State Impacts of the One Big Beautiful Bill Act of 2025
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Key Takeaways:

  • The FDA recently narrowed COVID-19 vaccine eligibility to adults 65 and older plus younger people with qualifying health conditions, while the CDC's vaccine advisory committee was disbanded, creating a federal leadership vacuum. This shift away from universal adult eligibility has left states to navigate vaccine policy independently during a critical public health period.
  • State pharmacy laws now create a complex patchwork where Massachusetts, Nevada, and New Mexico prohibit vaccinations outside FDA guidelines even with prescriptions, while about 16 other states allow broader access with doctor approval. Pennsylvania's pharmacy board and New York Governor Kathy Hochul have pushed back with policies allowing pharmacists greater vaccination authority than federal rules permit.
  • California, Oregon, Washington, and Hawaii formed the West Coast Health Alliance to develop independent, science-based immunization guidance separate from federal oversight. This coalition represents a coordinated effort by these states to maintain broader vaccine access and public trust despite narrowed federal recommendations.
  • Florida is moving in the opposite direction by planning to eliminate all vaccine mandates, including childhood school requirements for diseases like chickenpox and hepatitis B. Surgeon General Joseph Ladapo and Governor Ron DeSantis are pursuing legislation to remove statutory mandates, with critics warning this could trigger outbreaks of preventable diseases.

Vaccine policy in the U.S. is undergoing major changes, and the result is a patchwork system where access and requirements vary dramatically depending on where you live. Here’s a breakdown of the most recent developments at the federal and state levels. 

The Food and Drug Administration (FDA) recently updated its guidance, authorizing COVID-19 vaccines only for adults aged 65+ and for younger adults and children with certain qualifying health conditions. This marks a shift away from the previous universal eligibility for all adults. At the same time, the CDC’s Advisory Committee on Immunization Practices (ACIP)—which normally helps guide national vaccine recommendations — has been disbanded, leaving a gap in federal leadership. 


State Responses Create Patchwork of Vaccine Access Policies

Restrictive State Policies Limit Pharmacy Vaccination Authority

Pharmacies are finding themselves constrained by state laws. For example, in Massachusetts, Nevada, and New Mexico, pharmacies cannot vaccinate anyone outside of FDA-defined eligibility—even with a doctor’s prescription. In about 16 other states, vaccination depends on both age and whether a patient has a prescription.

Progressive States Expand Vaccine Access Beyond Federal Guidelines

Some states are pushing back. For example, the Pennsylvania State Board of Pharmacy voted to accept guidance from trusted medical groups, which allows pharmacies to vaccinate more people than federal rules alone permit. New York Governor Kathy Hochul (D) has also issued an executive order that will allow pharmacists to administer COVID vaccines, providing access for all residents who wish to be vaccinated.

West Coast Alliance Develops Independent Immunization Framework

Meanwhile, California, Oregon, Washington, and now Hawaii have launched the West Coast Health Alliance. The coalition is writing its own science-based immunization guidance, independent of the federal government, to ensure access and maintain public trust.

Florida Moves to Eliminate All Vaccine Mandates

In stark contrast, Florida is moving to end all vaccine mandates, including those required for children attending school. Surgeon General Dr. Joseph Ladapo compared mandates to “slavery” and said the decision should rest between patients and their physicians. Governor Ron DeSantis and Republican lawmakers plan legislation to remove statutory mandates. Critics warn that rolling back requirements for diseases like chickenpox and hepatitis B could spark new outbreaks of preventable illnesses.


Future Implications of Divergent Vaccine Policies

As federal guidance narrows, states are splitting in different directions: some tightening access, others building independent frameworks, and some dismantling mandates altogether. The result is a confusing, uneven landscape that leaves patients, providers, and families struggling to navigate vaccine access at a critical moment for public health.


Tracking State Vaccine Legislation 

MultiState’s team is actively identifying and tracking health care issues so that businesses and organizations have the information they need to navigate and effectively engage. If your organization would like to further track health care or other related issues, please contact us.