States Seek Policy Guidance Beyond ACIP Vaccine Recommendations

October 24, 2025 | Andy Baker-White

Established in 1964, the Advisory Committee on Immunization Practices (ACIP) makes recommendations about vaccines to the CDC director for the control of vaccine-preventable diseases. ACIP recommendations may inform clinical and public health practice and state vaccine policy, including “(1) the age and other population groups (e.g., by sex, occupation) recommended to receive that vaccine; (2) the recommended age or frequency to receive each dose and the interval between doses (for multidose vaccines); and (3) any precautions and contraindications.” That said, the level of deference to the committee’s recommendations varies across state and territorial vaccine policy. And many jurisdictions are revisiting the subject, following recent changes to ACIP.

Reliance on ACIP Recommendations

In nearly every state, three territories, and Washington, D.C., statutes and regulations reference ACIP recommendations. These references appear in many different areas of vaccine policy and practice (e.g., laws related to school immunizations, mandatory insurance coverage, provider scope of practice to dispense or administer vaccines, immunizations for health care workers and patients, and vaccine purchasing).

The amount of deference given to ACIP recommendations, however, varies. Some laws require state or territorial vaccine policy to be in accordance with or conform to ACIP recommendations while others only direct the use or consideration of ACIP recommendations. For example, North Dakota authorizes EMS personnel to administer vaccines to adults if a hospital medical director establishes a protocol that meets health department standards, which may be based on ACIP recommendations. In other states, policy for some, but not all, vaccines must conform to ACIP recommendations. Under Iowa law, parents must assure, unless exempted for medical or religious reasons, that their children are immunized against certain diseases (i.e., diphtheria, whooping cough, measles, chicken pox, and more). The law also directs most immunizations to be provided “according to recommendations provided by the [health] department,” but requires immunization against meningococcal disease to be in accordance with ACIP recommendations.

Expanding Vaccine Policy Sources

Recent changes to ACIP, as well as delays and unpredictable processes, are leading many states to consider how much deference to give ACIP recommendations for their vaccine policy and practice. In some states, the use of ACIP recommendations only goes back a few decades. For example, in 1998, New Mexico changed its law so that state vaccine policy and practice conformed with the recommendations of ACIP and the American Academy of Pediatrics (AAP). Before then, the administration of immunizations was to conform to the “recognized standard medical practice in the state.” Today, New Mexico is among a growing number of states to consider decoupling vaccine policy and practice from federal recommendations. The state recently enacted SB 3, removing ACIP recommendations as the source for the state’s school vaccine policy but leaving the use of AAP recommendations in place and adding the state health department as another source. These changes are effective until July 1, 2026. On this date, the prior policy language will be restored, unless further action is taken. 

Enacted Legislation Incorporating Other Recommendations

So far this year, California, Colorado, Maine, Maryland, and Washington, D.C., have enacted legislation moving away from sole reliance on ACIP recommendations, and bills are under consideration in Massachusetts, New Mexico, New York, and Pennsylvania. The policies and practices impacted by these bills include the scope of practice for administering vaccines, insurance coverage for vaccines, vaccine purchasing, and school immunizations. The bills address ACIP recommendations in a variety of ways, including: (1) adding the use of recommendations from other bodies, organizations, or entities (e.g., AAP, ACOG, the state health department, health commissioner, etc.) along with ACIP recommendations, (2) reducing the level of deference given to ACIP recommendations (e.g., “conform” to “consider”), (3) removing or replacing the use of ACIP recommendations with another entity, and (4) allowing or directing the use of an earlier version of ACIP recommendations. Enacted legislation includes:

• California (AB 144) amends more than 25 statutes addressing topics like vaccine coverage, school entry requirements, and provider scope of practice, by removing references to ACIP recommendations and instead deferring to state health department recommendations and/or ACIP recommendations as of Jan. 1, 2025.
• Colorado (SB 196) gives the state insurance commissioner the authority to use previous ACIP recommendations to establish coverage requirements, stating that if ACIP recommendations “are repealed, modified, or otherwise no longer in effect, the commissioner may adopt rules to require compliance with the guidelines or recommendations that were in effect in January 2025, or that comply with the recommendations of the Nurse-Physician Advisory Task Force for Colorado Healthcare.”
• Colorado (HB 1027) expressly authorizes the state board of health to determine the list of required school immunizations and directs the board to consider recommendations from ACIP, AAP, the American Academy of Family Physicians, ACOG, and the American College of Physicians when establishing required school immunizations, manner, and frequency. The new law also allows the state health department to use guidelines from these organizations, along with ACIP, when conducting its annual evaluation of immunization practices.
• Maine (LD 93) removes reference to ACIP recommendations when determining the vaccines available through the state’s universal vaccine program.
• Maryland’s HB 974 requires insurance carriers to provide coverage based on the ACIP recommendations that were in effect on Dec. 31, 2024, and HB 1315 authorizes pharmacists to administer a vaccine subject to a protocol based on ACIP recommendations in effect on Dec. 31, 2024, or at a later date to account for new recommended vaccines.
• Washington, D.C., enacted B 26-0350, which temporarily authorizes pharmacists and pharmacy technicians to order and administer immunizations recommended by ACIP or other medical organizations designated by the Department of Health. The new D.C. law is effective for 90 days.

Additional Proposed Legislation

Several other jurisdictions considered bills this session that would change the role ACIP plays in local vaccination laws. Two proposed bills in Washington, D.C., would make the changes noted earlier effective for 225 days (B 26-0351) or permanent (B 26-0414). And in Massachusetts, H 4251 would replace "ACIP" with "commissioner" in relation to payment for immunizations on the vaccine schedule, while H 4429 would authorize the health commissioner, in consultation with the state’s vaccine advisory council, to review and establish alternative standards to ACIP recommendations. New York also considered several bills this session:

• Companion bills A 8383 and S 7823A would add the commissioner of health as a recommendation source for prescriptions or standing orders that physicians/nurse practitioners provide to pharmacists for FDA approved vaccines. The bills would also require the privacy area where a pharmacist administers a vaccine to post the recommended adult immunization schedule as published by ACIP or the health commissioner and would remove ACIP as the recommendation source for the meningococcal vaccine.
• Two other companion bills (A 9060 and S 8496) would add the New York State Immunization Advisory Council and the 21st Century Workgroup for Disease Elimination and Reduction as recommendation sources for vaccine prescriptions or standing orders that physicians/nurse practitioners provide to pharmacists.
• A 9077 would replace a number of statutory references to ACIP recommendations with nationally recognized clinical practice guidelines (e.g., for vaccine standing orders).

Finally, in Pennsylvania, HB 1828 and SB 989 would allow immunizations to be added to health insurance coverage requirements if they are: (1) recommended by ACIP or (2) supported by medical evidence and would benefit public health. In making the second determination, the health department may consider information from AAP, ACOG, the American College of Physicians, the American Academy of Family Physicians, the Infectious Disease Society of America, and the Society for Maternal-Fetal Medicine.

ASTHO will continue to monitor legislation on vaccine policy and provide necessary updates.