10 rural states launch lawsuit against CMS' COVID-19 vaccine mandate for healthcare workers

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In a complaint filed Nov. 10, states argued the Centers for Medicare & Medicaid Services' healthcare worker vaccine requirements will exacerbate the ongoing labor shortage, particularly in rural areas. The Biden administration, meanwhile, has affirmed its support for these and other vaccination requirements by pointing to increased uptake over the past few months. (Getty/eccolo74)

Ten rural states brought a lawsuit against the Biden administration Wednesday over the nationwide requirement that staff working at healthcare facilities be vaccinated for COVID-19 as a condition of participation in Medicare and Medicaid.

Filed in the U.S. District Court for the Eastern District of Missouri, the complaint asks the court to declare the interim final rule issued last week unlawful and prohibit the administration from imposing a nationwide vaccine mandate through the Centers for Medicare & Medicaid Services (CMS).

As of now, CMS is requiring applicable healthcare facilities to have a policy in place ensuring that eligible staff receive their first dose of a COVID-19 vaccine series by Dec. 5 and to have completed their series by Jan. 4, 2022.

In the complaint, the states outlined widespread workforce shortages affecting providers within each of their borders.

Although an industrywide issue, the increased need for workers in rural areas means these regions will be harder hit by any staff departures and are more vulnerable to interruptions in services, they wrote. As such, they argued the decision to enact such a requirement should be left to individual states.

RELATED: CMS: Healthcare workers must get first COVID shot by Dec. 5 to continue Medicare, Medicaid participation

“Vaccination requirements are matters that depend on local factors and conditions. Whatever might make sense in New York City, St. Louis or Omaha could be decidedly counterproductive and harmful in rural communities like Memphis, Missouri or McCook, Nebraska,” the states wrote in the complaint. “Federalism allows States to tailor such matters in the best interests of their communities. The heavy hand of CMS’s nationwide mandate does not.”

Outside of the core workforce shortage concern, the states also took issue with the proposed enforcement of the mandate, CMS’ foregoing of a standard notice and comment period and what the states described as contradictory or unexplained requirements included in the mandate.

For the former, the mandate “directly injures” states by seeking to “commandeer” Medicare and Medicaid surveyors that are employed by the state so that they may enforce CMS’ requirements, they wrote. This forces states to take on increased enforcement costs and infringes on their sovereign authority, according to the complaint.

As for the requirements themselves, the states highlighted incongruities with other federal vaccination requirements from the Occupational Safety and Health Administration (OSHA).

RELATED: How many employees have hospitals lost to vaccine mandates? Here are the numbers so far

For instance, CMS did not explain why it chose to break away from OSHA’s decision to allow a regular testing alternative, they wrote, and also failed to “discuss how other countervailing considerations—such as workforce shortages and personal liberty considerations—factored into the rejection of the periodic testing option” in the interim rule or its messaging.

The states argued that the agency has “ignored key evidence” on infection-induced immunity and cited a preprint Israeli study reporting reduced infection risk among those who had recovered from COVID-19 when compared to those who were uninfected and unvaccinated. They also noted that CMS has, to date, been inconsistent when publicly discussing the value of such immunity, further clouding its decision-making process around what the states view as a dangerous overreach of federal authority.

“Unfortunately, with this latest mandate from the Biden administration, last year’s healthcare heroes are turning into this year’s unemployed. Requiring healthcare workers to get a vaccination or face termination is unconstitutional and unlawful, and could exacerbate healthcare staffing shortages to the point of collapse, especially in Missouri’s rural areas,” Missouri Attorney General Eric Schmitt, who co-led the coalition of states alongside Nebraska Attorney General Doug Peterson, said in a statement. “My office has been, and will continue to be, a national leader in challenging the Biden Administration’s illegal edicts, and this instance is our latest effort to push back on this unprecedented federal overreach.”

Joining Missouri and Nebraska in the nine-count suit were Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire.

RELATED: Conflicting federal, state COVID-19 vaccine requirements have hospitals trapped in noncompliance

The state’s case is one of several challenges to the Biden administration’s vaccination push. Primarily Republican-led states have recently filed complaints seeking to block concurrent federal vaccination mandates applying to organizations working with federal contractors and those with 100 or more employees.

The president and his administration have stood firm on the role these requirements will have in spurring new vaccinations and cutting down new cases.  

“The simple truth is that vaccination requirements are working. In fact, vaccination requirements have helped reduce the number of unvaccinated Americans ages 12 and older by almost 40%—from about 100 million in July to under 60 million now,” White House COVID-19 response coordinator Jeff Zients said during a Wednesday night press briefing. “Vaccination requirements get more people vaccinated, strengthen our economy, and help continue us on our path out of the pandemic.”

The requirement is also starting to shift policy among holdout health systems, with major hospital chain HCA Healthcare reportedly telling employees this week that it will enact its own workforce vaccine mandate to ensure compliance with the government's rule.