Maryland and Illinois have become the latest states to establish independent vaccine recommendations, creating a patchwork of guidance that varies by state and could affect which vaccines your insurance covers and where you can get them. Maryland issued its first-ever state vaccine schedules for children and adults in July, while Illinois adopted its own respiratory virus immunization guidance in September, joining a growing group of states that have decoupled from federal recommendations over the past year.

Why Are States Creating Their Own Vaccine Schedules?

Maryland's move came through legislation rather than administrative action. Governor Wes Moore signed the Vax Act in April, which took effect July 1 and gave the state health secretary authority to establish official recommendations for immunizations and preventive services. According to state officials, the goal was to reduce confusion as families navigate shifting vaccine guidance from the federal government, particularly during back-to-school season and respiratory virus season.

Illinois took a different path, adopting guidance developed by its own Immunization Advisory Committee, a 20-member panel of experts spanning infectious diseases, pediatrics, family medicine, internal medicine, obstetrics and gynecology, nursing, pharmacy, and public health. The state described its action as responding to federal immunization decisions it viewed as not rooted in scientific evidence.

Maryland's schedule anchors its recommendations to guidance from the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. Notably, the state does not cite the CDC or FDA as the basis for its schedule, and it specifically reaffirms the combined measles, mumps, and rubella vaccine and the hepatitis B series beginning with the birth dose, both areas where federal recommendations changed earlier this year.

What Vaccines Do These States Recommend?

Maryland's children's schedule lists 18 vaccines by age from birth to 18, while its adult schedule lists 16 vaccines organized for pregnancy and age bands from 19 to 49, 50 to 64, and 65 and older.

Illinois recommends flu vaccination for everyone 6 months and older. For RSV (respiratory syncytial virus), the state recommends vaccination for pregnant people during weeks 32 through 36 of pregnancy if not previously vaccinated, with the maternal vaccination season running from September through March 1. Illinois also recommends RSV protection for infants under 8 months entering their first RSV season without maternal antibody protection, for some higher-risk toddlers, and for adults 75 and older.

How Does This Affect Your Insurance Coverage and Access?

The practical difference between state and federal recommendations becomes concrete at the insurance level. Under Maryland's Vax Act, state-regulated health plans must cover routine immunizations recommended by the state with no out-of-pocket cost. Additionally, pharmacists may administer those vaccines to anyone age 3 or older without a prescription.

However, there are important limitations. Self-funded employer plans, which cover a large share of workers, are governed by federal law rather than state insurance rules. People in those plans should verify coverage directly with their plan administrator rather than assuming the state rule applies. Illinois has a comparable requirement through state law requiring insurers to cover state recommendations, with the same limitation for self-funded plans.

For uninsured and underinsured residents, Illinois directs people to local health departments and the state's vaccine locator dashboard for no-cost options. Maryland residents can contact their local health department for similar assistance.

Steps to Prepare for Fall Vaccination Season

• Check Your State's Schedule: Determine which vaccine recommendations apply to you by identifying your state's official guidance. Maryland and Illinois now publish their own schedules, while other states may still follow federal CDC recommendations.
• Verify Insurance Coverage: Contact your health plan directly to confirm whether state-recommended vaccines are covered without cost-sharing, especially if you have a self-funded employer plan that may follow federal rules instead of state rules.
• Plan Pharmacy Access: In Maryland, pharmacists can vaccinate anyone 3 and older without a prescription. In other states, you may need a prescription or a pediatric visit, so plan accordingly before clinics fill up in October.
• Schedule Before Late October: Full protection takes roughly two weeks, and flu, COVID-19, and RSV typically peak in December, so aim to get vaccinated before the end of October.
• Account for Multiple States: If you moved states this year or have a child in college in another state, check both your home state's and your current state's vaccine schedules, as rules do not travel across state lines.

Neither Maryland nor Illinois added new vaccination mandates. School entry requirements remain set separately from recommendation schedules everywhere in the country, and Maryland's back-to-school immunization requirements for the 2026-2027 academic year are unchanged.

Maryland and Illinois join a growing group of states, including California, Colorado, Maine, and Massachusetts, that have decoupled their vaccine recommendations from federal guidance over the past year. What remains unresolved is how insurers outside state regulation will treat vaccines recommended by a state but not federally, whether more states will follow, and how pharmacies and electronic records will handle two schedules at once. Both states say they will update guidance as the season develops.

For most households, the reasonable next step is narrow: check which schedule your state publishes, confirm with your own plan whether a recommended vaccine is covered without cost-sharing, and book an appointment before the end of October, since full protection takes roughly two weeks and respiratory viruses typically peak in December.