CMS Launches WISeR Gold Card Exemption Program July 6 in Washington State
CMS will launch the WISeR (Worthy of Individual Systematic Exemption and Review) gold-carding exemption program on July 6, 2026, in Washington state, with quarterly rollouts planned for five additional states. The program exempts certain high-performing providers from prior authorization requirements based on performance metrics. Medicaid managed care organizations operating in Washington and the subsequent rollout states will need to implement gold card criteria and modify prior authorization workflows. The initiative aims to reduce administrative burden for providers with strong approval track records while maintaining utilization management oversight for other providers.
Medicaid MCOs in participating states must redesign prior authorization systems, update provider communications, and ensure compliance with new gold card exemption criteria while maintaining appropriate utilization controls.
Managed Care
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