The Trump administration has officially withdrawn four immunization-related metrics from federal health care quality assessments for Medicaid and the Children’s Health Insurance Program (CHIP) starting in 2026. The decision was announced by the Centers for Medicare and Medicaid Services (CMS) on December 30 and affects childhood and prenatal immunization status, among other categories.
Secretary of Health and Human Services Robert F. Kennedy Jr. said the shift is intended to end what he described as coercive vaccine-related policies. According to Kennedy, the administration will now prioritize informed consent and religious liberty, moving away from federal standards that previously tied quality evaluations to vaccine uptake.
Vaccine Status Removed from Federal Quality Measures
The CMS announcement details that four immunization measures (covering childhood vaccinations, adolescent vaccinations, and prenatal immunizations for individuals under and over age 21) will be removed from the 2026 Child and Adult Core Sets. These sets are used nationally to gauge the quality of care delivered under Medicaid and CHIP programs.
According to the CMS report, the affected measures will no longer be part of the “mandatory stratification requirements,” and will instead be designated as optional for states to report. Immunization coverage data will not factor into federal quality evaluations for these public insurance programs, marking a notable shift in federal health policy.
The removal of these measures aligns with broader changes in vaccine policy under the Trump administration. In October 2025, the Centers for Disease Control and Prevention (CDC) revised its COVID-19 vaccine guidance, shifting from a near-universal recommendation to one focused on individual decision-making. According to the Associated Press, the CDC also modified language on its vaccine safety webpage to state that the claim “vaccines do not cause autism” is not evidence-based, citing a lack of studies conclusively ruling out the link.
Supporters of the CMS changes argue that the new policy prevents doctors from being penalized financially when patients decline vaccines. Robby Starbuck, a conservative media figure, wrote on social media that “Medicaid and CHIP payments will no longer be tied to prenatal and childhood vaccine numbers,” a statement later shared by Kennedy. Starbuck added that some physicians previously avoided patients with religious objections to vaccines out of concern for their performance ratings and payments.
Administration Signals Wider Shift in Public Health Approach
According to CMS, the agency intends to explore new ways of capturing family preferences and informed consent within future immunization quality measures. This includes potentially developing metrics to reflect awareness of vaccine safety, side effects, and alternative vaccine schedules. The agency also stated plans to engage with state stakeholders and immunization registry managers to better account for religious exemptions in future data reporting.
CMS clarified that it does not currently link federal Medicaid or CHIP payments to performance on immunization measures. While states can use quality metrics in their own payment structures, the agency “strongly discourages” the use of immunization-related measures in performance-based payment systems.
Additional changes in the 2026 core sets include shifting postpartum and prenatal depression screenings from required to optional reporting. Looking ahead to 2027, CMS has indicated that hepatitis B and C testing, along with certain diabetes evaluations for adults, will also move from mandatory to voluntary reporting categories.
The recent CMS decision comes amid a broader decline in vaccination rates and the re-emergence of vaccine-preventable diseases across the United States, including measles and whooping cough. According to past studies cited in the CMS report, including immunization in quality measures has historically helped drive vaccine uptake by providing reliable data on coverage.
