A sign at a University of Utah health clinic warns visitors about the spread of measles. Under the Trump administration, federal health officials have cut back the number of recommended vaccines, and more states are offering exemptions for parents who don't want to vaccinate children entering public schools. (Photo by McKenzie Romero/Utah News Dispatch)

States that were leaders in childhood vaccination before the pandemic are among those losing ground as exemptions and unfounded skepticism take hold, encouraged by the Trump administration’s stance under U.S. Health and Human Services Secretary Robert F. Kennedy Jr.

Expanded exemptions for parents are likely to drop both Mississippi and West Virginia from the top national rankings they held before the pandemic, according to a Stateline analysis of federal data. Other states like Florida, Idaho, Louisiana and Montana also are pushing the envelope on vaccine choice.

At least 33 states were below herd immunity in the 2024-25 school year, compared with 28 states before the pandemic in 2018-2019, the analysis found. Herd immunity refers to the percentage of people who must be vaccinated or otherwise immune from an infectious disease to limit its spread.

Research shows that in the case of measles — a highly contagious disease — states need to maintain at least 95% vaccination rates to protect people who can’t get vaccinated. Other diseases have similar herd immunity rates. People who can’t be vaccinated might include infants too young to receive certain vaccines and those with underlying health conditions.

Misinformation and expressions of distrust from influential leaders have an effect on parents, doctors say, as do new state exemptions making it easier for families to avoid the vaccines.

Some people who never questioned vaccines before notice a national debate and get confused, said Dr. Patricia Tibbs, a pediatrician in rural Mississippi and president of the Mississippi chapter of the American Academy of Pediatrics. New religious exemptions may already be fueling an increase in pertussis, also known as whooping cough, in Mississippi, she said.

“If they hear something about it in the news, then it must be right, they think,” Tibbs said. “We’re just following the guidelines and informing patients that this is a scientific discussion. Nothing has changed about the science. But people who don’t know science are making decisions.”

Under Kennedy’s leadership, federal support for vaccination has continued to slide, and many states have joined a movement to set their own course by following more science-based recommendations from doctors. On Jan. 26 the Governors Public Health Alliance, a group of 15 Democratic governors, endorsed child and adolescent vaccination standards from the American Academy of Pediatrics rather than the federal government.

Federal health officials in Trump’s administration have cut back the number of recommended vaccines. The chair of a vaccine advisory committee, pediatric cardiologist Kirk Milhoan, suggested in a Jan. 22 podcast that individual freedom was more important than protecting community health with vaccines, even for measles and polio.

New leading states

Before the pandemic, Mississippi and West Virginia had the highest kindergarten vaccination rates in the nation, according to the Stateline analysis. About 99% of kindergartners in each state had their required vaccinations before entering public schools in the 2018-2019 school year.

In the latest statistics for the 2024-25 year, Connecticut gained the No. 1 spot, followed by New York and Maine. Those states have reined in exemptions to school vaccine requirements, while Mississippi and West Virginia have begun to allow more exemptions.

West Virginia didn’t report vaccinations to the federal Centers for Disease Control and Prevention for the 2024-25 school year. The state department of health told Stateline the data wouldn’t be available until later this year.

But the state is likely to be pushed out of the top 10. Republican Gov. Patrick Morrisey issued an executive order a year ago giving parents the right to ask for religious exemptions. To date, the state has approved 693 such requests for the current school year, spokesperson Gailyn Markham wrote in an email. That alone is enough to shift the state’s ranking significantly.

Stateline computed an average of required kindergarten vaccination rates to compare states. The analysis uses 2018-19 as a pre-pandemic baseline because a large number of states did not report the information in 2019-20 in the chaos that followed the early COVID-19 spikes and school closings.

A January study published by JAMA Pediatrics found increased vaccination rates among kindergartners in states that had repealed nonmedical exemptions, suggesting the repeals “played a role in maintaining vaccination coverage in repeal states during a period of heightened vaccine hesitancy.”

