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Changes to Childhood Vaccine Schedule
On January 5, 2026, The Department of Health and Human Services (HHS) announced a reduction in the number of recommended pediatric vaccines. The new CDC vaccine schedule no longer universally recommends six vaccines - flu, Hepatitis A, Hepatitis B, rotavirus, meningococcal disease, and RSV - instead recommending them only to certain "high-risk" groups or based on "shared clinical decision-making" with a health care provider.
HHS underscored that all vaccines recommended as of Dec. 31, 2025, will continue to be fully covered by Affordable Care Act insurance plans and federal insurance programs, including Medicaid, CHIP and the Vaccines for Children (VFC) Program. AHIP, the national trade association representing the health insurance industry, released a statement in the fall, saying, “Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026." Coverage beyond that is uncertain.
The change to the vaccine schedule may have implications for who can administer vaccines at the state level. Moving from “routine” to “shared clinical decision-making” may mean that pharmacists, nurses, and medical assistants can no longer administer those vaccines, which would have major implications for vaccine access in many communities. To avoid any disruption to access, states can update scope-of-practice laws and issue standing orders to preserve flexibility for vaccine administration and delivery capacity.
As detailed in a recent New England Journal of Medicine article, the CDC’s recommendation to vaccinate based on shared clinical decision-making “does not meaningfully change the clinical interaction [between patient and provider] but rather serves to mislead and introduce more paperwork and perceived clinician liability into an already complex system.” By introducing the concept that some vaccines are “optional,” it implies those are less important than vaccines recommended for routine use.
Under HHS’ new policy, states will have the option to continue collecting and reporting these measures to CMS on a voluntary basis. Notably, states must still collect data on vaccination for other programs, such as the VFC Program, which provides free vaccines for children who are Medicaid-eligible, uninsured or underinsured (with health insurance that does not cover vaccines), as well as to administer vaccination requirements for school attendance, among other functions.
This policy decision, which the American Academy of Pediatrics rejects and 17 states have announced they will not follow, will have widespread affects on public health.
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