By Stephanie Armour
April 30, 2026 / 5:00 AM EDT / KFF Health News
Complaints about hospital food are nothing new, but the Trump administration has intensified scrutiny by urging the public to report hospitals and nursing homes that serve sugary drinks, nutrition shakes or meals it says don’t follow the Department of Agriculture’s 2025–30 dietary guidelines. Officials have vowed to withhold millions in federal funding if violations occur.
The initiative, led by HHS Secretary Robert F. Kennedy Jr., has drawn backlash from some doctors and providers who say it ignores patients’ individualized dietary needs and conflicts with Republicans’ usual anti-regulatory stance. Lawyers and dietitians also question whether HHS has the authority to enforce such a threat without formal rulemaking.
“Most of this is political theater. HHS doesn’t have the power to do much,” said Kevin Klatt, a dietitian and assistant professor at the University of Toronto. “Also, if it’s to the point that you’re trying to control people’s choices, well, you look a little fascist.”
HHS sent notices to hospitals asking them to align food purchases with the administration’s dietary guidelines to maintain eligibility for Medicare and Medicaid payments, Kennedy said at a March 30 press event. “We are going to bring all the hospitals in the country in line with good food,” he said, calling the instructions “essentially a federal mandate.”
HHS spokesperson Andrew Nixon later said the guidance “does not establish new mandates, change Medicare Conditions of Participation, or create any new penalties for hospitals or nursing homes.” He added there are “no changes to enforcement, survey, or accreditation processes associated with this guidance,” describing the notice as building on “long-standing expectations” that facilities meet patients’ nutritional needs as part of safe, patient-centered care.
Still, a top Kennedy adviser, Calley Means, urged the public to report hospitals that don’t comply, linking to an HHS webpage with a toll-free number used for medical-bill complaints. Means posted on X: “If a hospital is serving patients sugary drinks, they are out of compliance with government standards and are putting their reimbursements in jeopardy… If you see patients being served sugary drinks, please post information below or let CMS know.” Means also warned that serving liquid nutrition products like Ensure could put hospitals at risk: “They need to change or lose reimbursement. Please report them if you see it.”
Nixon said references to external websites or hotlines are not connected to the guidance and do not reflect HHS or CMS policy. Means dismissed critics on X, accusing Democrats of defending “the medical importance of mass-serving soda and junk food to American patients.”
Withholding federal funding is among the most extreme enforcement tools and has been seldom used by the Centers for Medicare & Medicaid Services. Medicare and Medicaid together are the largest payers of hospital expenditures, making any threat of funding loss significant for hospitals.
HHS can withhold or threaten funding if hospitals violate mandatory health and safety standards. Those standards cover issues such as privacy and infection control and require that “individual patient nutritional needs must be met in accordance with recognized dietary practices” and that facilities have access to qualified dietitians. But the standards do not explicitly cite the USDA’s 2025–30 dietary guidelines.
Lawyers say CMS’s memo takes the “notable step” of incorporating the dietary guidelines into hospital regulatory expectations without new rulemaking. “CMS has never before interpreted this requirement as mandating adherence to any set of dietary guidelines,” an April 13 brief from law firm Akin Gump notes.
Hospitals are likely to comply to avoid legal or enforcement trouble even if the agency’s legal basis is uncertain. “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,” said Nicholas Bagley, a University of Michigan law professor. Hospitals could sue if funding were withheld.
The agency’s memo gives examples of what should and shouldn’t be served: “don’ts” include sugar-sweetened beverages or juice; “do’s” include water, unsweetened tea, milk or coffee. Suggested meals include grilled salmon with quinoa or bean-based entrees with leafy greens.
Some nutritionists welcomed the focus. Marion Nestle called the recommendations “terrific.” Others warned that hospitalized patients often need individualized nutrition that may not fit broad guidelines. “For 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,” Klatt said.
Hospitals that fail to provide certain standards of care—such as protein shakes to treat malnutrition—could face legal liability. A clinical trial published in Nutrición Hospitalaria found 80% of malnourished elderly patients gained weight and muscle mass on nutritional supplements such as Ensure.
Abbott, which makes Ensure, noted it produces products for people who “could be malnourished due to medical treatments, such as chemotherapy, and not be getting the calories they need because they don’t have much of an appetite,” company spokesperson John Koval said.
Clinicians cautioned that losing weight in the hospital raises mortality risk. Mary Talley Bowden, a sleep medicine specialist who has supported MAHA causes, criticized the administration’s snitch-line approach on X: “Give me a break Calley. A hospital snitch line for soda?” she posted, calling it “a little tyrannical.”
The focus on hospital food is part of Kennedy’s Make America Healthy Again (MAHA) initiative, which promotes changes to federal dietary guidelines that emphasize protein and healthy fats while discouraging processed foods. Kennedy has made food policy a prominent part of MAHA and it polls well across parties: a Navigator Research poll released in September 2025 found 86% of registered voters say it should be easier for families to access fresh fruits and vegetables.
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