Requirements and exemptions

All 50 states and the District of Columbia require students to have certain vaccines before attending public school. They also all allow exemptions for children who cannot receive vaccinations for medical reasons, and most states allow nonmedical exemptions, often for religious or sometimes personal reasons. But Florida Republican Gov. Ron DeSantis’ administration has proposed dropping all requirements, and Idaho enacted a 2025 law allowing vaccination exemptions for any reason. Idaho had the lowest rate of kindergarten vaccination, about 80% in the 2024-25 school year before the law took effect in July last year.

Louisiana in 2024 enacted a law dropping COVID-19 vaccine requirements for public schools, and the state has opted to halt publicity about flu vaccination and end public vaccine clinics.

A Florida bill that progressed out of committee in January would maintain school vaccine requirements but expand exemptions to include “conscience” as well as medical and religious reasons.

Dr. Jennifer Takagishi, a Tampa pediatrician and vice president of the Florida chapter of the American Academy of Pediatrics, said the organization opposes both the DeSantis administration proposal to revoke vaccine requirements and the bill that would expand exemptions. Florida’s kindergarten vaccination rate fell from 94% before the pandemic to about 90% in 2024-25, according to the Stateline analysis.

“They’re ignoring the 90% of their constituents who want vaccines and want to stay safe,” said Takagishi. “The legislators are listening to the louder voice of those who want to oppose vaccines instead of the majority. We also know that there are teachers in the school system and school nurses who are fighting this because it puts them at risk.”

All states except Montana report kindergarten vaccine statistics to the federal government. Montana enacted a 2021 law making vaccine status private and unavailable for statistical reports, over the objections of medical experts. The law also made medical exemptions easier for families who think their children have been injured by vaccines.

Dr. Lauren Wilson, a pediatrician and then-vice president of the Montana chapter of the American Association of Pediatrics, said in a hearing that the law would make “vaccination information unavailable for responding to and mitigating public health emergencies.”

“Vaccines have saved millions of lives. I personally have seen cases of tetanus, pertussis, measles and meningitis and the tragedies that these mean for families,” Wilson said in her testimony.

A 2023 court order forced Mississippi to accept religious exemptions. West Virginia allows religious exemptions following the governor’s order last year.

Tibbs, who practices pediatrics in rural Jones County, Mississippi, said she has been seeing more pertussis than usual, and thinks vaccine exemptions could be a factor.

In Mississippi, which reported 394 religious exemptions for the 2024-25 school year, overall rates remained high enough that year, at about 97.8%, to ensure “herd immunity” in most cases.

Mississippi has granted 617 religious vaccination exemptions for kindergartners this school year, about 1.8% of the class, according to Amanda Netadj, immunizations director for the state health department. About 96.3% of kindergartners have all required vaccinations this year.

But the state’s whooping cough cases last year were the highest they’d been in at least decade, and in September health officials announced an infant had died of the disease — the state’s first whooping cough death in 13 years.

“We do have a lot of people getting the religious exemption,” Tibbs said. ”But still, on any given day, the majority of my patients will still get their vaccines. We are keeping our fingers crossed that the numbers stay high enough.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Many candies contain Red No. 40, Yellow No. 5 and Yellow No. 6. They are among the food dyes banned in West Virginia by a measure signed into law in March. Such bans are just one example of how the "Make America Healthy Again" movement has made inroads in state legislatures. (Photo by Carol Johnson/Stateline)

This article first appeared on KFF Health News.

When one of Adam Burkhammer’s foster children struggled with hyperactivity, the West Virginia legislator and his wife decided to alter their diet and remove any foods that contained synthetic dyes.

“We saw a turnaround in his behavior, and our other children,” said Burkhammer, who has adopted or fostered 10 kids with his wife. “There are real impacts on real kids.”

The Republican turned his experience into legislation, sponsoring a bill to ban seven dyes from food sold in the state. It became law in March, making West Virginia the first state to institute such a ban from all food products.

