Medical, religious, and philosophical exemptions to vaccine requirements.
All U.S. states that require vaccinations for school entry also provide at least one category of exemption, according to the National Conference of State Legislatures (NCSL). These exemptions allow individuals to attend school without meeting standard vaccination requirements under specific legal conditions.
Three types of exemptions exist in U.S. law: medical, religious, and philosophical (also called personal belief). Not all states permit all three types. As of April 2026, all 50 states and the District of Columbia grant medical exemptions, 44 states and D.C. permit religious exemptions, and 15 states permit philosophical exemptions, according to NCSL. Washington state permits philosophical exemptions for most vaccines but eliminated them for the MMR (measles, mumps, and rubella) vaccine in 2019 via HB 1638.
The legal foundation for state vaccination requirements dates to Jacobson v. Massachusetts, 197 U.S. 11 (1905), in which the Supreme Court held that states may enforce compulsory vaccination laws under their police power (their authority to protect health and safety). The legal framework governing exemptions draws on both constitutional principles and state legislation, and continues to evolve through court decisions, legislative action, and federal policy.
The availability of exemptions varies significantly by state. Debates continue over how to balance public health goals, parental autonomy, religious liberty, and individual rights. This page provides an overview of the three exemption categories, a state-by-state reference table, and links to detailed subpages for each exemption type.
The following table shows which exemption types each state and the District of Columbia currently permit. The data is based on NCSL and individual state statutes. For detailed documentation requirements and recent legislative changes, see the State-by-State Exemption Database at /legal/mandates/exemptions/state-by-state.
| State | Medical | Religious | Philosophical |
|---|---|---|---|
| Alabama | Yes | Yes | No |
| Alaska | Yes | Yes | No |
| Arizona | Yes | Yes | Yes |
| Arkansas | Yes | Yes | Yes |
| California | Yes | No | No |
| Colorado | Yes | Yes | Yes |
| Connecticut | Yes | No | No |
| Delaware | Yes | Yes | No |
| D.C. | Yes | Yes | No |
| Florida | Yes | Yes | No |
| Georgia | Yes | Yes | No |
| Hawaii | Yes | Yes | No |
| Idaho | Yes | Yes | Yes |
| Illinois | Yes | Yes | No |
| Indiana | Yes | Yes | No |
| Iowa | Yes | Yes | No |
| Kansas | Yes | Yes | No |
| Kentucky | Yes | Yes | No |
| Louisiana | Yes | Yes | Yes |
| Maine | Yes | No | No |
| Maryland | Yes | Yes | No |
| Massachusetts | Yes | Yes | No |
| Michigan | Yes | Yes | Yes |
| Minnesota | Yes | Yes | Yes |
| Mississippi | Yes | Yes* | No |
| Missouri | Yes | Yes | No |
| Montana | Yes | Yes | No |
| Nebraska | Yes | Yes | No |
| Nevada | Yes | Yes | No |
| New Hampshire | Yes | Yes | No |
| New Jersey | Yes | Yes | No |
| New Mexico | Yes | Yes | No |
| New York | Yes | No | No |
| North Carolina | Yes | Yes | No |
| North Dakota | Yes | Yes | Yes |
| Ohio | Yes | Yes | Yes |
| Oklahoma | Yes | Yes | Yes |
| Oregon | Yes | Yes | Yes |
| Pennsylvania | Yes | Yes | Yes |
| Rhode Island | Yes | Yes | No |
| South Carolina | Yes | Yes | No |
| South Dakota | Yes | Yes | No |
| Tennessee | Yes | Yes | No |
| Texas | Yes | Yes | Yes |
| Utah | Yes | Yes | Yes |
| Vermont | Yes | Yes | No |
| Virginia | Yes | Yes | No |
| Washington | Yes | Yes | Yes* |
| West Virginia | Yes | No** | No |
| Wisconsin | Yes | Yes | Yes |
| Wyoming | Yes | Yes | No |
* Mississippi: The state statute (Miss. Code 41-23-37) authorizes only medical exemptions. However, a federal court ordered the Mississippi State Department of Health to create a religious exemption process in Bosarge v. Edney (S.D. Miss., April 18, 2023). That process is now operational through MSDH procedures but has not been codified in statute.
** Washington permits philosophical exemptions for most required vaccines but eliminated them for the MMR vaccine in 2019 (HB 1638).
*** West Virginia has never legislatively enacted a religious exemption. However, the state's exemption status is the subject of active litigation (Guzman v. West Virginia Board of Education, WV Supreme Court Case No. 25-740). See the Religious Exemptions page for a full timeline.
** Washington permits philosophical exemptions for most required vaccines but eliminated them for the MMR vaccine in 2019 (HB 1638).
