There is no longer a statewide California healthcare worker vaccine mandate for COVID-19, but vaccination rules still reach into every clinical workplace in the state. Cal/OSHA requires employers to offer a specific list of vaccines to workers with occupational exposure, hospitals must run an annual influenza vaccinate-or-decline process, and individual employers can lawfully impose their own vaccination requirements as a condition of employment. Whether you have to be vaccinated to keep your job depends on which of these applies to you, and on whether you qualify for a medical or religious exemption.
Where COVID-19 Vaccination Stands Now
The California Department of Public Health rescinded its COVID-19 vaccination order for healthcare workers effective April 3, 2023, when the state’s public health emergency ended.1California Department of Public Health. Order of the State Public Health Officer Health Care Worker Vaccine Requirement The federal CMS vaccination requirement for staff at Medicare- and Medicaid-certified facilities ended when the national public health emergency concluded on May 11, 2023.2Centers for Medicare & Medicaid Services. COVID-19 PHE Report to Congress No statewide or federal rule currently compels California healthcare workers to be vaccinated against COVID-19.
Individual employers can still require it, and many large California health systems do. A private employer policy carries the same practical weight as a government mandate: comply, get a valid exemption, or face potential termination. CDPH also retains authority to issue new public health orders during respiratory virus surges, which could include vaccine-or-mask requirements for healthcare workers.
Vaccines Your Employer Must Offer Under Cal/OSHA
Two Cal/OSHA standards impose year-round obligations on healthcare employers, independent of any emergency declaration. Both use the word “offer”: your employer must make the vaccine available and pay for it, and you can generally sign a declination form to decline.
Aerosol Transmissible Diseases
Title 8, Section 5199 requires employers to offer these vaccines to susceptible healthcare workers at no cost:3Department of Industrial Relations. Section 5199 Appendix E – Aerosol Transmissible Disease Vaccination Recommendations for Susceptible Health Care Workers
- Measles, two doses
- Mumps, two doses
- Rubella, one dose
- Varicella (chickenpox), two doses
- Tdap, one dose, with boosters as recommended (typically every 10 years)
- Influenza, one dose annually
Bloodborne Pathogens
Title 8, Section 5193 requires employers to offer the hepatitis B vaccine series to every employee with occupational exposure to blood or other potentially infectious materials.4Department of Industrial Relations. Frequently Asked Questions About the Bloodborne Pathogens Standard The offer must come within 10 working days of your initial assignment to duties that create the exposure, and the employer pays. You can decline. If you decline and later change your mind while still in a covered role, your employer must offer it again.
The Hospital Influenza Rule
General acute care hospitals face a stricter flu rule than other healthcare settings. Under Health and Safety Code Section 1288.7, every general acute care hospital must offer free onsite influenza vaccinations to all employees each year and require each employee to either get vaccinated or submit a written declination.5California Department of Public Health (CDPH). AFL-10-35 – Mandatory Reporting of Influenza Vaccination and Declination of Hospital Personnel Hospitals report their vaccination and declination rates to CDPH, which publishes the data.
If you work at a hospital and do not want the flu shot, you have to say so in writing. Ignoring the requirement or verbally refusing does not satisfy the statute.
Who Counts as a Healthcare Worker
California’s public health orders define “healthcare worker” broadly. The definition covers all paid and unpaid people working in indoor settings where care is provided or where patients have access.6California Department of Public Health (CDPH). Public Health Order Questions and Answers – Health Care Worker Protections in High-Risk Settings Nurses, physicians, therapists, and technicians are obviously covered, but so are people who never touch a patient: dietary, environmental services, security, administration, billing, laundry, and facilities staff. Volunteers and contract workers fall under the same rules.
Covered facilities include general acute care hospitals, skilled nursing facilities, intermediate care facilities, clinics, doctor’s offices, behavioral health facilities, and residential treatment centers.6California Department of Public Health (CDPH). Public Health Order Questions and Answers – Health Care Worker Protections in High-Risk Settings
Medical Exemptions
A medical exemption requires a written statement from a licensed physician, nurse practitioner, or other qualified medical professional confirming a legitimate medical contraindication.7California Department of Public Health. Public Health Order Questions and Answers – Health Care Worker Vaccine Requirement The statement should indicate whether you are unable to receive the vaccine permanently or for a specific period, but it should not describe your underlying medical condition. Your employer needs to know a qualified clinician evaluated you, not your diagnosis.
Under the Americans with Disabilities Act, once you request the exemption your employer must work with you to find a reasonable accommodation. The employer conducts an individualized assessment of whether an unvaccinated worker poses a “direct threat” — a significant risk of substantial harm — and whether any reasonable accommodation could reduce that risk.8U.S. Equal Employment Opportunity Commission. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws Possible accommodations include enhanced protective equipment, modified shifts, physical barriers, reassignment to a role with less patient contact, or telework where the job allows.
Religious Exemptions
You can also request an exemption based on a sincerely held religious belief that conflicts with vaccination, by submitting a signed declination that explains the religious basis.7California Department of Public Health. Public Health Order Questions and Answers – Health Care Worker Vaccine Requirement Employers are generally expected to assume the belief is sincere. The EEOC has said questioning sincerity requires an objective basis, not just skepticism. Factors that can raise legitimate questions include behavior markedly inconsistent with the stated belief, timing suggesting the request is really about something else, or an accommodation that people frequently seek for nonreligious reasons.9U.S. Equal Employment Opportunity Commission. Section 12 – Religious Discrimination None of these alone is enough to deny the request.
The Undue Hardship Standard After Groff v. DeJoy
For decades, employers could deny a religious accommodation by showing anything “more than a trivial cost.” In June 2023, the Supreme Court in Groff v. DeJoy held that an employer claiming undue hardship must show the accommodation would result in “substantial increased costs in relation to the conduct of its particular business.”10Supreme Court of the United States. Groff v. DeJoy, 600 U.S. 447 (2023) For California healthcare workers, that means an employer cannot deny your religious vaccine exemption based on minor scheduling inconveniences or modest costs of masking, testing, or reassignment. The analysis is fact-specific: a small clinic with three employees may face a legitimate hardship where a 500-bed hospital would not.
The Interactive Process
Once you submit any exemption request, medical or religious, your employer must engage in the interactive process, a back-and-forth to identify an accommodation that works for both sides. Both Title VII, the ADA, and California’s Fair Employment and Housing Act require it. The employer should explore enhanced PPE, staggered shifts, workspace modifications, periodic testing, or reassignment. If nothing in your current role works, the employer must consider reassignment to a vacant position as a last resort before taking adverse action.
If You Are Denied or Terminated
Without vaccination and without a valid exemption, most facilities will suspend or terminate you. If you believe your employer wrongfully denied an accommodation or retaliated against you for requesting an exemption, you can file a complaint with California’s Civil Rights Department (formerly DFEH) under FEHA, or with the EEOC under federal anti-discrimination law. The filing windows are firm: 300 days for EEOC complaints and three years under FEHA. Do not sit on a claim if you think your rights were violated.