Craig Moore of Sumner gets a bandage after his first dose of the Moderna COVID-19 vaccine from Everett Flannery, paramedic with Redington-Fairview EMS, at the Skowhegan State Fair on Aug. 20, 2021. Credit: Linda Coan O'Kresik / BDN

Overlapping federal and state COVID-19 vaccine mandates could cover at least 2 out of 5 Maine workers by the end of the year, boosting efforts to increase the state’s vaccination rate as the highly contagious virus continues to rage here.

But the timeframe for several of those regulations is uncertain and legal challenges remain, with questions about religious exemptions and federal jurisdiction expected to play out in Maine and other states in the coming months.

Maine workers could fall under one of several vaccine mandates this fall. The state will begin enforcing a vaccine requirement for all health care workers, including paramedics and hospital and nursing home employees, by the end of October. A similar federal mandate for workers at facilities receiving Medicare or Medicaid funding could go into effect shortly thereafter.

A separate federal regulation will require all workers at companies employing more than 100 people to get vaccinated later this fall or submit to weekly COVID-19 testing. That affects at least 169,000 workers at private Maine companies as well as all state and local government employees, including public school teachers.

In total, more than 40 percent of Maine’s roughly 640,000-person workforce is covered by at least one of these mandates, according to data from the state’s labor department. Some private employers also have their own vaccine requirements.

Maine already has among the highest vaccination rates of any U.S. state, with about two-thirds of people between the ages of 20 and 59 having received at least one dose, according to state data. But tens of thousands of Maine workers who are not yet vaccinated will be subject to the mandates.

Legal challenges still await, however. A national group filed a lawsuit in federal court saying Maine’s state mandate violates health care workers’ freedom of religion while another group is arguing in state court that Maine Department of Health and Human Services exceeded its authority. Federal regulations are not yet finalized, but likely face a barrage of lawsuits as well.

States have well-established authority to mandate vaccines, according to the Kaiser Family Foundation, a nonprofit that studies health care issues. Maine, like other states, already mandates certain immunizations for health care workers, as well as for public school students.

But a federal vaccine mandate has not been tested in the courts before, and some specifics of certain state requirements have been reason for pause elsewhere. Judges in distinct state and federal lawsuits temporarily halted part of New York’s vaccine mandate for health care workers from taking effect this week, saying it could not be enforced for workers who claimed a religious exemption. The state still has to respond to workers who sued, and litigation is likely to continue.

New York is one of a handful of states that, like Maine, does not have a testing exemption to the mandatory vaccination requirement for health care workers. Massachusetts and Rhode Island have similarly stringent requirements, with no religious exemption or option for employees to get tested in lieu of getting the vaccine. Rhode Island’s mandate goes into effect Oct. 1, nearly a month earlier than Maine or Massachusetts.

A hearing on the religious exemption challenge to Maine’s vaccine mandate for health care workers will take place in federal court Monday afternoon, with plaintiffs asking for the mandate to be temporarily halted while legal questions are addressed.