The bill was among a slew of state efforts to regulate synthetic dyes. In 2025, roughly 75 bills aimed at food dyes were introduced in 37 states, according to the National Conference of State Legislatures.

Chemical dyes and nutrition are just part of the broader “Make America Healthy Again” agenda. Promoted by Health and Human Services Secretary Robert F. Kennedy Jr., MAHA ideas have made their deepest inroads at the state level, with strong support from Republicans — and in some places, from Democrats. The $50 billion Rural Health Transformation Program — created last year as part of the GOP’s One Big Beautiful Bill Act to expand health care access in rural areas — offers incentives to states that implement MAHA policies.

Federal and state officials are seeking a broad swath of health policy changes, including rolling back routine vaccinations and expanding the use of drugs such as ivermectin for treatments beyond their approved use. State lawmakers have introduced dozens of bills targeting vaccines, fluoridated water and PFAS, a group of compounds known as “forever chemicals” that have been linked to cancer and other health problems.

In addition to West Virginia, six other states have targeted food dyes with new laws or executive orders, requiring warning labels on food with certain dyes or banning the sale of such products in schools. California has had a law regulating food dyes since 2023.

Most synthetic dyes used to color food have been around for decades. Some clinical studies have found a link between their use and hyperactivity in children. And in early 2025, in the last days of President Joe Biden’s term, the Food and Drug Administration outlawed the use of a dye known as Red No. 3.

Major food companies including Nestle, Hershey  and PepsiCo have gotten on board, pledging to eliminate at least some color additives from food products over the next year or two.

“We anticipate that the momentum we saw in 2025 will continue into 2026, with a particular focus on ingredient safety and transparency,” said John Hewitt, the senior vice president of state affairs for the Consumer Brands Association, a trade group for food manufacturers.

This past summer, the group called on its members to voluntarily eliminate federally certified artificial dyes from their products by the end of 2027.

“The state laws are really what’s motivating companies to get rid of dyes,” said Jensen Jose, regulatory counsel for the Center for Science in the Public Interest, a nonprofit health advocacy group.

Andy Baker-White, the senior director of state health policy for the Association of State and Territorial Health Officials, said the bipartisan support for bills targeting food dyes and ultraprocessed food struck him as unusual. Several red states have proposed legislation modeled on California’s 2023 law, which bans four food additives.

“It’s not very often you see states like California and West Virginia at the forefront of an issue together,” Baker-White said.

Although Democrats have joined Republicans in some of these efforts, Kennedy continues to drive the agenda. He appeared with Texas officials when the state enacted a package of food-related laws, including one that bars individuals who participate in the Supplemental Nutrition Assistance Program — SNAP or food stamps — from using their benefits to buy candy or sugary drinks. In December, the U.S. Department of Agriculture approved similar waivers sought by six states. Eighteen states will block SNAP purchases of those items in 2026.

There are bound to be more. The Rural Health Transformation Program also offers incentives to states that implemented restrictions on SNAP.

“There are real and concrete effects where the rural health money gives points for changes in SNAP eligibility or the SNAP definitions,” Baker-White said.

In October, California Gov. Gavin Newsom signed a bill that sets a legal definition for ultraprocessed foods and will phase them out of schools. It’s a move that may be copied in other states in 2026, while also providing fodder for legal battles. In December, San Francisco City Attorney David Chiu sued major food companies, accusing them of selling “harmful and addictive” products. The lawsuit names specific brands — including cereals, pizzas, sodas and potato chips — linking them to serious health problems.

Kennedy has also blamed ultraprocessed foods for chronic diseases. But even proponents of the efforts to tackle nutrition concerns don’t agree on which foods to target. MAHA adherents on the right haven’t focused on sugar and sodium as much as policymakers on the left. The parties have also butted heads over some Republicans’ championing of raw milk, which can spread harmful germs, and the consumption of saturated fat, which contributes to heart disease.

