The Trump administration has announced a significant change to how health care quality will be measured starting in 2026, especially when it comes to vaccines. This change affects how doctors, hospitals, and health programs are evaluated when they provide care to children, pregnant people, and adults who use government-funded health insurance programs.
On December 30, the Centers for Medicare and Medicaid Services said it will remove four vaccine-related measures from the official lists used to judge health care quality. These measures previously tracked whether children, teenagers, and pregnant patients were up to date on recommended vaccinations. Beginning in 2026, these vaccine measures will no longer be required and will instead be optional to report.
Health and Human Services Secretary Robert F. Kennedy Jr. explained the administration’s reasoning in a post on social media. He said that government agencies should not pressure doctors or families to accept vaccines, nor should they punish doctors for honoring a patient’s personal decisions. He emphasized that the administration wants to protect informed consent, religious freedom, and what he described as medical freedom, saying that people should be able to make their own health choices without fear of consequences.
This decision is part of a broader pattern by the Trump administration to reduce government involvement in vaccine recommendations and requirements. Earlier moves included changing guidance from the Centers for Disease Control and Prevention so that COVID-19 vaccination decisions are left to individuals and their doctors, rather than being broadly recommended for nearly everyone. The CDC also revised language on its vaccine safety website, and Kennedy Jr. ended the long-standing recommendation that all newborn babies receive a hepatitis B vaccine at birth.
The vaccine measures being removed are part of what are known as the Child and Adult Core Sets. These are standardized tools used to judge the quality of care provided through Medicaid and the Children’s Health Insurance Program, which cover millions of low-income Americans. In the past, vaccination rates were included in these quality scores, and higher scores could help providers receive better ratings or financial incentives.
By removing vaccination from mandatory quality assessments, immunization rates will no longer affect how care quality is judged for Medicaid and CHIP patients at the federal level. Supporters of the change argue that this prevents doctors from being financially penalized when patients refuse vaccines, including for religious or personal reasons. Some say that, in the past, providers felt pressured to push vaccines or even avoid patients who objected, out of concern that low vaccination numbers could hurt their funding or performance scores.
Critics, however, point out that research has shown that including vaccines in quality measurements often leads to higher vaccination rates. They warn that this change comes at a time when vaccination levels are already falling nationwide, and when diseases like measles and whooping cough are becoming more common again. Public health experts worry that making vaccine reporting optional could further weaken efforts to prevent outbreaks.
In addition to vaccine-related changes, CMS also announced that postpartum and prenatal depression screening measures will move from required reporting to voluntary reporting. Looking ahead, the agency plans more changes in 2027, including making certain testing and evaluation measures for hepatitis and diabetes optional instead of mandatory.
CMS has said it may explore new ways of tracking vaccine-related information in the future, such as whether families were given clear information about vaccine risks, benefits, side effects, and alternative schedules. The agency also said it wants to find ways to account for religious exemptions and personal preferences in its data, while encouraging states not to tie payments directly to vaccination numbers.
Overall, this announcement signals a major shift in federal health policy. Instead of using vaccine uptake as a measure of health care quality, the administration is moving toward a system that places more emphasis on individual choice and less on standardized public health goals. Supporters see this as a win for personal freedom and doctor-patient relationships, while critics fear it could undermine disease prevention efforts and public health protections across the country.
