Are CNAs Still Required to Get the COVID Vaccine?

As of 2026, CNAs are not required to get the COVID-19 vaccine under federal law. The Centers for Medicare and Medicaid Services withdrew its staff vaccination rule on August 4, 2023, and has not replaced it.¹ Whether you personally need the vaccine now depends on your employer’s policy and, in a small number of states, on rules that may still be on the books.

Your Employer Can Still Require It

This is where most CNAs run into a vaccine requirement today. Large hospital systems and nursing home chains have kept their own COVID-19 vaccination policies in place independent of any government mandate, and courts have consistently recognized an employer’s authority to set health and safety conditions for the workforce. The legal basis is straightforward: employers have a duty to maintain a safe workplace, and vaccination policies for staff in direct patient contact fit within that duty.

An employer policy must still comply with two federal anti-discrimination laws: the Americans with Disabilities Act, which requires reasonable accommodations for workers who cannot be vaccinated for medical reasons, and Title VII of the Civil Rights Act of 1964, which requires the same for workers with sincerely held religious beliefs against vaccination.² The EEOC has actively enforced these protections. Mercyhealth paid over $1 million to settle EEOC charges that it discriminated against employees by denying religious accommodations to its COVID-19 vaccine requirement.³

One point worth clearing up: HIPAA does not stop your employer from asking whether you have been vaccinated. The HIPAA Privacy Rule applies to health plans, healthcare clearinghouses, and providers conducting electronic transactions, not to an employer asking about your status.⁴ Your employer can ask for proof and keep records. Any medical information you provide as part of an exemption request should be kept in a confidential file separate from your regular personnel records, consistent with ADA requirements.

State Rules Vary and Keep Changing

States have their own authority over healthcare worker vaccination, and the picture has shifted since the early pandemic. Between September 2021 and March 2022, 15 states issued COVID-19 vaccine requirements for healthcare workers. Some required vaccination or termination with only medical or religious exceptions. Others allowed regular testing as an alternative.

Most of those state mandates were tied to the emergency conditions of the pandemic and have since expired, been repealed, or stopped being enforced. Several states went the other direction and passed laws prohibiting employers or government agencies from requiring COVID-19 vaccination. A small number of states may still have active requirements on the books. Because this area continues to move, checking with your state health department or nursing board is the only reliable way to know what applies where you work.

Medical and Religious Exemptions

Where a vaccine requirement exists, two types of exemptions are generally available. Personal or philosophical objections do not qualify for protection under federal law.

Medical Exemptions

A medical exemption applies when a healthcare provider determines that vaccination poses a risk to you because of a specific condition, such as a documented severe allergic reaction to a vaccine component or an immune condition where vaccination could cause harm. You will need documentation from your provider explaining the medical basis and expected duration of the contraindication. If the exemption is granted, your employer must offer a reasonable accommodation. That might mean enhanced masking, regular testing, or reassignment to a role with less direct patient exposure.

Religious Exemptions

Under Title VII, your employer should generally proceed on the assumption that a religious accommodation request is sincere. If the employer has an objective basis for questioning the sincerity or religious nature of the belief, it can make a limited factual inquiry. Factors that might undermine credibility include behaving inconsistently with the stated belief, requesting the accommodation only after a secular request for the same benefit was denied, or other circumstances suggesting the objection is not genuinely religious.²

Political views, concerns about side effects that are not rooted in religious belief, and general distrust of pharmaceutical companies do not qualify as religious objections under federal law. The belief does not need to be part of an organized religion, but it must be part of a comprehensive belief system rather than an isolated personal preference.

What Happens If You Refuse

If your employer requires COVID-19 vaccination and you refuse without an approved exemption, the most likely consequence is termination. Healthcare employers have generally been upheld in their right to enforce vaccination as a job requirement, and most courts have treated refusal to comply with a workplace health policy as a legitimate basis for separation.

Unemployment benefits after a vaccine-related termination are not guaranteed. Many states treat failure to comply with an employer’s policy as misconduct, which can disqualify you from benefits. Some states have carved out exceptions, particularly when the vaccine requirement was a new policy added after you were hired, or when a valid exemption was denied before termination. The outcome depends heavily on your state’s unemployment laws and the specific facts.

Refusing the vaccine does not, by itself, put your CNA certification at risk. State nursing aide registries track training, competency testing, and findings of abuse or neglect. No state ties CNA certification to COVID-19 vaccination status. You could lose a job over a vaccine dispute and still hold a valid certification that lets you work elsewhere.

If you believe your employer denied a legitimate medical or religious exemption request, you can file a charge of discrimination with the EEOC. The agency has investigated and resolved multiple cases involving COVID-19 vaccine mandates, and employers that improperly deny accommodations face potential liability for back pay and compensatory damages.³

Why the Federal Mandate No Longer Applies

From November 2021 until August 2023, CMS required COVID-19 vaccination for staff at Medicare- and Medicaid-participating facilities, including hospitals, skilled nursing facilities, home health agencies, hospices, and long-term care facilities. CNAs fell squarely within scope.⁵

The federal COVID-19 Public Health Emergency expired on May 11, 2023.⁶ CMS then published a final rule on June 5, 2023, formally withdrawing the staff vaccination requirement, and the withdrawal took effect August 4, 2023.¹ After that date, no Medicare- or Medicaid-participating facility was required to enforce COVID-19 vaccination as a condition of federal program participation, and no replacement rule has been issued. If someone tells you the CMS mandate still applies to CNAs, it does not.

1
Federal Register. Medicare and Medicaid Programs; Policy and Regulatory Changes to the Omnibus COVID-19 Health Care Staff Vaccination Requirements
2
U.S. Equal Employment Opportunity Commission. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws
3
U.S. Equal Employment Opportunity Commission. Mercyhealth to Pay Over $1 Million to Settle EEOC COVID-19 Vaccine Mandate Related Religious Discrimination Charges
4
U.S. Department of Health and Human Services. HIPAA, COVID-19 Vaccination, and the Workplace
5
Centers for Medicare & Medicaid Services. Revised Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination
6
U.S. Department of Health and Human Services. COVID-19 Public Health Emergency