ACIP Vote Explained: Vaccine Changes, Overhaul, and Court Block

ACIP vaccine recommendations are the votes of the CDC’s Advisory Committee on Immunization Practices, and they matter because once the CDC adopts them, most insurers, Medicare Part D, adult Medicaid, and the Vaccines for Children program must cover the listed shots at no cost to you. Since mid-2025 the committee has been remade under HHS Secretary Robert F. Kennedy Jr. and has voted to narrow long-standing recommendations for COVID-19, hepatitis B, and the combined MMRV shot. In March 2026 a federal judge blocked those votes and a broader schedule rewrite, so the recommendations in force today are largely the ones that existed before June 2025.¹²

How an ACIP Vote Reaches Your Wallet

ACIP is a federal panel of up to 19 voting members appointed by the HHS Secretary. Its votes are not self-executing. The CDC director reviews each recommendation and decides whether to adopt it by publishing it in the Morbidity and Mortality Weekly Report.³ Once a recommendation is adopted and placed on the official immunization schedule, several things happen automatically:

The Affordable Care Act requires private insurers and employer plans to cover the vaccine with no copay or deductible.⁴
The Inflation Reduction Act extends the no-cost requirement to Medicare Part D and adult Medicaid.⁴
The Vaccines for Children program uses ACIP’s pediatric list to provide free shots to eligible children.²
Immigration law ties admissibility of foreign nationals to ACIP-recommended vaccinations.³

Routine Versus Shared Clinical Decision-Making

ACIP writes recommendations in two different registers. A routine recommendation means everyone in a defined age or risk group should get the vaccine by default. A shared clinical decision-making recommendation carries no default; whether to vaccinate is a case-by-case conversation between patient and provider.⁵

Both types, once adopted by the CDC, still trigger the ACA’s no-cost coverage requirement.⁵ But the practical effect is different. Downgrading a vaccine from routine to shared clinical decision-making has produced confusion at pharmacies and lower uptake, as the University of Minnesota’s Center for Infectious Disease Research and Policy documented with COVID-19 shots.⁶ Remove a recommendation entirely and the ACA mandate disappears, leaving insurers free to decide whether to cover the vaccine at all.⁷

The 2025 Overhaul of the Committee

On June 9, 2025, Kennedy removed all 17 sitting ACIP members, calling it a “clean sweep” needed to “reestablish public confidence.” He noted the prior administration had appointed all 17 members, 13 of them in 2024, which would have blocked the new administration from seating a majority until 2028.⁸ Weeks earlier, on May 27, 2025, the CDC had already changed COVID-19 vaccine recommendations for children from routine to shared clinical decision-making without consulting ACIP.⁹

Kennedy then appointed new members, several of whom had publicly criticized mainstream vaccine policy. Biostatistician Martin Kulldorff became chair; biochemist Robert Malone, an early mRNA researcher who later became a prominent critic of the mRNA COVID-19 vaccines, was named vice chair.¹⁰¹¹ A group of former CDC directors publicly called the new members “unqualified” and said they held “dangerous and unscientific views.” The American Academy of Pediatrics boycotted the committee’s meetings, saying federal vaccine policymaking was no longer a “credible process.”¹²

Kulldorff left the chairmanship on December 1, 2025, for a role at the HHS Office of the Assistant Secretary for Planning and Evaluation. Pediatric cardiologist Kirk Milhoan replaced him and told Reuters he did not “see significant changes at all” in the committee’s direction.¹³

What the New Committee Voted to Change

COVID-19 Vaccines

At its September 18–19, 2025 meeting, the reconstituted committee moved COVID-19 vaccination from a routine recommendation to shared clinical decision-making for all age groups. Members voted unanimously (12-0) to recommend the vaccine for adults 65 and older and for people six months to 64 years old under that framework, saying the risk-benefit profile is “most favorable” for those at higher risk of severe disease. A proposal to require a prescription for COVID-19 vaccination failed on a 6-6 tie, with the chair casting the deciding vote against it.¹⁴

MMRV Vaccine

Also in September, the committee voted 8-3 to recommend that children under four receive separate MMR and varicella shots rather than the combined MMRV vaccine, citing febrile seizure risk. The two-dose schedule stayed the same, and children four and older could still receive the combined shot for their second dose.¹⁴ A separate vote the following day removed MMRV from the Vaccines for Children program, affecting coverage for low-income children as well as Medicaid and CHIP.¹²

Hepatitis B Birth Dose

The hepatitis B birth dose was the most contested vote. After tabling the question in September, the committee voted 8-3 on December 5, 2025, to end the universal birth-dose recommendation that had been in place for more than three decades.¹⁵ Under the new framework, birth-dose vaccination is recommended only for infants born to mothers who test positive for hepatitis B or whose status is unknown. For infants born to mothers who test negative, the decision shifts to shared clinical decision-making.¹⁶ A separate 6-4 vote with one abstention added antibody testing after each dose.

