Unfortunately, as a result of lobbying by the Christian Science Church, the regulation that implemented the law required the states, as a condition of receiving federal assistance, to grant an exception
...which provides that a parent or guardian who does not provide medical treatment to a child because of the parent's religious beliefs is not considered, for that reason alone, to be a negligent parent or guardian.
Prior to 1974, only eleven states had religious exemption statutes (Massachusetts being one). In order to comply with the new child abuse regulation, 33 states subsequently passed laws granting a religious exemption to child abuse and neglect laws. As a result of the 1974 regulation, the federal government effectively implemented a state-sanctioned form of child abuse.
However, in 1983 the Congress and the Department of Health and Human Services at least partially recognized the contradiction between establishing protections for most children while at the same time mandating death and disability, through religious exemption, to a smaller group of children. The regulations implementing the "Child Abuse Prevention and Treatment and Adoption Reform Act of 1983" state that:
Nothing in this part should be construed as requiring or prohibiting a finding of negligent treatment or maltreatment when a parent in practicing his or her religious belief does not, for that reason alone, provide medical treatment for a child; provided, however, that if such a finding is prohibited, the prohibition shall not limit the administrative or judicial authority of the State to ensure that medical services are provided to the child when his health requires it. 45 CFR p. 1340.2(d)
In other words, the 1983 amended regulations grant states the choice of whether to maintain or repeal religious exemption to legal determinations of parents' neglect. However, according to the regulation, state religious exemption may not interfere with the state's obligation to provide a child with necessary medical care. The absence of such religious exemption is no longer a bar to states obtaining child abuse monies. Further, the new law expresses the judgment of Congress that there is no obligation on the states, legislative or constitutional, requiring religious exemption.
The Massachusetts legislature, by congressional mandate, therefore, has the clear option of repealing the Massachusetts religious exemption (Chapter 273, section 1). In 1990, South Dakota became the first state to repeal a religious exemption statute permitting parents to substitute spiritual healing for necessary medical care for children. Far more significant for children across the United States would be the repeal of the Massachusetts religious exemption since Massachusetts is the home of the Christian Science Church's world headquarters. The example of repeal in Massachusetts would give children's advocates in other states additional political leverage in their own repeal efforts.
Note: The Christian Science Church has adamantly argued that the existence of the Christian Science Church and its religious practice would not be possible if the state religious exemption laws are repealed and if its parents no longer have the choice of relying exclusively on prayer, even in the case of serious or life-threatening childhood illnesses. In fact, the Massachusetts religious exemption has existed in law only since 1971. Prior to this date, the Christian Science Church operated in Massachusetts for over eighty years without any exemption. Moreover, at present, both in England and Canada, national law requires that parents of children suffering from severe illness, in addition to using spiritual healing, must also obtain medical care. Christian Science has not died in these two countries.