Nearly 20 states have announced COVID-19 vaccine requirements for government employees as the delta variant brings on a rise in coronavirus cases.

Under most governors’ requirements, state employees can choose to undergo regular virus testing in place of getting vaccinated. However, that is not an option for patient-facing health care workers in New York, and state workers in Illinois, Oregon, Rhode Island and Washington.

Here are the states that have taken action to impose vaccine requirements for government employees.

California

All state workers will need to be fully vaccinated or undergo testing at least once a week starting Sept. 30. For health care workers, the option for testing will apply only to those with religious or medical reasons for not receiving the vaccine.

Colorado

By Sept. 20, unvaccinated state workers must begin twice-weekly testing and continue mask-wearing indoors in public spaces.

Connecticut

Employees at long-term care facilities must receive at least one dose of the vaccine by Sept. 7.

Hawaii

All state and county employees must be vaccinated or undergo weekly testing by Aug. 16, according to an emergency proclamation signed by Gov. David Ige (D) on Aug. 5.

Illinois

Vaccinations will be required starting Oct. 4 for all state employees working in high-risk settings, such as prisons and veterans homes.

Kentucky

All contractors and state employees working in state-operated facilities must be fully vaccinated by Oct. 1. If they cannot get vaccinated for religious or medical reasons, they must submit to testing twice a week.

Maryland

Gov. Larry Hogan (R) announced Aug. 5 that state employees working in congregate settings will be required to receive their first dose of the COVID-19 vaccine by Sept. 1. The vaccine protocols apply to employees of 48 state facilities, including the Department of Health, Department of Juvenile Services, Department of Public Safety and Correctional Services, and Department of Veterans Affairs.

Those who fail to provide proof of vaccination are required to follow strict face covering requirements and submit to weekly COVID-19 testing, according to a public health order. Hogan warned that employees who lie about their vaccination status will face disciplinary action.

Massachusetts

Massachusetts on Aug. 4 became the first state to mandate COVID-19 vaccinations for nursing home staff. Gov. Charlie Baker (R)’s administration ordered long-term staff at 378 non-state operated skilled nursing facilities and two soldiers’ homes to get their first dose of a two-dose series vaccine by September.

Starting Oct. 10, the state Department of Public Health will be authorized to stop new admissions at any nursing home with fewer than 75 percent of its staff vaccinated, according to a public health emergency order. The order will grant exemptions to those with medical restrictions or “sincerely held religious beliefs.”

Nevada

Starting Aug. 15, state employees who are not fully vaccinated must take and submit weekly COVID-19 tests until their workplace reaches a 70 percent vaccination rate. Gov. Steve Sisolak (D) announced the testing policy in July, while urging all state employees to get vaccinated before “to avoid the required weekly COVID-19 testing protocol and protect themselves from this deadly virus.”

New Jersey

New Jersey is requiring employees in certain state and private health care facilities and high-risk congregate settings to get fully vaccinated by Sept. 7 or comply with COVID-19 testing at least one to two times a week. Gov. Phil Murphy (D) said in an Aug. 2 announcement that the state is “prepared to consider additional measures if we do not see a satisfactory increase in vaccination uptake in those settings as this new requirement is put into effect.”

New Mexico

Gov. Michelle Lujan Grisham (D) on July 29 signed an executive order mandating all state employees either be fully vaccinated or provide a negative COVID-19 test at least biweekly. Under the order, which took effect Aug. 2, state employees who are not fully vaccinated must wear a facemask when indoors.

New York

New York’s 130,000 state workers and all patient-facing health care workers at state-run hospitals are required to get vaccinated before Labor Day, Gov. Andrew Cuomo (D) said on July 28. He announced the same requirement for MTA and Port Authority employees on Aug. 2. Transit and state workers will have the option to undergo weekly testing in lieu of vaccination. That option will not apply to health care workers.

North Carolina

On July 29, Gov. Roy Cooper (D) said in a statement that the state government started verifying the vaccination status of government workers. Unvaccinated employees must wear a mask and be tested for the virus at least once a week, according to his executive order.

Oregon

Oregon will mandate full vaccination for employees of all state agencies by Oct. 18 or six weeks after a COVID-19 vaccine receives approval from the Food and Drug Administration, Gov. Kate Brown (D) announced Tuesday. Employees will not have the option of weekly testing, although there will be exceptions for those unable to get vaccinated due to a disability or “sincerely held religious belief.”

Pennsylvania

Starting Sept. 7, employees in state-run health care and high-risk congregate care facilities must be fully vaccinated or face weekly testing. The requirement, announced by Gov. Tom Wolf (D) Tuesday, comes with an incentive of 8 hours paid time off for all vaccinated state employees beginning in October.

Rhode Island

At a news conference on Tuesday, Gov. Dan McKee (D) said health care workers in state-licensed health facilities will be required to get vaccinated by October. Until then, all unvaccinated employees in those settings must wear surgical masks and undergo COVID-19 testing twice a week.

Virginia

Gov. Ralph Northam signed an executive directive on Aug. 5 that requires state workers to show proof that they are fully vaccinated by Sept. 1 or be tested for COVID-19 weekly.

Washington

All state employees, even those working remotely, will have until Oct. 18 to be fully vaccinated, Gov. Jay Inslee (D) announced at a press conference last Monday. A “test-out option” is not offered to employees, and anyone who refuses without medical or religious exemption will “be subject to dismissal.” The order applies to private health care and long-term care employees as well.