States will no longer be required to report how many children they vaccinate to the Centers for Medicare and Medicaid Services (CMS), according to a December 30 letter to state health officials.
As a measure of the quality of the care, states have been required to report the percentage of patients covered by Medicaid and the Children's Health Insurance Plan who are immunized.
About 40% of children are covered by Medicaid, a federal health program administered by states for people with low incomes, pregnant women, those with disabilities, and others. CHIP provides health insurance to children whose families do not qualify for Medicaid.
States may continue to provide the information voluntarily, according to the letter, “to allow CMS to maintain a longitudinal dataset while exploring alternative immunization measures.”
In the future, however, CMS will explore “new vaccine measures that capture information about whether parents and families were informed about vaccine choices, vaccine safety and side effects, and alternative vaccine schedules,” according to the letter.
The change comes amid efforts by US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s efforts to restrict access to vaccines. The Trump administration in December issued a memo to HHS officials to alter the US child immunization schedule, which currently protects against 18 life-threatening diseases, to resemble that of Denmark, which protects children against 10 diseases.
The Centers for Disease Control and Prevention (CDC) in December also stopped recommending the hepatitis B vaccine for all newborns, instead recommending the vaccine for infants whose mothers test positive for hepatitis B or whose infection status is unknown.
Burdensome regulations, ‘red tape’
Tracking childhood immunization data is important, because it can help researchers and policymakers identify trends and problems in vaccine access, said Joshua M. Sharfstein, MD, a professor at the Johns Hopkins Bloomberg School of Public Health.
“If CMS makes this change, it will become harder to understand gaps in vaccination that leave communities exposed to outbreaks of serious and even deadly infectious diseases,” Sharfstein told CIDRAP News.
A spokesman for HHS declined to answer emailed questions about the CMS letter, instead referring CIDRAP News to Kennedy’s December 31 post on X, the social media platform.
“Government bureaucracies should never coerce doctors or families into accepting vaccines or penalize physicians for respecting patient choice,” Kennedy wrote. “That practice ends now. Under the Trump administration, HHS will protect informed consent, respect religious liberty, and uphold medical freedom.”
The letter from CMS states that the agency, “does not tie payment to performance on immunization quality measures in Medicaid and CHIP at the federal level.”
Although states can use quality measures such as immunization rates as part of payment incentive programs, CMS said in the letter that it “strongly discourages” states from basing payment on immunization levels.
If CMS makes this change, it will become harder to understand gaps in vaccination that leave communities exposed to outbreaks of serious and even deadly infectious diseases.
Thomas Nguyen, DO, a pediatrician in Canton, Ohio, said he has no intention of counseling parents to follow “alternative vaccine schedules.” Nguyen said he follows the practice recommendations of the American Academy of Pediatrics because the organization’s advice is based on rigorous science.
“Why would I discuss an alternative vaccine schedule if I don't recommend it?” said Nguyen, who estimates that 25% to 30% of his patients are covered by Medicaid.
Nguyen said he’s concerned that burdensome regulations or “red tape” could dissuade pediatricians from accepting Medicaid insurance plans, which typically reimburse doctors at a lower rate than private insurance.
Reducing data collection
The Trump administration has stopping collecting data on other key health measures such as whether people have a reliable source of healthy food.
Other government agencies also collect data on vaccination. For example, the CDC conducts the National Interview Surveys.
Surveying the needs of children covered by Medicaid is important, Nguyen said, because these children are more vulnerable than others. Research shows that kids covered by Medicaid often have greater barriers to care—such as a lack of reliable transportation—than children who are privately insured.
“These are the poorest, most disadvantaged patients,” Nguyen said.
