The Medicaid and CHIP Payment and Access Commission (MACPAC) has recommended that CMS and states increase transparency and oversight of AI algorithms used for prior authorization in Medicaid. The commission flagged a lack of clarity around how these AI tools make decisions, which can lead to arbitrary denials and opaque appeal processes. This is a federal-level signal that pressure is mounting on payers to reveal the clinical criteria and logic behind automated review systems, a key friction point for practices managing Medicaid populations. No binding rule is in place, but the recommendation adds weight to provider advocacy for more transparent and auditable systems.