Two states issued their own vaccine recommendations on the same day, and in Maryland's case it was the first time the state has ever done so. The Maryland Department of Health released 2026-2027 vaccine schedules for children and adults under authority created by a new state law, while the Illinois Department of Public Health adopted fall respiratory virus immunization guidance developed by its own expert committee.
The practical consequence for households is that the answer to a simple question, which vaccines are recommended for my child, now depends partly on which state you live in. Maryland's children's schedule lists 18 vaccines by age from birth to 18. Its adult schedule lists 16, organized for pregnancy and for age bands from 19 to 49, 50 to 64, and 65 and older.
Insurance is where the difference becomes concrete. Under Maryland's Vax Act, state-regulated health plans must cover routine immunizations recommended by the state with no out-of-pocket cost, and pharmacists may administer those vaccines to anyone age 3 or older without a prescription.
The Statutory Change That Made a State Schedule Possible
Maryland's schedule exists because of legislation rather than a memo. Gov. Wes Moore signed the Vax Act in April after it passed as House Bill 637 and Senate Bill 385, and it took effect July 1. The law gives the health secretary authority to establish official state recommendations for immunizations, screening and preventive services.
Health Secretary Meena Seshamani said Marylanders are facing back-to-school germs and the respiratory virus season "all while navigating shifting vaccine guidance from the federal government." Deputy Secretary of Public Health Services Meg Sullivan described the goal as consolidation, telling Maryland Matters in its coverage of the new schedule that the state wanted one place with clear recommendations to reduce confusion. Maryland says its guidance is anchored to recommendations from the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists, and it does not cite the CDC or the FDA as the basis for the schedule.
Maryland's guidance 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.
Illinois arrived at a similar place through a different route. Its guidance was adopted based on recommendations issued September 9 by the Illinois Immunization Advisory Committee, a 20-member panel spanning infectious diseases, pediatrics, family medicine, internal medicine, obstetrics and gynecology, nursing, pharmacy and public health. IDPH said the guidance responds to federal immunization actions it described as not rooted in scientific evidence.
Flu, RSV and Routine Shots Under the New Guidance
Illinois recommends flu vaccination for everyone 6 months and older. For RSV, it recommends vaccination for pregnant people during weeks 32 through 36 of pregnancy if not previously vaccinated, and extends the maternal vaccination season to run from September through March 1. It also recommends 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.
Illinois separately endorsed the routine, non-seasonal adult and maternal immunization schedules previously approved by leading medical associations. For children, IDPH tells pediatric providers to follow the American Academy of Pediatrics immunization schedule, which the state adopted in February.
Neither state added a new vaccination mandate. Maryland's back-to-school immunization requirements for the 2026-2027 academic year are unchanged. School entry requirements remain set separately from recommendation schedules everywhere in the country.
Maryland and Illinois join a group of states, including California, Colorado, Maine and Massachusetts, that have decoupled their vaccine recommendations from federal guidance over the past year.
Cost and Access Details Worth Checking Locally
The coverage guarantee in Maryland applies to state-regulated plans. Self-funded employer plans, which cover a large share of workers, are governed by federal law rather than state insurance rules, so 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 a state law requiring insurers to cover IDPH recommendations, which carries the same limitation.
Illinois points uninsured and underinsured residents to local health departments and to the state's vaccine locator dashboard for no-cost options. Residents can also track flu and COVID-19 vaccine coverage rates in their own county through the state's seasonal respiratory illness dashboard.
Pharmacy access is the other variable. Maryland's law lets pharmacists vaccinate anyone 3 and older without a prescription. That threshold means parents of younger children will generally still need a pediatric visit, which is worth planning around before clinics fill in October.
For most households, the reasonable 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 before the end of October, since full protection takes roughly two weeks and respiratory viruses typically peak in December.
Families who moved states this year, or who have a child in college in another state, should check both. A rule that governs a plan in Maryland does not travel, and a pharmacy in a state without a comparable law may ask for a prescription for a child who would not need one at home.
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.
Key Questions Answered
What did Maryland actually do? It issued its first state vaccine schedules for children and adults under the Vax Act, which took effect July 1 and gives the health secretary that authority.
Does this change school requirements? No. Maryland's back-to-school immunization requirements for 2026-2027 are unchanged, and recommendation schedules are separate from school entry rules.
Will my insurance cover a state-recommended vaccine? In Maryland, state-regulated plans must cover routine state-recommended immunizations with no out-of-pocket cost. Self-funded employer plans follow federal rules, so check directly.
Can a pharmacist give the shot? In Maryland, pharmacists may administer state-recommended vaccines to anyone age 3 or older without a prescription.
What does Illinois recommend for RSV in pregnancy? Vaccination during weeks 32 through 36 if not previously vaccinated, with the maternal season running September through March 1.
Where can uninsured residents get vaccinated? Illinois directs residents to local health departments and its vaccine locator dashboard. Maryland residents can contact their local health department.
When should someone get vaccinated? Before the end of October is the general guidance, since protection takes about two weeks and flu, COVID, and RSV typically peak in December.