*** West Virginia has never legislatively enacted a religious exemption. However, the state's exemption status is the subject of active litigation (Guzman v. West Virginia Board of Education, WV Supreme Court Case No. 25-740). See the Religious Exemptions page for a full timeline.
Source: NCSL, "States With Religious and Philosophical Exemptions From School Immunization Requirements" (updated January 2025). Individual state statutes cited on the State-by-State Exemption Database page.
All 50 states and D.C. provide exemptions for individuals with medical contraindications or precautions (situations in which a vaccine should not be given, or should be delayed) as defined by CDC guidelines. These typically require certification from a licensed physician (MD or DO), and in some jurisdictions, review by state health officials.
Read full analysis →44 states and D.C. allow parents to claim exemptions based on sincerely held religious beliefs. Six states do not permit religious exemptions: California, Connecticut, Maine, Mississippi, New York, and West Virginia. The legal framework draws on the First Amendment's Free Exercise Clause and has been shaped by federal court decisions, including Jacobson v. Massachusetts (1905) and Employment Division v. Smith (1990).
Read full analysis →15 states permit exemptions based on personal, moral, or conscientious beliefs unrelated to religion or medical need. Documentation requirements vary from simple signed forms to mandatory educational consultations. Washington permits philosophical exemptions for most vaccines but eliminated them for the MMR vaccine in 2019.
Read full analysis →For highly contagious diseases such as measles, the CDC states that a community vaccination coverage rate of approximately 95% is needed to prevent sustained transmission (continued spread over time), according to CDC Kindergarten Vaccination Coverage data (MMWR, 2024).
Multiple peer-reviewed studies have examined the relationship between nonmedical exemption rates and disease incidence (the number of cases in a population over time). A 2006 study in JAMA (Omer et al.) found that states with easier exemption processes had approximately 50% higher pertussis incidence compared to states with more stringent processes (incidence rate ratio 1.53, 95% CI 1.10-2.14). A 2000 study in JAMA (Feikin et al.) reported that children with personal exemptions were 5.9 times more likely to acquire pertussis than vaccinated children (95% CI 4.2-8.2). A 2013 study in Pediatrics (Atwell et al.) found that California communities with clustered nonmedical exemptions were 2.5 times more likely to be in a pertussis cluster during the state's 2010 outbreak.
A 2008 study in the American Journal of Epidemiology (Omer et al.) found significant geographic overlap between clusters of nonmedical exemptions and clusters of pertussis cases in Michigan. A 2016 review in JAMA (Phadke et al.) examined 18 measles outbreaks and 32 pertussis outbreaks and found that at least 25% of those infected in the five largest pertussis epidemics were unvaccinated.
Note: Co-authors of the Omer et al. (2006) study disclosed payment from Sanofi Pasteur, GlaxoSmithKline, Merck, Chiron, and the Department of Justice (unrelated to the study). Co-author Daniel Salmon of the Phadke et al. (2016) review disclosed grant funding from Crucell, Pfizer, and Merck.
Several states have changed their exemption laws since 2015. The following summary highlights legislative and judicial actions that have changed the availability of nonmedical exemptions.
California (2015): SB 277 eliminated both religious and philosophical exemptions. In 2019, SB 276/SB 714 increased state oversight of medical exemption forms.
New York (2019): A02371 eliminated religious exemptions.
Maine (2019, effective September 1, 2021): HP 586 eliminated both religious and philosophical exemptions.
Washington (2019): HB 1638 eliminated philosophical exemptions for the MMR vaccine specifically. Religious and philosophical exemptions remain available for other required vaccines.
Connecticut (2021): PA 21-6 eliminated religious exemptions effective April 28, 2021.
West Virginia (2023-2026): The West Virginia Legislature enacted the Equal Protection for Religion Act (EPRA) in 2023. In January 2025, Governor Patrick Morrisey issued Executive Order 7-25 claiming EPRA creates a religious exemption from the state's compulsory vaccination law. A circuit court injunction was issued in November 2025, but the WV Supreme Court stayed that ruling in December 2025. The case (Guzman v. WVBE, Case No. 25-740) is pending before the WV Supreme Court, with briefing scheduled through June 2026. See the Religious Exemptions page for a full timeline.
HHS OCR (September 2025): The U.S. Department of Health and Human Services' Office for Civil Rights issued a nationwide letter to Vaccines for Children Program (VCP) awardees stating that VCP-participating providers must respect state religious and conscience exemptions from vaccine mandates, according to the HHS press release dated September 4, 2025. See the Religious Exemptions page for full details.
First Amendment protections and state religious exemption laws
CDC contraindications and physician certification requirements
Personal belief exemptions and documentation requirements
Detailed exemption data for all 50 states and D.C.
Required vaccines and schedules by state
How states adopted ACIP vaccine recommendations
Legal framework for vaccination requirements
National vaccine injury compensation program
Note: Some subpages are under construction.