2019 Legislation

AVFCA Bills Supported and Opposed

i 3 Table of Contents

2019 CA Legislation – SB 276

Starting January 1, 2021 all NEW Vaccine Medical Exemptions for California daycare through 12th grade must be submitted by an MD or DO through the California Immunization Registry (CAIR)

SB276 and SB714 were signed into law in California in 2019, modifying the statute that was put in place in 2015 by SB277 with regard to vaccine medical exemptions for school. As of January 1, 2021 these laws have gone into full effect. In response to this, the California Department of Public Health (CDPH) has launched the California Immunization Registry – Medical Exemption (CAIR-ME) website (https://cair.cdph.ca.gov/exemptions/home) to request, issue, and track vaccine medical exemptions for acceptance into child care facilities and K-12 schools in California. Starting January 1, 2021, all NEW vaccine medical exemptions for California child care or K-12 school must be issued through CAIR-ME website by MDs or DOs licensed in California. They must meet Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) criteria for appropriate medical exemptions. Note: These do not exist. Only CDC, ACIP, or AAP vaccination guidelines (https://www.cdc.gov/vaccines/vpd/should-not-vacc.html) exist.  AVFCA has requested the criteria from CDPH but have not received a response as of today.

To get a vaccine medical exemption filed in CAIR-ME:

1) Parents create an account in CAIR-ME to submit a request for a medical exemption.  

2) Then the child’s physician (who cannot be on probation for vaccine related issues) completes the medical exemption in CAIR-ME, no more than 12 months prior to the medical exemption being required for the child care facility/school. The physician prints a copy for the parents to give to the child’s child care facility/school.

3) Child care facilities/Schools can only accept new medical exemptions issued through CAIR-ME, and will cross-check them in CAIR-ME once submitted. 

Note: If a child changes child care facility/school within a grade span, the parent will need to update the information in CAIR-ME and provide a copy to the new child care facility/school. By having a physician issue a vaccine medical exemption through CAIR-ME, a parent is authorizing the physician to disclose medical records including evaluation, diagnosis, and treatment of their child to the CDPH and the Enforcement Programs of the Medical Board of California/Osteopathic Medical Board of California, for eight years with no way to retract this authorization. If a parent is not willing to sign such an authorization, a vaccine medical exemption will not be issued.

The following will cause a child’s vaccine medical exemption to be reviewed, with the possible result in revocation:

– A school’s immunization rate falls below 95% (https://www.shotsforschool.org/k-12/how-doing/)

– A doctor writes more than 5 medical exemptions per year

– A school fails to provide reports of vaccination rates to CDPH

– CDPH determines it is necessary to protect public health

AVFCA has privacy concerns given that the CAIR-ME website requires a user to certify that they agree to only look up information on their patients’, students’ or child’s medical exemption records and not attempt to access any other records, seeming to imply that one could logistically do so.  We are consulting with our lawyers as to possible next steps on this front.

Important Note:  DO NOT submit any vaccine medical exemptions dated prior to 2021 to CAIR-ME or any other database. These should be filed directly with the school, even if your child changes school within a grade span. If you filed a vaccine medical exemption prior to 2021, we recommend you file a privacy notice with it (https://www.avoiceforchoiceadvocacy.org/wp-content/uploads/2016/06/Objection-to-Disclosure-of-Student-Records.pdf)

Your child is exempt from the CA vaccination requirement if they are:

Homeschooled – A pupil in a home based private school or a pupil who is enrolled in an independent study is exempt from vaccination requirements. (SB277)

In Public school with an IEP or in a Private school with public school IEP services – A pupil with an IEP or IEP services is exempt from vaccination requirements. (SB277 and Federal law)
Your school may ask for their vaccination records to be on file if they have any, but cannot require them to be up to date or have a Medical Exemption on file for the remainder. 

One possible WIN: The new CDPH guidelines (https://www.shotsforschool.org/laws/exemptions/) no longer state that a child entering child care/school for the first time, TK/Kindergarten or 7th grade in 2020 requires a vaccine medical exemption letter dated 2020.  Therefore for those of you whose schools have stated your pre-2020 medical exemption is not valid for this 2020-21 school year, you may want to try again, noting that this requirement was removed from the CDPH website. If you need help with wording for this, please email us.

More information is expected to be forthcoming from CDPH in the next few weeks.  As always, AVFCA will keep you posted.

If you found this information helpful and appreciate the work A Voice for Choice Advocacy is doing, please support us by making a donation today.

Together we can make change happen.