Policymakers expect other flash points. Moves by the FDA and the Centers for Disease Control and Prevention that are making vaccine access more difficult have led blue states to find ways to set their own standards apart from federal recommendations, with 15 Democratic governors announcing a new public health alliance in October. Meanwhile, more red states may eliminate vaccine mandates for employees; Idaho made them illegal. And Florida Gov. Ron DeSantis is pushing to eliminate school vaccine mandates.

Even as Kennedy advocates eliminating artificial dyes, the Environmental Protection Agency has loosened restrictions on chemicals and pesticides, leading MAHA activists to circulate an online petition calling on President Donald Trump to fire EPA Administrator Lee Zeldin.

Congress has yet to act on most MAHA proposals. But state lawmakers are poised to tackle many of them.

“If we’re honest, the American people have lost faith in some of our federal institutions, whether FDA or CDC,” said Burkhammer, the West Virginia lawmaker. “We’re going to step up as states and do the right thing.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.

President Donald Trump displays a signed bill in the Oval Office on Jan. 14, 2026. Trump signed the Whole Milk for Healthy Kids Act, which restores whole milk to school lunches across the country. (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — President Donald Trump signed a law Wednesday that will restore whole milk in federally subsidized school lunches.

The dairy staple — out of school meal programs for more than a decade amid a broader push to curb childhood obesity — will soon return to school cafeterias under the law. 

Trump said during a signing ceremony in the Oval Office that the Whole Milk for Healthy Kids Act will “ensure that millions of school-aged children have access to high-quality milk as we make America healthy again.” 

Seated with a jug of milk on the Resolute Desk, Trump said the changes will also be “major victories for the American dairy farmers who we love and who voted for me in great numbers.” 

White House ceremony

Agriculture Secretary Brooke Rollins celebrated the legislation becoming law and said her department would post Wednesday the “new rulemaking that is necessary to get whole milk back into school lunches.” 

Health and Human Services Secretary Robert F. Kennedy Jr. also lauded Trump’s efforts and described the measure as a “long overdue correction of the school nutrition policy that puts children’s health first.” 

Trump was also joined by Dr. Ben Carson, national advisor for nutrition, health, and housing at USDA, along with Democratic Sen. Peter Welch of Vermont, GOP Sens. John Boozman of Arkansas, Mike Crapo of Idaho and Roger Marshall of Kansas, Commerce Secretary Howard Lutnick and advocates who supported the bill.

Rep. Glenn “GT” Thompson of Pennsylvania, who chairs the House Agriculture Committee, and Rep. Tim Walberg of Michigan, chair of the House Committee on Education and Workforce, also attended the ceremony. 

The U.S. House passed the bill in December, following unanimous passage in the Senate in November. 

Welch and Marshall, along with Pennsylvania Sens. Dave McCormick, a Republican, and John Fetterman, a Democrat, introduced the measure in the Senate. 

Thompson and Democratic Rep. Kim Schrier of Washington state brought corresponding legislation in the House.

What the new law does 

Under the law, schools that are part of the USDA’s National School Lunch Program can offer “flavored and unflavored organic or nonorganic whole, reduced-fat, low-fat, and fat-free fluid milk and lactose-free fluid milk.” 

The program — which provides free or low-cost lunches in public and nonprofit private schools and residential child care institutions — saw nearly 29.4 million children participate on a typical day during the 2023-2024 school year, according to the Food Research & Action Center.

The schools can also provide “nondairy beverages that are nutritionally equivalent to fluid milk and meet the nutritional standards established by” the Agriculture secretary.

The law exempts milk fat from being considered saturated fat as it applies to schools’ “allowable average saturated fat content of a meal.” 

Parents and guardians, as well as physicians, can also offer a written statement for their student to receive a nondairy milk substitute. 

Michael Dykes, president and CEO of the International Dairy Foods Association, celebrated the bill becoming law in a Wednesday statement.

