Gillibrand introduced the Seniors Deserve SMARTER Care Act on December 17, 2025. This bill aims to prohibit CMS from implementing the WISeR model, a pilot program that uses artificial intelligence for prior authorization decisions in traditional Medicare, which is scheduled to begin in six states on January 1, 2026.

The WISeR pilot would involve private companies using AI to review and potentially delay or deny care, with compensation linked to a share of any cost savings achieved. The program is planned to run for six years in the selected states.

The New York Times published an article on January 17, 2026, highlighting these regulatory changes and the introduction of the WISeR pilot as three policy moves likely to alter health care for older adults. The article focused on the rollback of nursing home staffing rules, the omission of AI guardrails in Medicare Advantage, and the launch of the new AI-driven pilot program.

These policy developments reflect a period of regulatory adjustment in federal health programs, with changes impacting both care standards in long-term facilities and the role of artificial intelligence in Medicare processes. The actions taken by HHS, CMS, and members of Congress indicate ongoing shifts in how care is delivered and managed for older Americans.

* This article is based on publicly available information at the time of writing.