Committee member Cody Meissner, the only holdover from prior ACIP panels, voted against the change, saying “We are doing harm by changing this wording.”¹⁵ Members Joseph Hibbeln and Raymond Pollak said the vote proceeded without the GRADE evidence-review framework the committee had traditionally used.¹⁷ The AAP called the change “reckless” and lacking a scientific basis.¹⁸

The January 2026 Schedule Rewrite Outside ACIP

On January 5, 2026, the CDC Acting Director approved a revised childhood immunization schedule that went beyond what ACIP had voted on. Following a December 2025 presidential memorandum, federal officials led by FDA’s Tracy Beth Høeg and Kulldorff at ASPE reduced universally recommended childhood vaccines from 17 to 11.¹⁹ Hepatitis A, rotavirus, and influenza vaccines were moved to shared clinical decision-making. Hepatitis A and hepatitis B were reclassified as recommended only for high-risk groups. HPV dosing was changed from two or three doses to one.² AAP president Andrew Racine called the changes “dangerous and unnecessary.”²⁰

The Court Blocks the Changes

On March 16, 2026, U.S. District Judge Brian E. Murphy in Massachusetts issued a preliminary injunction in American Academy of Pediatrics v. Kennedy, finding the plaintiffs were likely to prove that the reconstitution of ACIP and the January 2026 schedule changes violated the Administrative Procedure Act. The court wrote that “the government has disregarded those methods and thereby undermined the integrity of its actions.”¹

The ruling stayed the appointments of 13 ACIP members and blocked every decision the reconstituted committee had made, including the September and December 2025 votes on COVID-19, MMRV, and hepatitis B. The January 2026 childhood schedule was also blocked, reverting guidance to what was in place before the changes.²¹ Because the court found the committee cannot function without its full membership, ACIP was left unable to convene, and a March 18–19, 2026 meeting was postponed.²²

The federal government appealed on April 29, 2026. On May 29, 2026, President Trump signed Executive Order 14407 designating the proposed 2026 schedule updates as a “guiding resource” and directing the CDC and ACIP to review them and update schedules “to the extent permitted by law.”²

What Applies to You Right Now

As of mid-2026, the preliminary injunction remains in effect while the appeal proceeds. The childhood and adult immunization schedules have largely reverted to the pre-June 2025 versions. Two exceptions were not covered by the court’s stay: the April 2025 recommendations on meningococcal and RSV vaccines, and the May 2025 CDC guidance moving COVID-19 vaccination for children to shared clinical decision-making.²

Insurers and states have also created their own backstops in case the appeal changes the picture. In September 2025, America’s Health Insurance Plans said member insurers, including Aetna, Centene, Cigna, Elevance Health, Humana, Blue Cross Blue Shield plans, and Oscar Health, would voluntarily keep covering all vaccines ACIP recommended as of September 1, 2025, with no cost-sharing, through the end of 2026.²³²⁴

Several states passed legislation decoupling their vaccine coverage and school-entry requirements from whatever the current ACIP list says:

California’s AB 144 set the January 1, 2025 ACIP schedule as the state’s baseline for insurance coverage, let the state health department supplement it using guidance from leading medical organizations, and gave providers liability protection through 2030. California, Oregon, Washington, and Hawaii also formed a “West Coast Health Alliance” to issue coordinated recommendations.²⁵
Colorado authorized its insurance commissioner to fall back on January 2025 vaccine guidelines if ACIP recommendations are repealed or modified, and empowered the state board of health to consider recommendations from the AAP, the American Academy of Family Physicians, and the American College of Physicians for school requirements.²⁶
Maryland required insurance carriers to cover vaccines based on the ACIP list in effect as of December 31, 2024, and authorized pharmacists to administer shots under protocols reflecting those same recommendations.²⁶
New Mexico replaced ACIP recommendations with AAP recommendations and state health department guidelines for school vaccine policy.²⁶

ACIP has not met since the injunction was issued, and its next scheduled meeting dates, June and October 2026, remain uncertain.²⁷ The appeal will decide whether the reconstituted committee resumes work and whether any of its 2025 votes take effect. Until it is resolved, if you are checking what your plan must cover, the reference point is the ACIP schedule that existed before June 2025, plus the two carve-outs the court left in place and any additional protections your state has enacted.

1
CIDRAP. Federal Judge Blocks Kennedys Changes to Childhood Vaccine Policy
2
Congressional Research Service. ACIP and the Childhood Immunization Schedule
3
Congressional Research Service. Advisory Committee on Immunization Practices
4
KFF. ACIP, CDC, and Insurance Coverage of Vaccines in the United States
5
CDC. ACIP Shared Clinical Decision-Making Recommendations
6
CIDRAP. Confusion Surrounds CDCs Shared Clinical Decision-Making Paradigm
7
Commonwealth Fund. Advisory Committee on Immunization Practices: What It Does
8
HHS. HHS Actions to Restore Public Trust in Vaccines and ACIP
9
New England Journal of Medicine. Changes to CDC Vaccine Recommendations
10
The Hill. Martin Kulldorff Kennedy HHS Appointment
11
CDC. ACIP Membership
12
NPR. CDC ACIP Vaccine Hepatitis B MMRV
13
Reuters. US HHS Names Pediatric Cardiologist Milhoan Chair of Vaccine Panel
14
Contemporary Pediatrics. Reactions to the September ACIP Meeting
15
NPR. CDC Hepatitis B Vaccine ACIP Meeting
16
ABC News. CDC Vaccine Advisory Committee Votes to Remove Universal Recommendation
17
Avalere Health. December 2025 ACIP Insights and Emerging Priorities
18
CNN. CDC Vaccine Meeting Hepatitis B
19
CIDRAP. HHS Announces Unprecedented Overhaul of US Childhood Vaccine Schedule
20
AAP News. AAP: CDC Plan to Remove Universal Childhood Vaccine Recommendations
21
NACCHO. Federal Judge Blocks Immunization Schedule Changes
22
Federal Register. Advisory Committee on Immunization Practices: Cancellation of Meeting
23
AHIP. AHIP Statement on Vaccine Coverage
24
Fierce Healthcare. Major Health Insurance Group Maintains Commitment to Vaccine Coverage
25
California Medical Association. Governor Signs New Law Safeguarding Vaccine Access in California
26
ASTHO. States Seek Policy Guidance Beyond ACIP Vaccine Recommendations
27
CDC. ACIP Meetings