Personal belief exemptions — which states permit them and how they work
Philosophical exemptions — also called personal belief, conscience, or conscientious objection exemptions — allow parents to decline required school vaccinations for their children based on personal, moral, or philosophical beliefs rather than religion or medical need. As of April 2026, 15 states permit philosophical exemptions, according to the National Conference of State Legislatures (NCSL). Washington state permits them for most required vaccines but eliminated them for the MMR (measles, mumps, and rubella) vaccine in 2019 via HB 1638.
Unlike religious exemptions, which may involve First Amendment Free Exercise protections, philosophical exemptions are created by state law. No court has held that the U.S. Constitution requires a state to offer a philosophical exemption. States may create, modify, or eliminate these exemptions through ordinary legislation, as reflected in Brown v. Smith, 24 Cal.App.5th 1135 (Cal. Ct. App. 2018), and Phillips v. City of New York, 775 F.3d 538 (2d Cir. 2015).
The terminology varies by state. Some state statutes use the term "philosophical," while others use "personal belief," "conscience," "conscientious objection," "moral or ethical," or "nonmedical." The documentation required to claim an exemption also varies significantly, from a simple signed parental statement to notarized affidavits, state-approved educational modules, or healthcare provider consultations.
| State | Statutory Term Used | Documentation Required | Primary Statute |
|---|---|---|---|
| Arizona | Personal Belief | Signed statement | Ariz. Rev. Stat. Section 15-873 |
| Arkansas | Philosophical | Notarized statement and state-issued education form; Annual renewal | Ark. Code Section 6-18-702 |
| Colorado | Nonmedical | State-approved educational module or healthcare provider signature; Annual renewal | Colo. Rev. Stat. Section 25-4-903 |
| Idaho | Other Ground | Signed statement | Idaho Code Section 33-903 |
| Louisiana | Written Dissent | Signed statement | La. Rev. Stat. Section 17:170 |
| Michigan | Philosophical | Health department education session and certified state form | Mich. Comp. Laws Section 333.9215 |
| Minnesota | Conscientiously Held | Notarized statement | Minn. Stat. Section 121A.15 |
| North Dakota | Moral or Philosophical | Signed statement | N.D. Cent. Code Section 23-07-17.1 |
| Ohio | Conscience | Signed statement | Ohio Rev. Stat. Section 3313.671 |
| Oklahoma | Personal | Signed statement | Okla. Stat. tit. 70, Section 1210.192 |
| Oregon | Nonmedical | Healthcare provider signature or state-approved educational module | Or. Rev. Stat. Section 433.267 |
| Pennsylvania | Strong Moral/Ethical | Signed statement | 28 Pa. Code Section 23.84 |
| Texas | Conscience | Notarized state-issued affidavit; Valid for 2 years | Tex. Health & Safety Code Section 161.004 |
| Utah | Personal | Online educational module and certified state form | Utah Code Section 53G-9-303 |
| Washington | Personal/Philosophical | Healthcare provider signature; Philosophical exemption prohibited for MMR vaccine (HB 1638, 2019) | Wash. Rev. Code Section 28A.210.090 |
| Wisconsin | Personal Conviction | Signed statement | Wis. Stat. Section 252.04 |
Note: Colorado and Oregon use the term "nonmedical" in statute, which encompasses both religious and philosophical exemptions under a single category. In this table, they are listed under philosophical because both states permit exemptions based on personal or philosophical beliefs.
States that permit philosophical exemptions differ in what they require from parents. The following categories represent the range of procedural requirements across the 15 states and Washington.
In several states (Arizona, Idaho, Louisiana, North Dakota, Ohio, Oklahoma, Pennsylvania, Wisconsin), a signed written statement from the parent or guardian is the only documentation required. No educational component, provider consultation, or notarization is required.
Some states require the exemption statement to be notarized. Arkansas requires a notarized statement along with a state-issued education form. Minnesota requires a notarized statement. Texas requires a notarized state-issued affidavit (Tex. Health & Safety Code Section 161.004), which is valid for two years.
