San Diego Immunization Coalition

Current as of October 14, 2021​. Source: https://www.shotsforschool.org/laws/exemptions/

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1. What were the main changes to the medical exemption process that came into effect under Senate Bills (SB) 276 and SB 714?

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• Under Senate Bills (SB) 276 and SB 714 (Pan, 2019), all new medical exemptions for school and child care entry must be issued through CAIR-ME beginning January 1, 2021. Medical exemptions can only be issued by MDs or DOs licensed in California and must meet applicable Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) criteria.

 

2. For admissions on or after January 1, 2021, what is required for a medical exemption to a required immunization?

 

Starting January 1, 2021:

• Medical exemptions can only be issued through the California Immunization Registry – Medical Exemption website (CAIR-ME) by physicians licensed in California. 

• Schools and child care facilities may only accept from parents new medical exemptions that are issued using CAIR-ME.

 
3. Are medical exemptions filed for children in attendance at a California child care facility or school before 2021 valid in later years?

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A medical exemption filed at a pre-kindergarten facility or school remains valid until the earliest of:

• When the child enrolls in the next grade span (TK/K-6th grade, 7th-12th grade)

• The expiration date specified in a temporary medical exemption

• Revocation of the exemption because the issuing physician has been subject to disciplinary action from the physician’s licensing entity.

 
4. A doctor has told a child’s parents that their child needs a medical exemption from a required immunization. How do parents get a medical exemption for their child?

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Starting January 1, 2021, all new medical exemptions for school and child care entry must be issued through CAIR-ME.  Parents and physicians can register and create an account in CAIR-ME at any time.  Once registered, parents can log in to CAIR-ME to request a medical exemption.  Parents take the exemption request number to their child’s physician who can log in to CAIR-ME to issue the exemption.  Once the exemption is issued, the physician prints the two page form and provides a copy to the parents to give to their child’s school or child care facility.

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5. When may schools and child care facilities sign up to use CAIR-ME?

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 Schools and child care facilities may register to use CAIR-ME after they receive a medical exemption issued using CAIR-ME for one of their enrollees.  Schools and child care facilities can then email medicalexemptions@cdph.ca.gov to request access to the CAIR-ME website.  After registering and creating an account, schools and child care facilities will be able to see the medical exemptions in CAIR-ME that have been issued in CAIR-ME for children that attend their school or child care facility.

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6. How early may a physician issue a medical exemption in CAIR-ME before a child first enters a grade span starting in 2021?

 

A medical exemption may be issued in CAIR-ME no more than 12 months before a child first enters a grade span (grade spans are birth-preschool, TK/K-6th, and 7th-12th).
 

7. Which medical exemptions in CAIR-ME will the State of California Department of Public Health (CDPH) review?

 

Starting January 1, 2021, new medical exemptions must be issued using the medical exemption website CAIR-ME.  Under Senate Bills (SB) 276 and SB 714 (Pan, 2019), CDPH is required to review exemptions in CAIR-ME when:

• A school's immunization rate falls below 95% or

• A doctor writes more than 5 medical exemptions per year beginning January 1, 2020 or

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

 

CDPH may also review a medical exemption if CDPH determines it is necessary to protect public health.

 

8. Who at CDPH will review my child's medical exemption in CAIR-ME?

 

Medical exemptions reviewed based on the specific criteria under SB 276 and SB 714 will be reviewed by clinical staff at CDPH with expertise in immunization. Only the State Public Health Officer, or a physician they designate from the CDPH's immunization program, can revoke a medical exemption.
 

9. Does a child with an existing medical exemption in CAIR-ME need a new medical exemption if the child enrolls in a new school or child care facility within the same grade span?

 

No.  While a new medical exemption does not need to be issued, the school or child care facility information listed in CAIR-ME for the exemption must be the same as the new school or child care facility.  Parents must log in to CAIR-ME, update the school or child care facility information, and show proof of the change to the new school or child care facility.  Parents will be able to print a copy of the changes to show the school or child care facility.  The new school or child care facility can also log in to CAIR-ME to confirm that the medical exemption is listed for their school or child care facility.

 

10. What happens if my child's medical exemption in CAIR-ME is revoked? May I appeal?

 

SB 276 and SB 714 provide an appeal process for parents if CDPH revokes a medical exemption because the exemption did not meet applicable Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) criteria or the standard of medical care.  Parents will receive information about their options if their child’s medical exemption is revoked.  Parents will have 30 days to appeal.

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Appeals will be reviewed by an independent expert panel appointed by the California Health and Human Services (CHHS). The panel’s decision shall be adopted by CHHS and is final.

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11. Who can access the medical exemption website CAIR-ME? 

 

CAIR-ME is available to parents/guardians seeking a medical exemption, California-licensed physicians, schools and child care facilities, local health departments, the Medical Board of California, the Osteopathic Medical Board of California, the California Department of Public Health, and the California Health and Human Services Agency.  Access to information in CAIR-ME is restricted based on the type of user and in compliance with state and federal confidentiality and privacy laws.

 

12. To meet the chickenpox immunization requirement for TK/K-12 admission or for advancement into 7th grade, may a school accept an immunization record that indicates a "history of chickenpox disease"? 

 

No, this is not sufficient documentation to meet school requirements. A medical exemption may be used for a child who had chickenpox disease that was documented by a physician. Starting in 2021, new medical exemptions must be issued using CAIR-ME.

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13. When do medical exemptions issued in CAIR-ME expire?

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Medical exemptions issued in CAIR-ME expire at the earliest of:

• When the child enrolls in the next grade span (TK/K-6th grade, 7th-12th grade)

• The expiration date specified in a temporary medical exemption

• Permanent revocation of the exemption.

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14. Effective January 1, 2021 do changes in the law prevent a licensed physician from issuing a medical exemption?

 

Yes, under certain circumstances. Licensed physicians will not be able to issue new medical exemptions if they are:

• on probation for immunization-related practices,

• have a pending accusation for immunization-related practices, or

• CDPH determines they are a public health risk.  In this case, the physician may be barred from submitting an exemption for no less than two years.

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15. Do Senate Bills 276 and 714 (2019) limit doctors from issuing more than 5 medical exemptions a year? 

No, physicians are not limited to issuing 5 medical exemptions a year. By law, CDPH will review medical exemptions when a doctor issues 5 or more exemptions in a year to ensure that the exemptions are consistent with the standard of medical care for a particular medical condition and align with CDC, ACIP, and AAP guidelines.

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16. Do medical exemptions issued prior to 2021 need to be uploaded into CAIR-ME?

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No. Existing MEs issued for children in attendance before 2021 will remain on file at schools and child care facilities and do not need to be uploaded into CAIR-ME.

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17. As a school or child care user, I already have a login for the California Immunization Registry (CAIR2).  Do I need a different account to log in to CAIR-ME to view exemptions issued through CAIR-ME for my enrollees?

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Yes, school and child care staff will need to register separately to access CAIR-ME.  To register for a CAIR-ME account, you will need to have an exemption issued through CAIR-ME for one of your enrollees.  Once you receive the exemption from the parent, email the medical exemption number and school/childcare ID from the form to medicalexemptions@cdph.ca.gov to receive a code to allow you to register.

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