Massachusetts Vaccine Mandate: Requirements, Exemptions, and Records

Massachusetts vaccine requirements and exemptions are set primarily by the Department of Public Health under Chapter 111, Section 6 of the General Laws, and they reach students from preschool through college, healthcare personnel, and state agency staff.¹ Medical exemptions are available in every setting. Religious exemptions apply to school-age children under most circumstances, and federal law adds religious and disability-based protections for workers.

What Schools and Childcare Programs Require

Chapter 76, Section 15 bars a child from attending school without a physician’s certificate showing immunization against diphtheria, pertussis, tetanus, measles, and polio, plus any additional diseases DPH designates.² DPH has used that authority, through 105 CMR 220.000, to expand the list well beyond those five diseases.³

For the 2026–2027 school year, children entering childcare or preschool at age two or older need doses of Hib, DTaP, polio, hepatitis B, MMR, and varicella. Students in kindergarten through sixth grade need five doses of DTaP (four if the fourth was given after age four), four doses of polio, three doses of hepatitis B, and two doses each of MMR and varicella. Meningococcal vaccination is added in grades seven through twelve.⁴ Laboratory evidence of immunity can substitute for some doses, and a documented history of chickenpox confirmed by a physician satisfies the varicella requirement.

College and University Students

The rules follow students into higher education. All full-time undergraduate and graduate students under age 30, and all health science students regardless of enrollment status, must show two MMR doses, three hepatitis B doses, one Tdap dose, and two varicella doses. Full-time students aged 21 or younger also need a meningococcal (MenACWY) dose received on or after their sixteenth birthday.⁵

What Employers Require

Hospitals must ensure all personnel receive the seasonal influenza vaccine under 105 CMR 130.325, unless a worker qualifies for an exemption or declines under the regulation’s provisions. The same rule allows the Commissioner to require pandemic or novel influenza vaccination when guidelines are issued.⁶

State agency staff are covered separately by 101 CMR 23.04, which addresses both COVID-19 and influenza vaccination. Workers who fail to comply with the vaccination requirements or with required mitigation measures face discipline up to and including termination. Contracted staff who refuse are barred from working at the agency facility.⁷

Private employers outside those categories are not required by state rule to mandate vaccination, but the EEOC has confirmed they may do so as a condition of employment, provided they offer reasonable accommodations for medical and religious objections.

Medical Exemptions

A child can be admitted to school without immunization if a physician certifies, after a personal examination, that the child’s physical condition makes vaccination a health risk. The certification must be resubmitted at the start of each school year to the school health program physician. If the school’s physician disagrees with the child’s doctor, DPH makes the final call.²

At work, employees who cannot be vaccinated because of a disability are protected by the Americans with Disabilities Act. The employer and employee are expected to engage in an interactive process to identify a reasonable accommodation, such as masking, remote work, or reassignment, that does not impose an undue hardship on the business.⁸ The employer can request reasonable documentation about the disability and the need for accommodation if the situation is not obvious.

Religious Exemptions

Massachusetts allows a religious exemption from school vaccination. Under Chapter 76, Section 15, a child cannot be required to present a vaccination certificate if the parent or guardian submits a written statement that vaccination conflicts with sincerely held religious beliefs.² There is an important carve-out: during an emergency or epidemic declared by DPH, the religious exemption does not apply, and all children must be vaccinated.

Schools evaluate whether an objection is genuinely religious rather than a philosophical or political one framed in religious terms. A parent who simply distrusts vaccines or the pharmaceutical industry does not qualify; the objection has to be rooted in religious belief.

Religious Accommodation at Work

Employee religious objections are governed by Title VII of the federal Civil Rights Act, not the school-entry statute. An employer must generally assume a religious accommodation request is sincere, though it can conduct a limited factual inquiry if it has an objective basis for doubt. The employer must then provide an accommodation unless doing so would impose an undue hardship.⁸

The undue hardship standard changed after the Supreme Court’s 2023 decision in Groff v. DeJoy. The old rule treated anything above a trivial cost as undue hardship. Groff raised the bar: an employer now must show that granting the accommodation would cause “substantial increased costs in relation to the conduct of its particular business.”⁹ That makes it harder for employers to deny religious vaccine exemption requests and easier for employees to challenge a denial.

If You Don’t Comply

For families, the consequence is immediate. A child without the required immunizations and without an approved exemption cannot be admitted to school.²

For workers in hospitals and state agencies, refusing vaccination without an approved exemption can lead to discipline up to termination.⁷ Being fired for refusing a vaccine can also affect unemployment eligibility. Because benefits generally require that a worker be out of a job through no fault of their own, refusing to follow a lawful workplace policy is typically treated as disqualifying conduct.

Retaliation runs the other way. An employer that punishes a worker for merely requesting a medical or religious exemption faces a retaliation claim under federal law. The EEOC treats requesting an accommodation as protected activity whether or not the request is granted, and using threats to discourage someone from asking is separately unlawful under the ADA.⁸

How Your Records Are Handled

Every provider who administers immunizations in Massachusetts must report to the Massachusetts Immunization Information System (MIIS). There is no opt-out. The system is confidential and is used by schools to verify compliance and by providers to flag missed doses.¹⁰

At work, asking whether an employee has been vaccinated is not a disability-related inquiry under the ADA, so an employer can request proof of vaccination. Once the employer has that documentation, it counts as confidential medical information and must be stored separately from the regular personnel file, with access limited to those who need it.⁸ If your employer keeps your vaccination card in a general HR folder, that is a compliance problem on the employer’s side.

1
General Court of Massachusetts. Massachusetts General Laws Part I, Title XVI, Chapter 111, Section 6
2
General Court of Massachusetts. Massachusetts General Laws Part I, Title XII, Chapter 76, Section 15
3
Commonwealth of Massachusetts. 105 CMR 220.00 Immunization of Students Before Admission to School
4
Commonwealth of Massachusetts. 2026-2027 Massachusetts School Immunization Requirements
5
Commonwealth of Massachusetts. College Immunization Data by School
6
Cornell Law Institute. 105 CMR 130.325 Requirement That Personnel Be Vaccinated
7
Cornell Law Institute. 101 CMR 23.04 COVID-19 Vaccination and Influenza Vaccination Requirements
8
U.S. Equal Employment Opportunity Commission. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws
9
Supreme Court of the United States. Groff v. DeJoy, 600 U.S. 447 (2023)
10
Commonwealth of Massachusetts. About the Massachusetts Immunization Information System (MIIS)