Colorado requires parents to complete a state-approved educational module or obtain a healthcare provider's signature (Colo. Rev. Stat. Section 25-4-903; SB 163, 2020). Oregon requires either a healthcare provider's signature or completion of a state-approved online education module (Or. Rev. Stat. Section 433.267; SB 442, 2013). Utah requires completion of an online educational module and a certified state form (Utah Code Section 53G-9-303). Michigan requires an in-person educational session at a local health department before a certified waiver is issued (Mich. Comp. Laws Section 333.9215; Admin Rule R 325.176, 2014).
Washington requires a signature from a healthcare practitioner verifying that they provided vaccine information (Wash. Rev. Code Section 28A.210.090; SB 5006, 2011). Colorado and Oregon also accept a healthcare provider's signature as an alternative to the educational module.
Some states require exemptions to be renewed periodically rather than remaining valid indefinitely. Arkansas and Colorado require annual renewal. Texas requires renewal every two years.
Philosophical exemptions are a matter of state legislative policy, not a constitutional requirement or right. Courts have consistently held that states are not required to provide philosophical or personal belief exemptions from vaccination requirements.
The following court decisions are relevant:
Zucht v. King, 260 U.S. 174 (1922): The U.S. Supreme Court held that vaccine mandates are a valid exercise of state police power (the state's authority to protect health and safety) and do not violate the Due Process or Equal Protection Clauses. The decision established that states are not constitutionally required to provide personal belief exemptions.
Phillips v. City of New York, 775 F.3d 538 (2d Cir. 2015): The Second Circuit ruled that there is no constitutional right to a nonmedical exemption and that the state may require vaccination for school attendance.
Brown v. Smith, 24 Cal.App.5th 1135 (Cal. Ct. App. 2018): The California Court of Appeal affirmed that the elimination of the personal beliefs exemption (SB 277) was constitutional. The court held that the state has a compelling interest in public health that the legislature may act on through vaccination requirements.
Because philosophical exemptions are statutory rather than constitutional, a state legislature may eliminate or modify them at any time through ordinary legislation. Several states have done so since 2015, as described in the section below.
Multiple peer-reviewed studies have examined the relationship between nonmedical exemption rates and the incidence of vaccine-preventable diseases (the number of cases in a population over time). The following findings are drawn from studies verified against primary sources.
A 2006 study in JAMA (Omer et al.) found that states classified by the study authors as having 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.
For the 2023-24 school year, the total kindergarten exemption rate (medical and nonmedical combined) was 3.3%, up from 3.0% in 2022-23 and 2.6% in 2021-22, according to CDC MMWR data published October 17, 2024 (Vol. 73, No. 41).
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 eliminated philosophical exemptions through legislation:
Vermont (2015): Act 157 eliminated the philosophical exemption, effective July 1, 2016. The act did not include a broad grandfathering clause; students were required to meet vaccination or religious/medical exemption criteria for the 2016-2017 school year.
California (2015): SB 277 eliminated both religious and philosophical (personal belief) exemptions, effective January 1, 2016.
Maine (2019): HP 586 eliminated both religious and philosophical exemptions, effective September 1, 2021.
Washington (2019, partial): HB 1638 eliminated philosophical exemptions for the MMR vaccine specifically. Philosophical exemptions remain available for other required vaccines.
Several states have added procedural requirements to the philosophical exemption process without eliminating the exemption:
Washington (2011, SB 5006): Added a requirement for a signature from a healthcare practitioner verifying they provided vaccine information.
Oregon (2013, SB 442): Required parents to either obtain a signature from a healthcare provider or complete an online education module.
Michigan (2014, Admin Rule R 325.176): Required an in-person educational session at a local health department before a certified waiver is issued.
Colorado (2020, SB 163): Required annual submission of a certificate of nonmedical exemption, obtained via a state educational module or healthcare provider signature.
No states have added a new philosophical exemption category or broadened the scope of an existing one since 2015, according to NCSL data and state legislative records reviewed for this page.