Federal judge halts CMS' COVID-19 vaccine mandate for healthcare workers in 10 rural states

Courthouse and red prohibition sign
A preliminary injunction is an early win for the 22 rural and red states that have filed challenges against the Centers for Medicare & Medicaid Services’ COVID-19 vaccine requirement for healthcare workers. It follows a similar court-ordered pause on the Occupational Safety and Health Administration's vaccination requirement for businesses with 100 or more employees. (Getty/Andrii Yalanskyi)

A judge has blocked enforcement of the Biden administration’s COVID-19 vaccine mandate for healthcare workers in 10 rural states pending a trial over whether the federal government exceeded its authority in issuing the nationwide requirement.

Matthew T. Schelp, U.S. district judge for the Eastern District of Missouri, granted the preliminary injunction Monday in the wake of a Nov. 10 lawsuit brought by the attorneys general of those 10 states.

Their complaint—along with another filed shortly afterward by 12 more states—asked the court to declare the Centers for Medicare & Medicaid Services’ (CMS’) emergency interim final rule unlawful, citing the ongoing workforce shortages affecting healthcare providers in their states and elsewhere across the country.

“This is a huge victory for healthcare workers in Missouri and across the country, including rural hospitals who were facing near-certain collapse due to this mandate,” Missouri Attorney General Eric Schmitt, who co-led the coalition of states alongside Nebraska Attorney General Doug Peterson, said in a statement. “While today’s ruling is a victory, there’s more work to be done, and I will keep fighting to push back on this unprecedented federal overreach.”

CMS announced in early November that it would be 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. Failure to comply with the requirement could place an organization’s Medicare funding in jeopardy.

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The decision to impose such a requirement should be left to individual states, as they are better equipped to assess local factors and make decisions that will be in the best interest of their residents, the coalition of attorneys general wrote in the complaint.

The plaintiffs also highlighted incongruities with other federal vaccination requirements from the Occupational Safety and Health Administration (OSHA) and took issue with CMS’ foregoing of a standard notice and comment period prior to enforcement.

Schelp acknowledged the states’ arguments that Congress had not clearly granted CMS the authority to roll out such a mandate and agreed that enforcement of the rule would cause "irreparable harm" to the plaintiff states.

The plaintiffs “are likely to succeed in establishing that the CMS vaccine mandate is arbitrary or capricious,” the judge wrote.

CMS has also said that the full effectiveness of its mandate on preventing further disease transmission is “not currently known,” Schelp wrote, whereas understaffing a healthcare facility in the plaintiffs’ states is certain to “create a critical shortage of services … and jeopardize the lives of numerous vulnerable citizens.”

“CMS mandate raises substantial questions of law and fact that must be determined,” the judge wrote. “Because it is evident CMS significantly understates the burden that its mandate would impose on the ability of healthcare facilities to provide proper care, and thus, save lives, the public has an interest in maintaining the ‘status quo’ while the merits of the case are determined.”

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Monday’s preliminary injunction halts enforcement of the CMS vaccine mandate in the 10 states that signed onto the lawsuit: Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire.

It also sets a precedent for similar action in the other challenge filed by Louisiana, Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah and West Virginia in the U.S. District Court for the Western District of Louisiana's Monroe Division.

Healthcare associations, individual experts and the Biden administration have all stood firm on the importance of organizations’ vaccination mandates, with the novel omicron variant only adding to the president’s urgency to get shots in arms.  

However, the Biden administration’s broader requirements have so far faced stiff competition from courts and right-leaning lawmakers and governors alike.

A U.S. appellate court ordered OSHA to temporarily halt its emergency temporary standard that would require businesses with 100 or more employees to require COVID-19 vaccination or testing. OSHA published a statement shortly after saying it “remains confident in its authority to protect workers in emergencies” but has suspended implementation and enforcement of the requirement “pending future developments in the litigation.”