Vaccine schedule overhaul could put coverage at risk, state official says

With the federal childhood immunization schedule tied up in court, health systems and health plans face a question few have had to plan for: What happens if insurance coverage stops following federal vaccine recommendations?

In January, HHS cut the number of routinely recommended childhood vaccines from 17 to 11 and moved others into high-risk or shared clinical decision-making categories. A federal judge stayed the change in March in a lawsuit brought by the American Academy of Pediatrics (AAP) and other medical groups, and the government's appeal is pending before the U.S. Court of Appeals for the First Circuit.

Jamilia Sherls, DNP, director of the Office of Immunization at the Washington State Department of Health, said the revised schedule could still become reality, with consequences for coverage under private plans and the federal Vaccines for Children program.

In an interview with Managed Healthcare Executive at the 2026 Health System Executive Summit, Sherls discussed how health systems can track that coverage risk, why she points them to schedules from the AAP and other professional societies and how clinicians can keep patients' trust amid conflicting guidance. Some views she shared are her professional opinion rather than the agency's position.

This interview has been edited for length and clarity.

MHE: Over the past year, federal vaccine policy has shifted quickly, with new ACIP [Advisory Committee on Immunization Practices] membership, revised recommendations and executive orders. What's the single most consequential change health system leaders may not yet fully appreciate?

Sherls: There have been several changes across the immunization landscape, mostly in regard to policy. I think the most important thing for health care systems to be aware of, which could lead to some pretty big changes for the patients they take care of, is the overhaul of the U.S. child and adolescent immunization schedule. It currently stayed—held up in federal court in the AAP lawsuit against HHS—but it still has the potential to become reality.

In that schedule, the total number of recommended vaccines went from 17 to 11. So technically, there are only 11 recommended vaccines on that schedule. Other vaccines that used to be on the typical CDC schedule are still there, but they are categorized differently. Some vaccines are recommended only for high-risk children, and some are not recommended but can still be given through shared clinical decision-making between a provider and a patient.

The issue is that if this becomes reality, there are implications for insurance coverage. Right now, health plans are required to cover ACIP-recommended vaccines. Of course, those recommendations have to be approved by the CDC director to be put on the schedule, but plans are required to cover them. If a vaccine falls out of that bucket and it's not technically recommended, they technically don't have to cover it, and that could have huge implications for population health and the patients health care systems take care of.

We also have the Vaccines for Children [VFC] program, a federally run program through which kids who are underinsured, uninsured, on Medicaid or identify as American Indian or Alaska Native can receive vaccines. Immunizations under the VFC program are covered only through ACIP, so if ACIP isn't recommending something, it's not going to be on the VFC schedule. That would affect our nation's most vulnerable children and could lead to disparities and inequities. So on the horizon, this is a possibility health care systems should be tracking and monitoring carefully.

MHE: How should health systems interpret and respond to a policy change that isn't evidence-driven?

Sherls: I will say that this is my professional opinion, not technically the agency's standpoint. But I feel that when there are policy changes, especially some that may not be grounded in the evidence, health care systems should continue to strive for evidence-based practices and recommendations grounded in the science. In looking at the new recommendations, or any recommendations that could come in the future, it's important to look at the rationale and scientific justification behind them.

I think it's best to always look to the American Academy of Pediatrics for child and adolescent immunization recommendations. This organization is fully committed to the science and to evidence-based practice for the best care of kids. My advice would be to look at what their recommendations are and whether they differ at all from any future U.S. federal immunization recommendations.

MHE: Insurance coverage is holding steady through this plan year despite the schedule changes. What happens to access and affordability if coverage eventually decouples from federal recommendations, and how exposed are health systems to that risk?

Sherls: If insurance coverage eventually decouples from the U.S. child and adolescent immunization schedule, again, it could have some pretty grave [consequences] for populations. Some of our most vulnerable kids are not going to be able to receive vaccines through the Vaccines for Children program, and the same goes for other kids who might be covered by employer-based insurance. It would then perhaps allow only kids from privileged families to access vaccines—and that's if their provider still wants to carry those vaccines if they're no longer recommended. So there are a lot of different factors to consider.

The overall population health implications are pretty grave. Health care systems could potentially see increased incidence of vaccine-preventable diseases in their patient population, which could lead to a variety of other poor outcomes as well. So I think it'sreally important for health care systems to be tracking these policies, better understanding coverage and working closely with the major insurance plans to verify and confirm coverage.

MHE: Coalitions such as the West Coast Health Alliance, and state laws shifting recommendation authority to state health departments, are emerging as alternatives to federal guidance. If the federal schedule isn't grounded in evidence, what's the next logical step for health systems?

Sherls: If the current U.S. child and adolescent immunization schedule is not evidence-based—and right now it's not—the next logical step for health care systems would be to look to professional organizations such as the American Academy of Pediatrics, the American Academy of Family Physicians and other professional medical bodies to see what vaccine schedules they are promoting. Usually, the vaccine schedules are pretty aligned among the professional organizations. I think the best thing to do in those scenarios would be to look at incorporating and adopting those schedules into the systems and asking your providers to use them to take care of patients.

And of course, if a health care system happens to be in a state that'sparticipating in the West Coast Health Alliance or other regional alliances, it should also make sure its vaccine recommendations align with the spirit of those recommendations. I will say that those regional alliances also carefully look at immunization schedules and recommendations from the professional bodies I mentioned.

MHE: With mixed signals coming from federal, state and professional bodies, how should health systems talk to patients in a way that maintains trust rather than adding to the confusion?

Sherls: There's obviously a lot of confusion out there right now in regard to immunization schedules and recommendations. I think the most important thing providers and health care systems can do is listen to their patients. Several surveys and studies have shown that providers and health care systems tend to be patients' most trusted source of health care information, so providers are in a position to capitalize on that trust.

It starts with listening and acknowledging that there's a lot of information out there right now around immunizations—listening to patients' concerns and answering their questions. Providers may want to tailor the messaging around personal values, or personalize it in a way that makes it easier for patients to visualize themselves making a decision about vaccines.

I also think it's going to be really important to make sure practices have culturally appropriate resources that give the facts about vaccines and are translated into the languages commonly spoken in the population the health care system serves. After that conversation, the patient may be ready to be vaccinated, but sometimes that doesn't happen, and it might take several visits before a patient feels comfortable receiving vaccines. Each conversation does help, and it's going to be really important for health care providers to invest in having those genuine conversations with their patients.