There is no general California healthcare worker vaccine mandate in force in 2026. The statewide COVID-19 vaccination order for healthcare personnel was rescinded on April 3, 2023, and the federal CMS requirement ended with the national public health emergency on May 11, 2023.1California Department of Public Health. Order of the State Public Health Officer Health Care Worker Vaccine Requirement2Centers for Medicare & Medicaid Services. COVID-19 PHE Report to Congress What remains is a layered set of narrower rules: Cal/OSHA requires employers to offer specific vaccines, state law puts a flu-shot-or-declination rule on hospitals, and individual employers are free to make vaccination a condition of employment.
Where COVID-19 Vaccination Stands Now
No state or federal rule currently compels a California healthcare worker to be vaccinated against COVID-19. CDPH does retain authority to issue new public health orders, and a future respiratory virus surge could bring back vaccine-or-mask requirements for healthcare settings, but nothing of that kind is in effect.
Your employer is a different story. Hospitals, health systems, clinics, and long-term care operators can still require COVID-19 vaccination as a condition of employment, and many of the state’s larger systems do. A private employer policy carries the same practical weight as a government mandate: comply, obtain a valid exemption, or lose the job.
Vaccines Your Employer Must Offer Under Cal/OSHA
Two Cal/OSHA standards operate year-round, independent of any emergency declaration, and together they cover most clinical staff.
Aerosol Transmissible Diseases Standard
Title 8, Section 5199 requires employers to offer susceptible healthcare workers the following vaccines at no cost:3Department of Industrial Relations. Section 5199 Appendix E – Aerosol Transmissible Disease Vaccination Recommendations for Susceptible Health Care Workers
- Measles, two doses
- Mumps, two doses
- Rubella, one dose
- Varicella (chickenpox), two doses
- Tdap (tetanus, diphtheria, pertussis), one dose, with boosters as recommended (typically every ten years)
- Influenza, one dose annually
The operative word is “offer.” The employer must make these vaccines available and pay for them; you can generally decline by signing a declination form. Flu vaccination in hospitals has an additional rule, covered below.
Bloodborne Pathogen Standard
Title 8, Section 5193 requires employers to offer the hepatitis B vaccine series to any employee with occupational exposure to blood or other potentially infectious materials, within ten working days of initial assignment to those duties, at no cost.4Department of Industrial Relations. Frequently Asked Questions About the Bloodborne Pathogens Standard You can decline. If you change your mind later while still in a covered role, the employer must offer it again.
The Hospital Flu Vaccination Rule
If you work in a general acute care hospital, California Health and Safety Code Section 1288.7 applies to you. Every such hospital must offer free onsite influenza vaccination to all employees annually and must require each employee to either get vaccinated or submit a written declination.5California Department of Public Health (CDPH). AFL-10-35 – Mandatory Reporting of Influenza Vaccination and Declination of Hospital Personnel Hospitals report their vaccination and declination rates to CDPH.
If you don’t want the shot, you must say so in writing. A verbal refusal or no response at all doesn’t satisfy the statute. The declination exists to create a record, not to make vaccination optional in effect.
Who Counts as a Healthcare Worker
California defines “healthcare worker” broadly. The category covers all paid and unpaid individuals working in indoor settings where care is provided or where patients have access.6California Department of Public Health (CDPH). Public Health Order Questions and Answers – Health Care Worker Protections in High-Risk Settings Clinical roles are the obvious piece, but the definition also captures dietary services, environmental services, security, administration, billing, laundry, and facilities staff, along with volunteers and contract workers.
Covered facilities include general acute care hospitals, skilled nursing facilities, intermediate care facilities, clinics, doctor’s offices, behavioral health facilities, and residential treatment centers.6California Department of Public Health (CDPH). Public Health Order Questions and Answers – Health Care Worker Protections in High-Risk Settings If your job puts you in any of those buildings during patient hours, the rules reach you.
Medical Exemptions
A medical exemption requires a written statement from a licensed physician, nurse practitioner, or other qualified clinician confirming a legitimate contraindication to the vaccine.7California Department of Public Health. Public Health Order Questions and Answers – Health Care Worker Vaccine Requirement The statement should say whether the contraindication is permanent or time-limited. It should not disclose your underlying diagnosis. The employer needs to know a qualified clinician evaluated you and advised against vaccination; it does not need your medical history.
Under the Americans with Disabilities Act, the employer must then conduct an individualized assessment of whether you pose a “direct threat” (a significant risk of substantial harm) and whether a reasonable accommodation can reduce that risk.8U.S. Equal Employment Opportunity Commission. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws Possible accommodations include enhanced PPE, modified shifts, physical barriers, periodic testing, reassignment to a role with less patient contact, or telework when the position allows it.
Documentation tied to a medical exemption has to be kept confidential and stored separately from your regular personnel file. That is an ADA requirement, not a HIPAA one; HIPAA’s Privacy Rule does not apply to employment records.9U.S. Department of Health & Human Services (HHS). HIPAA, COVID-19 Vaccination, and the Workplace
Religious Exemptions
You can request an exemption based on a sincerely held religious belief that conflicts with vaccination. The request goes to your employer in the form of a signed declination explaining the religious basis.7California Department of Public Health. Public Health Order Questions and Answers – Health Care Worker Vaccine Requirement
Employers are generally expected to assume the stated belief is sincere. The EEOC has said that questioning sincerity requires an objective basis: behavior markedly inconsistent with the belief, suspicious timing, or an accommodation that people commonly seek for nonreligious reasons.10U.S. Equal Employment Opportunity Commission. Section 12 – Religious Discrimination No single factor justifies denial on its own, but any can support follow-up questions.
What Groff v. DeJoy Changed
For decades, employers could deny a religious accommodation if it imposed anything “more than a trivial cost.” In June 2023 the Supreme Court raised that threshold. Under Groff v. DeJoy, an employer claiming undue hardship must show the accommodation would cause “substantial increased costs in relation to the conduct of its particular business.”11Supreme Court of the United States. Groff v. DeJoy, 600 U.S. 447 (2023) Minor scheduling inconveniences or modest costs of alternative protective measures no longer qualify. The analysis is fact-specific; a three-person clinic may face a genuine hardship where a large hospital would not.
The Interactive Process
Once you submit an exemption request, medical or religious, your employer must engage in the interactive process: a back-and-forth conversation to find an accommodation that works for both sides. Options to explore include enhanced PPE, staggered shifts, workspace modifications, periodic testing, and reassignment to a lower-risk position. Both federal law (Title VII and the ADA) and California’s Fair Employment and Housing Act require it, which means California workers have two overlapping layers of protection. If no accommodation in your current role works, the employer must consider reassignment to a vacant position before taking adverse action.
If You Refuse and Have No Exemption
If you don’t meet a vaccination requirement that applies to your job and you don’t have a valid exemption, the usual outcome is suspension or termination. That is true whether the requirement comes from a Cal/OSHA standard, the hospital flu statute, or your employer’s own policy.
If you believe your employer wrongfully denied an accommodation or retaliated against you for requesting one, you can file a complaint with California’s Civil Rights Department under FEHA or with the EEOC under federal anti-discrimination law. The filing windows are strict: 300 days for the EEOC, three years under FEHA. Don’t wait on a claim you intend to pursue.