This guide will cover how to get a vaccine exemption in each of the 50 United States.

Parents who choose vaccination exemption for their children do so because they believe that children get too many shots altogether, and they have valid concerns about serious side effects, such as autism. Ultimately, it is a parent’s choice to make the right decision for their child’s individual needs. 

Types of Exemptions: 

Medical Exemptions:
These are granted when a child has a medical contraindication to a vaccine, such as allergies to vaccine components or a history of adverse reactions. 

Non-medical Exemptions:
These include: 

• Religious Exemptions: Allowing exemptions based on religious beliefs that prohibit vaccination. 
• Philosophical or Personal Belief Exemptions: Allowing exemptions based on personal or moral convictions against vaccination. 

State Variations: 

• • Medical Exemptions:
    All states and the District of Columbia allow medical exemptions for children unable to receive vaccines due to medical reasons. Typically, a medical exemption must be written by an MD or doctor of osteopathy (DO). 
  • Religious Exemptions:
  • This exemption is based on the First Amendment, the right to freely hold and exercise religious beliefs. Most states allow religious exemptions, with only a few (like California, New York, and West Virginia) not allowing any non-medical exemptions. 
  • Philosophical/Personal Belief Exemptions:

• A smaller number of states permit philosophical or personal belief exemptions.

• This must include all vaccinations, not just one. 

From the American Academy of Pediatrics| Policy Statement| July 28 2025

Medical vs Nonmedical Immunization Exemptions for Child Care and School Attendance

Medical Exemptions From Immunization

Although there are fairly consistent standards for immunizations across the United States, every state, the District of Columbia, and Puerto Rico have allowances permitting school attendance without certain vaccines for medically indicated reasons. Florida is currently working to remove requirements for some vaccinations madated for school but it is still in legislation.

Examples of such include allergy to a vaccine component, previous significant adverse reaction to a vaccine or its components, or other underlying health conditions such as immunosuppression in an organ transplant recipient.

Almost half of states have laws that distinguish between temporary and permanent medical contraindications, with nearly another half of these states requiring annual or more frequent health care provider recertification for the medical exemptions. 

Because only a very small proportion of children have medical conditions prohibiting specific immunizations, medically indicated exemptions, when granted appropriately, typically do not have a significant impact on overall community vaccination coverage.

Nonmedical Exemptions From Immunization

As of this writing in 2025, three states — California, New York, and West Virginia have laws that accept only medical exemptions from immunizations. (Note: Connecticut, and Maine have been modifying their laws so check with current status.)

Forty-five states allow religious beliefs to be used as a basis for an exemption, and 15 states allow “personal beliefs,” “philosophical,” or “conscientious objection” exemptions. 

Some states explicitly exclude “philosophical” and “personal belief” exemptions and define these as not falling under the scope of religious exemptions. More than one-quarter of the states require parents to provide an affidavit confirming either a religious or another nonmedical justification in applying for a nonmedical school immunization exemption. 

Here I will provide a map and a link to the map of the state-by-state vaccination exemptions for you. 

How To Get A Medical Exemption In California

To get a medical exemption for vaccines in California, a parent or guardian must first create an account on the California Immunization Registry-Medical Exemption website (CAIR-ME) and request an exemption. The parent will receive a Medical Exemption Request Number to give to the child’s physician. The physician must register with CAIR-ME, log in, and issue the exemption, providing a copy to the parent. The parent then submits this form to the child’s school or child care facility. 

• 1. Physician Registration and Exemption Issuance:

• The parent initiates the process by creating an account on CAIR-ME and applying for an exemption.

• The system generates a Medical Exemption Request Number.

• The parent provides this number to the child’s physician.

• The physician, if not already registered, registers on CAIR-ME.

• The physician logs into CAIR-ME, searches for the child’s request using the number or name, and issues the medical exemption.

• The physician then provides a copy of the completed form to the parent.

• 2. Submitting to School or Childcare:

• The parent submits the copy of the medical exemption form to the school or childcare facility.

• The school or childcare facility confirms the validity of the exemption by checking its information and status on CAIR-ME.

• Note that schools and childcare facilities cannot accept handwritten statements or other documentation in lieu of the CAIR-ME issued form.

How To Get A Medical Exemption In New York

In New York State, the only legally recognized way to avoid required school vaccines is through a medical exemption. Here’s a detailed breakdown.

Medical Exemption

• Allowed under Public Health Law §2164, if a physician (MD or DO licensed in NYS) certifies that a specific vaccine “may be detrimental” to a child’s health—due to contraindications or precautions as per ACIP guidelines.

• Must use the official NYSDOH medical exemption form, renewed annually.

• Schools review and may approve or deny; denials can be appealed to the Commissioner of Education.If parents refuse vaccination without a medical exemption, the child must either:

• Be homeschooled, or

• Withdraw from public/private school and enroll in home instruction that meets compulsory education standards.

Please see my post on Home Schooling Pods As A Safe and Happy Alternative [Podcast Episode 113]

Ultimately, it is a parent’s choice to make the right decision for their child’s individual needs. Do so by making educated decisions. To learn more about vaccinations please listen to my Podcast Interview with Dr. Sherri Tenpenny on Vaccinations [Podcast Episode #224]

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