Why can’t my student use a religious or philosophical exemption anymore?

Maine passed a law (LD 798, Public Law Ch. 154) in the spring of 2019 removing all non-medical exemptions for students. This new law goes into effect on September 1, 2021. Click here to view the statute.

Do positive titers qualify as proof of immunity if my child doesn’t have all required doses of immunizations? My doctor has told me they are not willing to order a titer test and/or that they are not valid for all diseases.

Yes, if a student has proof of sufficient immunity to a disease via blood titer testing, that will satisfy the requirement for immunity for school attendance under the law. Additionally, the student will not be required to stay home during any outbreak of that disease at the school. Per state law, proof of immunity using a blood titer test is perfectly acceptable in lieu of vaccination. In fact, Maine’s only medical school, the University of New England, REQUIRES proof of immunity for certain vaccinations, even with proof of vaccination dosages that qualify as being considered fully vaccinated. In addition, it is standard for healthcare employees to be given a titer test upon employment in a hospital, THEN vaccinated if an employee does not have sufficient titers (proof of immunity) for the disease. Unfortunately, Laura Blaisdell MD, Vice President of the Maine AAP, recently provided training for physicians on the new law, misrepresenting the use of titer testing in determining proof of immunity, and stated that a student that had a recent dose of MMR with a subsequent positive titer was not “fully immunized” against MMR. Certainly if Maine’s only medical school can use this same titer test to determine immunity for medical students who were likely vaccinated close to 20 years ago, Maine’s children can use this titer test to determine immunity from a recent dosage of a vaccine.

How do you get titer testing?

Titers (proof of immunity to a disease shown by blood testing) can be ordered by the primary care provider and drawn at any hospital or outpatient lab. The provider must order a titer for each disease, and insurance usually covers a portion of the blood work just like any other lab work.

Which shots & how many doses of each are required for my child to attend daycare? K-12 school? College?

For Children in Daycare: Please see the following immunization chart that the Maine CDC has created. The required vaccines are listed below and all but 2 require multiple doses that are to be administered at specific ages starting at 3 months through 43 months of age. DTaP (Diphtheria, Tetanus & Pertussis) - 4 doses Hib (Haemophilus influenzae type B) - 3 doses Polio - 3 doses MMR (Measles, Mumps & Rubella) - 1 doses Varicella (Chickenpox) -1 dose Hepatitis A - 2 doses Hepatitis B - 3 doses PCV (Pneumococcal Disease) - 4 doses For Pre K - grade 12 the proposed rules (as of 7/7/21) are as follows: A. Diphtheria/Tetanus/Pertussis (DPT/DTaP/Tdap/Td): For pre-kindergarten students only, four doses of DPT/DTaP are required. The third and fourth dose must be separated by at least six months. For students ages six years old and younger in kindergarten or grades above, a total of five doses of DPT/DTaP are required, except that, if the fourth dose was administered on or after the child’s fourth birthday, then only four doses are required For students seven years of age and older, a minimum of three doses of DPT/DTaP with the last dose administered on or after the child’s fourth birthday is required. A student who did not complete their primary DTP/DTaP immunization series or who has an unknown vaccine history, requires a single dose of Tdap followed by either Tdap or Td until three doses have been achieved. In addition to receiving the required doses for DPT/DTaP, one dose of Tdap vaccine is required for students entering grade 7. Any valid dose of Tdap after age seven satisfies the requirement for 7th grade entry. B. Measles/Mumps/Rubella (MMR): For pre-kindergarten students only, one dose of MMR vaccine is required. All students in grades kindergarten through 12 must have been immunized against measles, mumps, and rubella with two doses of MMR vaccine, provided the first dose is administered no sooner than 12 months of age and at least four weeks separate the two doses. C. Poliomyelitis (Polio): For students in pre-kindergarten only, three doses of IPV or OPV or a combination of both are required. The first dose must be administered at least six weeks after birth, with subsequent doses given at least four weeks apart. For students in grades kindergarten – 12, four doses of inactivated polio vaccine (IPV) or oral polio vaccine (OPV) or combination of both are required. The first dose must be administered at least six weeks after birth, with subsequent doses given at least four weeks apart. The fourth dose is not needed if the third dose is given on or after the fourth birthday. D. Varicella (chickenpox): One dose of varicella vaccine is required for children in grades kindergarten through 12 E. Quadrivalent meningococcal conjugate vaccine (MCV4) / Meningitis: One dose of MCV4 is required for children entering grade seven. Any child entering grade 12 is required to have received two doses of MCV4. The first dose must have been received on or after the eleventh birthday, and the second dose must have been received on or after the sixteenth birthday, at least eight weeks after the first dose. However, if the first dose is administered when the child is sixteen years of age or older, only one dose is required. For College students: Diphtheria/Tetanus: one dose of tetanus, diphtheria, pertussis (Tdap); diphtheria, tetanus, pertussis (DTPDTaP); diphtheria, tetanus (DT); or tetanus and, diphtheria (Td) toxoid within 10 years prior to enrollment.
Measles Mumps & Rubella (German Measles): Two doses of MMR vaccine, administered after the student's first birthday.

