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The Immunization Rule

Produced by Massachusetts Law Reform Institute
Reviewed October 2023

Under the TAFDC immunization rules, applicants and recipients must show either their TAFDC eligible children are up to date with all immunizations or that there is a medical or religious reason to refuse immunizations. 

How does the immunization rule work?

When DTA notifies you about the immunization rule (usually when you first apply, when a child is born, and when your child turns 2), you have 60 days to bring in proof that your children's immunizations are up to date, or that you have an appointment scheduled with their doctor or clinic.

If your child is enrolled in school or a licensed child care provider, immunization is verified by:

  • proof of enrollment in a Head Start or licensed day care program (unless DTA pays for the Head Start or day care in which case DTA has the proof already), or
  • proof that your child is enrolled in school.

. If your child is not enrolled in school or a licensed child care provider, proof includes one of the following:

  • a DTA immunization form filled out by your child's health care provider
  • a letter from your child's health care provider that your child is up to date on immunizations
  • a copy of a MassHealth or other insurance bill showing that your child had a well-child visit within a year 
  • a well child visit summary (including screen shot from provider's online portal) or a bill or receipt from a well child visit dated within a year 
  • copy of immunizations record book 


If your child is under age two, you may be asked to show your child is still up-to-date on immunizations after he or she turns age two.

If you fail to bring in proof of up-to-date immunizations, or proof that you have an appointment scheduled, you will lose your portion of the TAFDC grant. You may also lose income deductions on any earnings and other DTA support services (transportation or child care) you need to work or go to school. If your provider has lost the records or cannot schedule an appointment for you, you can ask your DTA worker for help to get the documents or get an appointment for a well-child visit.

Your MassHealth should not be cut. But your SNAP will not increase if your TAFDC goes down due to an immunization sanction. 

Contact [email protected] if you are sanctioned. 

Are there any exceptions?

You are exempt from this rule if immunizing your kids is against your religious beliefs or you or your doctor believe it would be medically harmful for your child.

If you do not want your children immunized, be sure to tell your DTA worker. DTA says that there are 3 situations when you do not have to follow the immunization rule:

  • if the immunizations are against your religious beliefs (statement from you)
  • if a doctor says in writing that your child should not be immunized for medical reasons
  • if you believe that there is a health risk from the immunizations after discussing this with a doctor (statement from you)

In all of these situations, you must give DTA this information in writing.

If you need help finding a doctor

You will receive MassHealth coverage automatically with your TAFDC benefits. MassHealth will pay for all required shots, as well as checkups and other medical services. If you need help finding a doctor, call MassHealth. Ask them to give you the name of a MassHealth doctor. You can also call your local neighborhood healthcenter or hospital pediatric clinic for information and help.

If you want to challenge denial of benefits

Ask your DTA worker for help getting immunization records if you needhelp. Under the TAFDC rules, the worker must help if you need help and ask for it. If you get a written notice saying your TAFDC benefits will be reduced because of this rule, you have the right to a hearing. If your worker refused your request for help in getting proofs, be sure to tell this to the hearings officer.

If your benefits are being reduced and you appeal within 10 days of thedate of the notice, your benefits will continue during the appeal. Be sure to bring with you any proofs that might help your case. You have a right to see your DTA case record and make copies of any documents in your file. You also have the right to bring a friend or advocate with you.

Find legal help

Free Legal Services may be available to give you more advice or representation. Contact the local Legal Services program in your community for help.

Find Legal Aid

You may be able to get free legal help from your local legal aid program. Or email a question about your own legal problem to a lawyer.

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