The Trump administration has ordered hospitals nationwide to align food purchases with federal dietary guidelines or risk losing Medicare and Medicaid funding, a move health experts warn may exceed regulatory authority and threaten hospital operations across America.

Federal Mandate Targets Hospital Menus

Health and Human Services Secretary Robert F. Kennedy Jr. announced at a March 30 press event that his agency sent notices to hospitals demanding compliance with 2025-30 dietary guidelines. Kennedy described the instructions as a federal mandate, warning that hospitals serving sugary drinks to patients violate government standards and jeopardize their reimbursements. Top Kennedy adviser Calley Means posted on social media urging Americans to report hospitals serving sugary beverages, even targeting liquid nutrition products like Ensure. Medicare and Medicaid combined represent the largest source of hospital revenue nationwide.

Legal Questions About Federal Authority

The Centers for Medicare and Medicaid Services issued the directive as a Conditions of Participation update, but legal experts question whether HHS possesses regulatory authority to enforce such threats without formal rulemaking. Kevin Klatt, a dietitian and research scientist at the University of Toronto, dismissed the effort as political theater, noting HHS lacks power to implement such controls. Law firm Akin Gump Strauss Hauer and Feld released an April 13 brief stating CMS has never interpreted existing requirements as mandating adherence to specific dietary guidelines. Current standards require hospitals meet individual patient nutritional needs according to recognized dietary practices but do not explicitly reference USDA guidelines.

High Stakes for American Hospitals

Withholding federal funding represents one of the most extreme enforcement tools available to regulators, one CMS has seldom deployed. Such action could imperil a hospital’s ability to remain open. HHS spokesperson Andrew Nixon initially stated the guidance was not a mandate and references to reporting noncompliance were not connected to official guidance, though he later commended hospitals making commitments to improve food offerings. Administration officials have signaled willingness to halt federal funding despite the unprecedented nature of such enforcement. Means responded to criticism by accusing opponents of defending mass-serving soda and junk food to American patients.