Does the law apply to private schools? Parochial? Charter? Fully online schools?

The law applies to all schools (public, private, charter, and online) except that students who are completely online and do not attend any classes in person may not be required to meet the immunization requirements. The recently proposed revisions in the rules provide a new exception for fully online students in prek-12 schools.

Can homeschool students participate in school sports or other extracurriculars if they don't meet the new vaccine requirements?

Maine law has always allowed homeschooled students to participate in extracurriculars and academic classes, so long as they meet the vaccination requirements of students enrolled in Maine schools. This means that, once the new law is implemented on Sept. 1, 2021, homeschooled students can no longer participate in extracurriculars unless they are fully vaccinated or have a medical exemption.

Do pre-k students abide by vaccinations required for daycare or kindergarten entry?

The current proposed rules state that there are slightly different immunization requirements for pre-kindergarten students. *Note: These are subject to change as the rules are not yet finalized. Pre-K students are required to have 4 doses of DPT or DTaP (Diphtheria, Pertussis, Tetanus), 1 dose of MMR (Measles, Mumps, Rubella) and 3 doses of Polio (note that the 4th dose of Polio is not needed for Kindergarten entry if the 3rd dose is given after the student’s 4th birthday).

Does the new law affect all daycares, even small in-home daycares or unlicensed daycares?

All children who attend a child care center, child care facility, small child care facility, home daycare, public preschool program, nursery school, pre-k program, early kindergarten, 4 year old program or any child development program under the control of the State Department of Education or under the control of the Office of Child Care and Head Start must be vaccinated in accordance with the “ Day Care Immunization Standards” as indicated by the Maine Department of Health and Human Services effective September 1, 2021.

Can students who have an IEP still use a philosophical or religious exemption?

YES. Students who have an IEP in place prior to September 1, 2021 AND filed a religious or philosophical exemption on or before September 1, 2021 are eligible to continue attending school with a religious or philosophical exemption in addition to a statement from a medical provider. Under the new law, the parent/guardian of a student with an IEP (or student if they are over 18) must provide a statement to the school from a licensed physician, nurse practitioner, or physician assistant that the medical provider has consulted with the parent (or student, if they are 18 or older) and has made the parent/guardian aware of the risks and benefits associated with the choice to vaccinate/not vaccinate.

Do students with an existing IEP who are submitting a non-medical exemption need a doctor’s note that the student/parent has been counseled on the risks and benefits associated with vaccination choice?

YES. The parent, guardian or student age 18 or older who has an IEP in place prior to September 1st, 2021 must receive counseling from a licensed physician, nurse practitioner, or physician’s assistant about the risks and benefits associated with the choice to vaccinate and provide written proof of that counseling to the student’s school. *Please note that a philosophical or religious exemption MUST be submitted to the student’s school on or before September 1, 2021.

If my child loses their IEP will their non-medical exemption be eliminated?

According to the new law, so long as the student has an IEP on 9/1/21 and elected a religious or philosophical exemption on or before 9/1/21, the student can continue in school under that exemption. The amended rules, however, state that if the child loses their IEP AND loses their protection under FAPE (Free and Appropriate Public Education), they lose the ability to use the grandfathered non-medical exemption. We advise families to ensure their children keep needed IEPs as long as possible, and to advocate to step down to 504 plans to ensure FAPE protection when they are no longer eligible for an IEP.