SB 276 and its companion bill SB 714 were signed into law on September 9th, 2019.


 What are the implications for your child in 2020 and 2021 under #SB276 #SB714 ?


If these infographics do not answer your question, please feel free to email info@avoiceforchoiceadvocacy.org and we will help explain specific to your situation.

This is AVFCA’s interpretation of the bill, based on the language of the statute, as well as how CDPH implemented SB 276, and also the HHS FAQ on SB 276: https://www.chhs.ca.gov/blog/2019/09/09/senate-bill-276-and-senate-bill-714-vaccinations-and-medical-exemptions-questions-and-answers/

CDPH has guidelines to the interpretation of SB276 on their Shots for School website: https://www.shotsforschool.org/laws/exemptions/

Submit an Objection to Release of Immunization data with your “grandfathered” medical exemption to prevent sharing of your child’s medical exemption with third parties.  https://avoiceforchoiceadvocacy.org/wp-content/uploads/2020/01/AVFCA-Objection-to-Release-of-Immunization-Data-Final.pdf

SB 276 and SB 714 Bill and Fiscal Summary
SB 276 and Sb714 as written would put school vaccine medical exemptions under the scrutiny of a state bureaucrat, penalizing children and their doctors rather than creating a bill that would specifically target unscrupulous doctors. We estimate the cost of these bills to be in excess of $50 million in the first year and in excess of approximately $35 million in each subsequent year, with an additional approximately $650 million potential loss in school ADA and/or approximately $5 billion potential increased healthcare costs. All to go after an extremely small and unquantified number of “unscrupulous” doctors and to mitigate the 11 cases of measles in California children this year. There has to be a better, more cost effective way.

Below are various documents that include A Voice for Choice Advocacy’s talking points, fiscal analysis and requested amendments for the bill wording.

AVFCA Fiscal Analysis submitted to the Committee and the Finance Department:


Final versions of SB 276 and SB 714 as signed into law:

SB 276: http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB276

SB 714: http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB714


Full CA Health and Safety Code relating to school vaccination requirements: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=120325.&lawCode=HSC 

AVFCA Issues with the bill and requested amendments can be found here:


For those who want to go deeper, AVFCA went through the bill line by line and made a list of unanswered questions, as well as issues with the bill, outlined here:


Our requested amendments were also transcribed onto the bill wording:


Click here for AVFCA SB276 Issues and Requested Amendments
Click here for AVFCA SB276 Legislative Flyer with all the talking points
Click here for AVFCA Fiscal Analysis of SB 276

TAKE ACTION this week – please do the following four things (Updated 9/17/19):

1.Get reinvigorated by watching this amazing HighWire clip. We are a part of the right side of history.  It’s 12 minutes of powerful…

2.Put yourself on your Senator’s and Assembly member’s mailing list (http://findyourrep.legislature.ca.gov/) and go to any and all events they have.

3.Donate to A Voice for Choice Advocacy (https://avoiceforchoiceadvocacy.org/donate/) – Thank you to all those who have generously donated!! Our 3 seasoned lobbyists worked so hard for us and even though we were not able to get the amendments we wanted, they made a real difference in their conversations with Senators and Assembly members, and allowed our questions and concerns to be raised in committee hearings and on the floor, making Senator Pan defend his bill.  Donations will go towards the lobbyist fees, so that we can hire them to get our legislation brought forward next year.  Every penny counts so ask your friends and family to donate.  Thank you!

AVFCA SB276 Press Releases:

AVFCA Press Release – Charity Dean self propelled Medical Exemption Czar –

published 10/2/19

AVFCA Press Release – SB714 Catch 22 – Check Mate –

published 9/9/19

AVFCA Press Release – SB 276 Collusion, Corruption or usual Sacramento politics-

published 8/9/19

AVFCA Press Release – SB 276 Naps In Suspense, While Infant Mortality Crawls Up –

published 8/1/19

AVFCA Press Release – California Heats Up As Human Rights are Put On ICE –

published 7/30/19

AVFCA Press Release – SB276 Pediatric Summer School –

published 7/30/19

AVFCA Press Release – SB276 Opponents want to be heard –

published 7/16/19

AVFCA Press Release – SB276 Set to Create Seismic Economic Rift –

published 7/10/19

AVFCA Press Release – SB276 Limps out of the Senate –

published 5/21/19

AVFCA Press Release – Richard Pan attacks Doctor Patient relationship –

published 3/27/19

AVFCA Press Release – Undermining the Doctor Patient relationship –

published 2/4/19