Washington, D.C. — The Trump administration has put hospitals and nursing homes on notice: serve sugary drinks or nutrition shakes that don’t meet federal dietary guidelines, and you risk losing your Medicare and Medicaid reimbursements.
The directive, pushed by Health and Human Services Secretary Robert F. Kennedy Jr. as part of his Make America Healthy Again initiative, is generating fierce pushback from doctors, dietitians, and even some conservative physicians who say the policy ignores the complex nutritional needs of sick and elderly patients.
Kennedy announced the move at a March 30 press event, describing the instructions as “essentially a federal mandate.” A CMS memo sent to hospitals asked facilities to align their food offerings with the 2025-30 USDA dietary guidelines to preserve eligibility for federal payments. Nursing homes were included in the scope.
“If a hospital is serving patients sugary drinks, they are out of compliance with government standards and are putting their reimbursements in jeopardy,” top Kennedy adviser Calley Means posted on X. Means went further, warning that products like Ensure — the nutrition shake widely used to combat malnutrition — could also put facilities at risk. He encouraged the public to report violations through an HHS tip line.
Not So Fast, Lawyers Say
Legal and medical experts are skeptical the agency has the authority to enforce these threats without going through formal rulemaking. The existing CMS standards require facilities to meet patients’ “individual nutritional needs in accordance with recognized dietary practices” — but they don’t explicitly require adherence to any particular dietary guidelines.
“CMS has never before interpreted this requirement as mandating adherence to any set of dietary guidelines,” according to an April brief from law firm Akin Gump Strauss Hauer & Feld. A University of Michigan law professor told industry reports that hospitals and nursing homes “can’t afford to ignore” the signals Kennedy is sending — but if funding were actually withheld, they’d have solid grounds to sue.
The Problem for Nursing Homes
Nutrition shakes like Ensure aren’t served as snacks — they’re prescribed interventions. According to a clinical trial published in Nutrición Hospitalaria, 80% of malnourished elderly patients gained weight and improved muscle mass on nutritional supplements. For nursing homes already navigating shifting expectations around resident dining and nutrition, the guidance creates a real dilemma: comply with Kennedy’s directives, or continue clinical nutrition practices backed by medical evidence.
Clinicians note that for patients recovering from strokes or struggling to swallow, protein shakes aren’t a junk food choice — they’re often the safest way to deliver adequate calories. “A patient struggling to swallow from just having a stroke — salmon and quinoa is the worst thing for them. They’re going to risk aspirating on it,” said Kevin Klatt, a University of Toronto dietitian and research scientist.
Industry Caught in the Middle
Nursing homes face a practical squeeze. Federal funding is their lifeline — Medicare and Medicaid are the largest payers of long-term care expenditures — and they’re loath to challenge any signals from regulators about compliance. At the same time, abandoning nutritional supplements for malnourished residents could expose them to liability and worse patient outcomes.
The Kennedy initiative has received some support from nutrition advocates who have long pushed for healthier hospital food. But the combination of a public tip line for reporting, vague enforcement authority, and sweeping guidance is creating the kind of uncertainty that nursing home operators dread.
Unless HHS clarifies the specific standards that will and won’t trigger enforcement — and goes through formal rulemaking to establish them — facilities are left guessing. And in nursing home care, guessing wrong can be costly.