What about grandfathering? Will my child's non-medical exemption be grandfathered since it was on file before this law was passed?

No, there is no grandfathering of non-medical exemptions except for students who have an IEP on 9/1/21.

Have any lawsuits been initiated to challenge the removal of the religious exemption?

There have not been any lawsuits filed yet in Maine challenging the removal of religious exemptions to vaccination.

What will happen if I send my student to school without being fully vaccinated?

We can not speak for any school administration as to the process that will occur in this situation. The rules state that unless a student is exempt, no superintendent may permit any student to be enrolled in or to attend school without a certificate of vaccination for each disease or other acceptable evidence of required immunization or immunity against each disease. How the superintendent/school enforces this will be different for each school. It is important to note that schools are authorized to accept:

• A one-time written assurance from the parent/guardian or adult student (age 18 or older) that the student will be immunized by private effort within ninety days of enrollment (officially registering) in school or of the student first attending, whichever date is the earliest.
• ​A medical exemption provided by a licensed physician, nurse practitioner, or physician's assistant that indicates that in that medical provider’s professional judgment, immunization is not medically advisable.
• A parent’s/guardian’s written consent for the child to be vaccinated by a public health officer, physician, nurse or other authorized person in their employ, or acting as an agent of the school, where such immunization programs are in effect.
• A philosophical or religious exemption so long as the student has, on or before September 1, 2021, an IEP and has submitted a philosophical or religious exemption to vaccination to the student’s school. Written documentation, from a licensed physician, nurse practitioner, or physician’s assistant, assuring that the parent, guardian, or adult student has received counseling on the risks and benefits of vaccination, must also be submitted to the student’s school. If a student with an IEP has a non-medical exemption for vaccination, the student will be able to maintain that exemption after dismissal from special education services and will be considered exempt until the child is no longer eligible for free, appropriate public education (FAPE).
• The student may be enrolled in a distance education program offered by a school, if the student does not physically attend any classes or programs at the school or a school facility.

Can we get non-medical exemptions back?

Yes, but it would require the State Legislature to change the law. State and federal elections really matter. It is imperative that any person in the state of Maine that is concerned about the right to make their own medical decisions gets involved politically. Ways that you can do this is are: Help in the 2022 Election for Governor. Governor Mills was heavily in favor of the passing of the new vaccine law and is unlikely to support any effort to reverse it. Make sure that future candidates are hearing from you on why you support medical freedom. If they are willing to support your beliefs, find out ways that you can help them get elected (make phone calls, go door to door, and donate financially). Find out who your state representative is and find out their stance on medical freedom. Find out who your state senator is and find out their stance on medical freedom. Attend local school board meetings and consider running for upcoming seats so your voice can be heard.

Are medical exemptions still allowed?

Yes. Medical exemptions are still allowed from a licensed physician, nurse practitioner, or physician assistant. Under the law, they are given FULL discretion to determine the risk and benefit of vaccination for their patients and may write a medical exemption based on their clinical judgement. There is no specific form that is required to be used, a simple written statement from the provider is all that is required.

Where can I find a doctor that will write a medical exemption?

The primary care provider, or whoever knows the child’s health history best, should be the one to write the medical exemption. If there is a specialist that the child sees for a health issue which impacts their ability to receive vaccines, then that specialist can also write the exemption. Similarly, if the child’s sibling or other close family member sees a specialist for an issue that impacts close family members being able to receive vaccines, then that specialist may also write the exemption. For example, if a child is undergoing chemotherapy and their sibling(s) should not receive live virus vaccines, then the parent should ask the specialist treating the sibling for an exemption, which might require coordination with the sibling’s PCP, or some other plan of coordination or communication between providers to obtain an exemption for the child in order to protect their sibling.

Do you have a list of doctors that will see an unvaccinated child?

