In the ongoing fight against COVID-19 through vaccinations, federal agencies have recently approved shots for kids and added requirements for workers.
The Food and Drug Administration’s approval of the Pfizer vaccine for emergency use in children ages 5-11 was followed by a formal recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. For some families and schools, this was a long-awaited recommendation. Nearly 2 million U.S. children ages 5-11 have been infected with COVID-19, and of those, 8,300 have been hospitalized and 170 have died.
Younger children will receive one-third of the dose authorized for people 12 and older, which means the vaccine distribution, and in some cases the administration, might be different for children in this age group. The federal government is working with children’s hospitals to set up vaccination clinics, and states are working with pediatricians and in some cases, schools, to provide vaccines to this population. Nearly 1 million children in this age group received their first COVID-19 vaccine as of yesterday.
In a widely publicized announcement, the Occupational Safety and Health Administration published an emergency temporary standard, known as an ETS, mandating that all employers with 100 or more workers require their employees to receive a COVID-19 vaccine. Those without proof of vaccination must submit weekly negative COVID-19 test results and wear masks. This requirement applies to approximately 84 million employees starting Jan. 4. To learn more about the ETS and how it impacts states, please see the article “OSHA’s Vaccine-or-Test Mandate for Large Employers Faces Pushback,” from NCSL’s State Legislatures News.
Requirements for Medicare, Medicaid Facilities
In addition to the announcements from the FDA and OSHA, a third came from the Centers for Medicare and Medicaid Services. In August, the CMS announced it would require staff at Medicare- and Medicaid-participating nursing facilities to be fully vaccinated against COVID-19. As of October, just over 70% of long-term care facility staff were vaccinated, according to the agency. CMS subsequently expanded the requirement to include other provider types and issued an emergency regulation requiring health care workers at all facilities participating in Medicare and Medicaid to be vaccinated, also by Jan. 4. This requirement applies to an estimated 17 million health care workers across 76,000 facilities, including nursing facilities, hospitals, dialysis facilities, ambulatory surgical settings and home health agencies.
The CMS regulation differs from the OSHA mandate in several ways. It does not allow covered workers to submit negative tests in lieu of a vaccine but does allow employees to request medical or religious exemptions. The consequence of not following the rule results in loss of Medicare or Medicaid reimbursement, two of the largest payers of health care in the U.S. According to the American Hospital Association, Medicare and Medicaid account for 60% of all services provided by hospitals.
Forty-eight states and the District of Columbia allow private employers to institute employee vaccination mandates, some of which require a regular testing option or allow for religious and medical exemptions. Nineteen states require state workers to be vaccinated, and 23 states require health workers to be vaccinated. These requirements were implemented in various ways, such as through state legislation, governor-issued proclamations or department of health directives. Several states prohibit vaccine requirements for state employees.
The OSHA mandate has been challenged in court by several states and is currently under a temporary injunction, while no state has yet challenged the CMS mandate for health care workers. NCSL will continue reviewing the state impact of federal regulations and tracking state actions related to COVID-19 vaccines.
Tahra Johnson is an associate director in NCSL’s health program.