The Major Healthcare Change Coming in 2026: How the U.S. Is Redefining Quality Care
A Quiet Policy Shift With Big Consequences

Beginning in 2026, the United States will fundamentally change how the quality of healthcare is evaluated for millions of Americans enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The change centers on immunization — and it signals a broader shift in federal healthcare policy under the Trump administration.

In an announcement released on December 30, the Centers for Medicare and Medicaid Services (CMS) confirmed that it will remove four immunization-related measures from the Child and Adult Core Sets, the standardized benchmarks used nationwide to assess healthcare quality for Medicaid and CHIP recipients.

Read more: New U.S. Laws Taking Effect January 1, 2026: Full State-by-State Americans Should Know

What Are the Child and Adult Core Sets?

The Child and Adult Core Sets are federally defined collections of healthcare quality measures. States use them to report how well healthcare providers are serving children and adults covered by Medicaid and CHIP.

These measures influence:

  • Quality ratings for providers

  • Federal and state oversight

  • In some cases, reimbursement and performance incentives

Until now, immunization coverage has been a central part of those evaluations.

The Major Healthcare Change Coming in 2026: How the U.S. Is Redefining Quality Care
Medicaid & the Children’s Health Insurance Program (CHIP)

Which Measures Are Being Removed in 2026?

According to CMS, the following four measures will no longer be mandatory starting in 2026:

  • Childhood immunization status

  • Adolescent immunization status

  • Prenatal immunization status for patients under age 21

  • Prenatal immunization status for patients age 21 and older

These measures will move from mandatory reporting to voluntary reporting, meaning states and providers may still submit the data, but it will no longer factor into required quality assessments.

CMS also announced that postpartum and prenatal depression screening and follow-up measures will shift to voluntary reporting as well.

What This Change Means in Practice

Once the change takes effect, immunization coverage will no longer be used to judge the quality of healthcare provided to Medicaid and CHIP patients.

In practical terms:

  • Providers will not be penalized in quality ratings if patients decline vaccines

  • Medicaid and CHIP payments will no longer be tied to vaccination benchmarks

  • Vaccination data will no longer “drive” provider performance scores

Public health researchers have long argued that including immunization in quality measures helps increase vaccine uptake by encouraging providers to prioritize vaccination discussions and follow-ups. CMS’s move represents a departure from that approach.

The Administration’s Rationale

Supporters of the change argue it restores patient choice and protects physicians.

Health and Human Services Secretary Robert F. Kennedy Jr defended the decision in a statement on X, writing:

“Government bureaucracies should never coerce doctors or families into accepting vaccines or penalize physicians for respecting patient choice.”

He added:

“Under the Trump administration, HHS will protect informed consent, respect religious liberty, and uphold medical freedom.”

The policy aligns with the broader healthcare philosophy of the Donald Trump administration, which emphasizes deregulation, individual choice, and reduced federal mandates in healthcare.

Why the Change Is Controversial

The timing of the shift has raised concerns among public health experts. Vaccination rates in the U.S. have declined in recent years, while cases of vaccine-preventable diseases such as measles and whooping cough have increased.

Critics argue that removing immunization from quality metrics could:

  • Reduce provider emphasis on vaccination

  • Further weaken public health tracking

  • Make it harder to identify gaps in immunization coverage

Supporters counter that vaccination decisions should remain strictly between patients and their doctors, without financial pressure from federal programs.

A Broader Redefinition of “Quality Care”

Taken together, the changes reflect a broader redefinition of what constitutes quality healthcare in federal programs.

Rather than emphasizing population-level preventive benchmarks, the 2026 framework places greater weight on:

  • Individual choice

  • Provider autonomy

  • Voluntary reporting instead of mandated metrics

Whether this approach improves trust in the healthcare system — or leads to lower preventive care uptake — remains an open question.

What Happens Next

States will begin preparing for the updated reporting rules in 2025, ahead of the 2026 implementation. CMS has indicated that voluntary reporting will continue to provide data for research and monitoring, though without enforcement mechanisms.

For millions of families using Medicaid and CHIP, the change may not be immediately visible — but it represents one of the most significant shifts in federal healthcare quality assessment in years.