No, we do not maintain a list of providers for several reasons. First, most practitioners are connected to large medical practices that must follow the corporate policies of the major hospitals with which they are affiliated, so even a provider who is personally supportive of a parent’s right to choose which vaccines their child does and does not receive will be limited in how they practice because of their employer’s policies. Secondly, a provider who is labeled as “friendly” to vaccine choice will be subjected to personal and professional attacks, as we have seen in other states and as providers in Maine experienced during the People’s Veto effort of LD 798. The best way to locate a provider who is supportive of delayed and selective vaccine schedules is to start with those in private practice and not affiliated with a hospital system, as they will typically have a greater ability to put the individual needs of their patients ahead of corporate, money-driven practice policies. Additionally, call and ask the office staff if 1) the provider is accepting new patients, and 2) what the office policy is on selective vaccination or unvaccinated patients. These two questions are quick and easy, they do not reveal a family’s own stance on vaccine choice, and they can help to rule out whether or not a practice might be a good fit for the family. You can also ask for a free consultation with the doctor and find out directly from that provider if he/she is a good fit for your family’s needs.

What information is required on a medical exemption?

A medical exemption must contain a statement from a licensed physician, nurse practitioner, or physician assistant indicating that in that medical provider’s professional judgment, vaccination against one or more of the diseases may be medically inadvisable. There is not a specific form or document that is required to be submitted as a medical exemption. For your convenience we have a sample form here (based on a draft previously made available on the Maine DOE website until it was removed in late March of 2021) that may be used, copied, or altered as desired. In April of 2021 the Maine Chapter of the American Academy of Pediatrics, Maine Medical Association and Maine Osteopathic Association jointly released a medical exemption form that grossly misrepresents medical exemption requirements per state law. If a provider insists that they must use that form, direct them to the state law (see below): Medical exemption. The parent or the child provides a written statement from a licensed physician, nurse practitioner or physician assistant that, in the licensed physician's, nurse practitioner's or physician assistant's professional judgment, immunization against one or more of the diseases may be medically inadvisable. [PL 2019, c. 154, §1 (AMD).]

Does the medical reason for exemption need to be listed on the medical exemption?

No, there is no law that requires the parent, student, or medical provider to state the medical reason(s) for the exemption to immunizations on the written medical exemption. We advise against providing additional information beyond state law requirements.

Who can write/provide a medical exemption?

A medical exemption must be provided by any licensed physician, nurse practitioner or physician assistant. Under the previous laws regarding vaccination, only a licensed physician could write a medical exemption.

Who sees a medical exemption/does it get turned into a state department or stay at my child’s school(s)?

Medical exemptions are kept in the student’s school health record and maintained by the nurse or superintendent. They are subject not to HIPAA laws, but to FERPA (school privacy) laws. According to the recent draft of the Maine DOE rules, the state and local health officials can inspect the child’s vaccination record and medical exemption to ensure compliance with immunization and documentation. Additionally, all school nurses and/or superintendents are required to maintain a list of unvaccinated students and report vaccination and exemption status to the state annually.

My college/university/post-secondary school requires vaccinations that are not required by state law. What can I do?

If your child is being required to get a vaccine that isn’t required by state law you can request that they allow a non-medical exemption, which they have the authority to allow so long as the vaccine they require is NOT required by law. They may or may not honor such a request, however the best option is for students to push back on requirements that go beyond state law. In addition, if you or your child will be attending post-secondary school out of state, it is important to determine the exemption laws in the state, as well as the policy for the institution. Many state vaccination rules for college are determined outside of state law, and this is highly important to research ahead of time. You can start your research by going to the National Vaccine Information Center to learn more. Doing your homework prior to reaching out to the school will be very helpful in understanding what rights that your child has and the proper way to move forward.

If my child uses a religious or medical exemption for covid vaccine in college, will they be discriminated against (special dorm, wear a mask, separate transportation). Is there any legal path to fight this?

It is unclear at this point if those that use exemptions will be given different accommodations from those that are vaccinated for COVID-19. Most colleges and universities are updating their websites with details so it is best to continually monitor the information that is posted. It is suggested that you keep any documentation from correspondence with your child’s school.

I am moving to Maine and my child is not up-to-date on vaccinations. How can I enroll them in school?

According to the draft of the proposed DOE rules, families moving into Maine or enrolling in school for the first time will have a 90-day grace period from the first date of enrollment in school to get their children caught up on vaccinations.

Are there resources for someone that is new to homeschooling?

There are some facebook pages including HOME (Homeschoolers of Maine), and many other local and regional resources online for parents getting started with homeschooling. Additionally, many local libraries and churches have homeschooling resources and groups that meet on a weekly basis. We encourage families to connect with others in their area.