Supreme Court Upholds Vaccine Mandate for Medicare, Medicaid Behavioral Health Providers

The U.S. Supreme Court upheld the Biden administration’s vaccine mandate for health care facilities that receive Medicare or Medicaid but struck down the vax-or-test mandate for large employers.

On Thursday, the high court handed down two rulings on lawsuits that challenged the Biden administration’s ability to drive a higher COVID vaccination rate in the U.S. through the executive branch’s ability to regulate business. 

In the case involving Medicare and Medicaid, the court issued a 5-4 ruling that states, in part, that the U.S. Health and Human Services Department, the top health care regulator in the federal government, was within the bounds set by Congress that allow the department to dictate which providers can participate in the programs.


“After all, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm,” the ruling states.

Medicaid is the single largest payer of mental health services. Federal vaccine mandates have been a source of worry for some behavioral health providers, and those worries haven’t always taken the industry into account.

In August, the Biden administration announced a vaccine mandate that targeted the nursing home industry. A few weeks later, the Biden administration announced the vaccine mandate would also apply to all health care settings that received compensation from the public health plans for vulnerable populations enrolled in Medicare and Medicaid.


On November 4, The U.S. Centers for Medicare & Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) both announced the pending release of interim final rules on the matter on Thursday.

In a previous statement, CMS has stated that the vaccine mandate would impact 76,000 providers and cover over 17 million health care workers across the country.

In the case for large employers (those with over 100 employees), the Supreme Court ruled 6-3 that OSHA had overstepped its authority. That mandate would have required workers to get vaccinated or wear masks and get tested for COVID weekly.

“Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly,” the ruling states. “OSHA has never before imposed such a mandate. Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here.”

Both vaccine mandates provide exemptions to vaccination for medical or religious reasons.

The Associated Press reports that the company’s six-judge conservative majority united behind nixing the mandate for large employers while Chief Justice John Roberts and Justice Brett Kavanaugh, both conservative justice, joined the court’s three liberal justice — Stephen Breyer, Elena Kagan and Sonia Sotomayor — in upholding the mandate for health care workers.

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