Dykes dubbed the law a “win for our children, parents, and school nutrition leaders, giving schools the flexibility to offer the flavored and unflavored milk options, across all healthy fat levels, that meet students’ needs and preferences.” 

The signing marked the second major nutrition policy change this month. The U.S. Department of Agriculture and U.S. Department of Health and Human Services released the 2025-2030 Dietary Guidelines for Americans, which encourages more full-fat dairy and protein.  

Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz speaks at the Department of Health and Human Services in Washington, D.C., on Dec. 18, 2025. Oz and other Trump administration officials announced proposed rules that would limit gender-affirming care for minors. (Photo by Alex Wong/Getty Images)

WASHINGTON — President Donald Trump’s administration took major steps Thursday in a campaign to block minors’ access to gender-affirming care nationwide. 

Under two proposed new rules from the Centers for Medicare and Medicaid Services, hospitals would be barred from providing gender transition treatment for children as a condition of participating in Medicare and Medicaid programs, and Medicaid funding would be prohibited from being used to fund such care for minors. 

As most hospitals receive Medicare and Medicaid funding, the rules would essentially have the effect of a nationwide ban if they are finalized. 

The announcement came a day after the U.S. House passed a bill that would impose federal criminal penalties for gender-affirming care for minors and hours before it advanced a separate measure that would prohibit Medicaid funding for gender transition treatment for minors. 

The proposed regulations, which will next undergo a period of public comments, are certain to draw legal challenges.

The efforts build on Trump’s executive order in January that restricted access to gender-affirming care for kids. 

More than half of states already have laws or policies aimed at limiting youth access to gender-affirming care, according to the nonpartisan health research organization KFF. 

Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced the proposals alongside several other health officials at a press conference at HHS headquarters in Washington, D.C. 

The room featured a handful of GOP members of Congress. At least two Republican state attorneys general — Ken Paxton of Texas and Todd Rokita of Indiana — were also in attendance.

At the press conference, Food and Drug Administration Commissioner Dr. Marty Makary said the FDA is also sending “warning letters” to 12 breast binder manufacturers and sellers for “illegal marketing of breast binders for children for the purposes of treating gender dysphoria.” 

Breast binders are used to flatten tissue in the chest.  

Kennedy said his agency’s Office for Civil Rights is moving to “reverse the Biden administration’s attempt to include gender dysphoria within the definition of disability.” 

House passes anti-transgender bills 

The proposed rules are part of the Trump administration’s broader anti-trans agenda. 

Trump has signed executive orders that make it the “policy of the United States to recognize two sexes, male and female,” aimed to bar openly transgender service members from the U.S. military, and sought to prohibit trans athletes from competing on women’s sports teams consistent with their gender identity.

Meanwhile, efforts at the congressional level to restrict youth access to gender-affirming care face a dismal path in the Senate, where any legislation would likely need the backing of at least 60 senators to advance past the filibuster.

The House passed a measure Wednesday night, 216-211, that would subject medical professionals to up to 10 years in prison for providing gender-affirming care for minors. 

Rep. Marjorie Taylor Greene, who sponsored the legislation, called its passage a “win for children all over America,” in a social media post Wednesday. 

It’s likely the last legislative achievement for the Georgia Republican, who is resigning from Congress in early January. 

Four Republicans voted against the measure: Reps. Gabe Evans of Colorado, Brian Fitzpatrick of Pennsylvania, Mike Kennedy of Utah and Mike Lawler of New York.

Three Democrats voted with the GOP to back the bill: Reps. Henry Cuellar and Vicente Gonzalez of Texas and Don Davis of North Carolina.

The House also passed a measure Thursday, 215-201, from Texas GOP Rep. Dan Crenshaw and Greene that aims to prohibit “Medicaid funding for gender transition procedures for minors.” 

Cuellar, Gonzalez and Davis also backed the GOP-led bill, along with fellow Democratic Rep. Marie Gluesenkamp Perez of Washington state. 

