Regulation of AI in Prior Authorization and Claims Review: A Look at Federal and State Consumer Protections Authors: Kaye Pestaina, Rayna Wallace, Michelle Long, and Justin Lo Published: May 6, 2026

https://www.kff.org/patient-consumer-protections/regulation-of-ai-in-prior-authorization-and-claims-review-a-look-at-federal-and-state-consumer-protections/ Rapid technological developments in artificial intelligence (AI) have resulted in growing public attention to the potential benefits and challenges of these developments as they relate to health care. The Trump administration recently released A National Policy Framework for Artificial Intelligence (“AI Framework”), a set of legislative recommendations that could jump-start congressional activity on the application of AI across a variety of policy areas, not just health care. A core part of the AI Framework emphasizes establishing federal AI policy that preempts many state AI laws to reduce barriers for deploying AI applications. Preemption could nullify state consumer protections governing the use of AI in health coverage, such as prior authorization, and claims review and appeals. This Issue Brief discusses the types of consumer protections for use of AI in prior authorization and claims review, describes the Trump administration’s AI Framework, and highlights areas to watch as Congress considers AI legislation.