The Trump administration has announced a significant shift in how health care quality will be evaluated beginning in 2026, with a major change affecting immunization standards.
In an announcement released on December 30, the Centers for Medicare and Medicaid Services (CMS) said it will remove four measures tied to pediatric and prenatal immunization from the 2026 Child and Adult Core Sets, which are used to assess health care quality.
Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. addressed the decision in a post on X, saying, “Government bureaucracies should never coerce doctors or families into accepting vaccines or penalize physicians for respecting patient choice.”
“That practice ends now,” he added. “Under the Trump administration, HHS will protect informed consent, respect religious liberty, and uphold medical freedom.”
Why It Matters
The move is part of a broader series of policy changes under the Trump administration that reduce the role of vaccines in federal health guidance.
In October 2025, the Centers for Disease Control and Prevention (CDC) revised its COVID-19 vaccine guidance, shifting from recommending updated vaccines for nearly all Americans aged six months and older to leaving the decision to individuals in consultation with their doctors.
The CDC also updated its vaccine safety webpage in the ongoing debate over vaccines and autism, stating that the claim “vaccines do not cause autism” is not evidence-based because studies have not fully ruled out a possible connection, according to The Associated Press.
Kennedy has also ended the longstanding recommendation that all U.S. newborns receive a hepatitis B vaccine at birth, among other policy changes that scale back vaccine development, recommendations, and requirements.
What to Know
The four measures being removed from the Child and Adult Core Sets include childhood immunization status, adolescent immunizations, and prenatal immunization status for individuals both under and over age 21, according to CMS.
The Child and Adult Core Sets are standardized health care quality measures used to evaluate care provided through Medicaid and the Children’s Health Insurance Program (CHIP).
Under the new policy, childhood and adolescent immunization measures will be removed from mandatory reporting requirements for 2026 and instead classified as voluntary. As a result, immunization coverage will no longer factor into how health care quality is assessed for Medicaid and CHIP providers.
Researchers have previously suggested that including immunization metrics in quality assessments can encourage higher vaccination rates by tracking coverage levels.
The policy shift comes as vaccination rates nationwide have declined, a trend often cited as contributing to the resurgence of vaccine-preventable diseases such as measles and whooping cough.
Supporters of the change argue it removes financial pressure from physicians. They say doctors will no longer face penalties if patients decline vaccines, including for religious reasons.
Robby Starbuck, a conservative social media activist with more than 860,000 followers on X, wrote that the change means Medicaid and CHIP payments will no longer be linked to childhood and prenatal vaccination rates.
“In the past, some providers avoided patients with religious objections to vaccines because it could hurt their ratings and payments,” Starbuck said. “That perverse incentive is now gone.” Kennedy later shared the post and thanked Starbuck for highlighting the update.
CMS also said postpartum and prenatal depression screening and follow-up measures will shift from mandatory reporting to voluntary reporting under the new framework.
What People Are Saying
In its announcement, CMS said it plans to explore new vaccine-related measures beginning in 2026 that focus on whether families are informed about vaccine choices, safety, side effects, and alternative schedules.
The agency said it will work with states, health care providers, immunization registry managers, and electronic health record vendors to determine how quality measures could better reflect family preferences, including religious exemptions.
CMS also emphasized that immunization quality measures are not tied to federal Medicaid or CHIP payments. While states may choose to use such measures in their own value-based payment systems, CMS said it strongly discourages linking immunization metrics to financial incentives.
What Happens Next
Additional changes are scheduled for 2027, including proposals to shift certain hepatitis B and C testing measures and adult diabetes evaluations from mandatory data collection to voluntary reporting. These changes would further reduce the number of required quality measures used to assess health care providers.