‘Cruel and unconstitutional attacks’ 

Kelley Robinson, president of the Human Rights Campaign, an LGBTQ+ advocacy group, blasted the administration’s proposals, saying they “would put Donald Trump and RFK Jr. in those doctor’s offices, ripping health care decisions from the hands of families and putting it in the grips of the anti-LGBTQ+ fringe.”  

Robinson also emphasized that the rules are “proposals, not binding law,” and called on community members, health care providers, administrators and allies to “be vocal in pushing back by sharing the ways these proposals would be devastating to their families and the healthcare community at large.” 

The American Civil Liberties Union also condemned the administration’s proposals and vowed to challenge the efforts in court. 

Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Rights Project, dubbed the proposals “cruel and unconstitutional attacks on the rights of transgender youth and their families.” 

Strangio said the proposals would “force doctors to choose between their ethical obligations to their patients and the threat of losing federal funding” and “uproot families who have already fled state-level bans, leaving them with nowhere to turn for the care they need to survive and thrive.”

Cows graze at Nice Farms Creamery in Federalsburg, Maryland.  (Photo by Preston Keres/USDA)

WASHINGTON — The U.S. Department of Agriculture will spend $700 million to support regenerative agriculture as part of the Make America Healthy Again agenda, Agriculture Secretary Brooke Rollins and Health and Human Services Secretary Robert F. Kennedy Jr. announced Wednesday. 

The USDA pilot program for regenerative agriculture — a conservation management approach centered on improving the health of soil and increasing biodiversity — enacts part of President Donald Trump’s administration’s September “Make Our Children Healthy Again Strategy,” which offered more than 120 recommendations for addressing childhood chronic diseases.  

The pilot program will take funding from existing USDA conservation programs, which provide financial and technical assistance to farmers, with the aim of improving soil health.

“Protecting and improving the health of our soil is critical, not only for the future viability of farmland, but to the future success of American farmers,” Rollins said at a press conference alongside Kennedy and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz. 

“In order to continue to be the most productive and most efficient growers in the world, we must protect our topsoil from unnecessary erosion and boost the microbiome of the soil,” Rollins said.

Kennedy said a September report from the administration’s Make America Healthy Again Commission, which the health secretary chairs, included “the promise to make it easier for farmers in this country, to give them an off-ramp — farmers who are dependent on … chemical and fertilizer inputs — to give them an off-ramp where they can transition to a model that emphasizes soil health.” 

Kennedy has long advocated against use of chemicals in farming.

Repurposing funding

The department will dedicate $400 million to the initiative through the department’s Environmental Quality Incentives Program and $300 million from its Conservation Stewardship Program, according to a USDA press release.

“It’s baseline funding that we received through our budget, so we have the ability to tag that funding specifically for this pilot, and that’s what we’re doing,” Aubrey J.D. Bettencourt, chief of USDA’s Natural Resources Conservation Service, or NRCS, said.

Rollins also said she would seek corporate partners for the program using a 2022 law that authorizes USDA to channel private contributions to conservation programs. 

The move “will bring corporate label and supply chain partners directly into partnership” with NRCS, Rollins said.

The pilot program “connects the producer and the work that they’re doing on the farm, granting them the credit for that voluntary action of change in practice on their farm that then can transition into the supply chain, into the marketplace and directly back to the consumer,” Bettencourt said. 

SNAP waivers 

Meanwhile, Rollins and Kennedy also announced Wednesday six more states whose waivers were approved to prohibit Supplemental Nutrition Assistance Program, or SNAP, benefits from being used to purchase certain non-nutritious items beginning in 2026. 

The effort, also part of the Make America Healthy Again agenda, adds Hawaii, Missouri, North Dakota, South Carolina, Virginia and Tennessee to the list of states that will have such bans. 

The bans restrict which items recipients of the federal food assistance program that helps 42 million Americans afford groceries can buy with their SNAP benefits.

Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Louisiana, Nebraska, Oklahoma, Texas, Utah and West Virginia already have similar incoming bans.