WASHINGTON, D.C. — The Department of Health and Human Services sent notices to U.S. hospitals and nursing homes directing them to align food purchases with the 2025-30 dietary guidelines established by the Department of Agriculture or risk losing Medicare and Medicaid reimbursements. Administration officials have vowed to withhold millions of dollars in federal funding from facilities that violate the guidelines, and the Trump administration is urging the public to report providers that serve sugary drinks, nutrition shakes, or noncompliant meals.

The guidance advises hospitals not to serve sugar-sweetened beverages or juice, recommending water, unsweetened tea, milk, or coffee instead. Suggested meals include grilled salmon with quinoa or bean-based entrées with leafy greens. Medicare and Medicaid are the largest payers of hospital expenditures.

HHS spokesperson Andrew Nixon said the notices do not carry new regulatory force. "It does not establish new mandates, change Medicare Conditions of Participation, or create any new penalties for hospitals or nursing homes," Nixon said. He added that the guidance builds on "long-standing expectations that healthcare facilities meet patients' nutritional needs as part of safe, high-quality, patient-centered care." Nixon also said, "References to external websites or hotlines are not connected to this guidance and do not reflect HHS or CMS policy. This effort reflects a commitment to supporting providers with clear, evidence-informed information as they continue to improve patient outcomes."

Calley Means, a senior adviser, called on patients and families to alert regulators. "If a hospital is serving patients sugary drinks, they are out of compliance with government standards and are putting their reimbursements in jeopardy," Means wrote, including a link to an HHS webpage with a toll-free number typically used for medical billing complaints. "If you see patients being served sugary drinks, please post information below or let CMS know," he added.

Lawyers and dietitians said HHS lacks authority to enforce the threat without a formal rulemaking process. The mandatory standards require hospitals to protect patient privacy, uphold infection control, and maintain access to a qualified dietitian. The standards also require that "individual patient nutritional needs must be met in accordance with recognized dietary practices," but do not explicitly reference the USDA guidelines. According to an April 13 brief from law firm Akin Gump Strauss Hauer & Feld, CMS has never before interpreted the nutritional requirement to mandate adherence to any set of dietary guidelines, and the CMS memo incorporates the guidelines into the regulatory framework without new rulemaking.

"He doesn't have a legal basis to do this, but hospitals and nursing homes can't afford to ignore it altogether because of what it signals about potential enforcement action," University of Michigan law professor Nicholas Bagley said. "When the agency goes to the hospital and says, We're going to take away your money for this, the hospital can sue and say, Look, nothing requires us to fry our fries in beef tallow or whatever," Bagley said.

Some doctors and medical providers said the initiative fails to account for patients' individualized dietary needs, which may not conform to federal recommendations. Hospitals that neglect to provide protein shakes to treat malnutrition or unhealthy weight loss could open themselves up to possible legal liability. According to a clinical trial published in Nutrición Hospitalaria, 80 percent of malnourished elderly patients gained weight and improved muscle mass on nutritional supplements such as Ensure.