Biden v. Missouri
The Facts
In November 2021, CMS issued an interim final rule conditioning Medicare and Medicaid participation on healthcare facilities ensuring their workers were vaccinated against COVID-19. Missouri and other states challenged the rule; the Eighth Circuit enjoined the rule nationally. A separate group of states obtained a Fifth Circuit injunction as well. The Biden administration applied to the Supreme Court for emergency relief.
The Application
CMS's long-established authority to set conditions of participation for Medicare and Medicaid providers encompasses requirements aimed at protecting patient and worker safety, bringing the COVID-19 vaccination mandate within the core of its patient-protection mission and thus outside the scope of the major questions doctrine. The lower courts' injunctions failed the equitable analysis for emergency relief because the Government demonstrated a strong likelihood of success on the merits, and the balance of equities, weighing the public health interest in preventing COVID-19 transmission in vulnerable healthcare settings against providers' administrative burden, favored allowing the mandate to proceed during the merits litigation. By vacating both injunctions, the Court privileged the agency's judgment on public health conditions and reinstated the rule immediately rather than letting it remain blocked during what could be years of appellate review.
The Conclusion
**The Supreme Court vacated both injunctions 5-4, allowing the CMS vaccination mandate to take effect.** The Court held CMS acted within statutory authority and the balance of equities favored reinstatement of the rule while merits review proceeded in the lower courts.
No circuit court data for this case.
Case Analysis
Overview
CMS issued an emergency rule requiring COVID-19 vaccination of workers at healthcare facilities participating in Medicare and Medicaid programs, as a condition of continued participation. Two sets of states obtained circuit court injunctions blocking the rule; the Supreme Court vacated both injunctions 5-4 and allowed the mandate to take effect pending full merits review.
Facts
In November 2021, CMS issued an interim final rule conditioning Medicare and Medicaid participation on healthcare facilities ensuring their workers were vaccinated against COVID-19. Missouri and other states challenged the rule; the Eighth Circuit enjoined the rule nationally. A separate group of states obtained a Fifth Circuit injunction as well. The Biden administration applied to the Supreme Court for emergency relief.
Issue
Whether CMS had statutory authority under the Medicare and Medicaid Acts to issue a COVID-19 vaccination mandate for healthcare workers, and whether the lower courts erred in entering injunctions blocking the mandate.
Rule
CMS has broad statutory authority to impose conditions on healthcare providers that participate in Medicare and Medicaid, including conditions aimed at protecting the health and safety of patients and staff. The major questions doctrine does not bar a vaccination requirement that falls within the core of the agency's patient-safety mission. Emergency injunctive relief requires a showing of a strong likelihood of success on the merits and balance of equities favoring relief.
Analysis
CMS's long-established authority to set conditions of participation for Medicare and Medicaid providers encompasses requirements aimed at protecting patient and worker safety, bringing the COVID-19 vaccination mandate within the core of its patient-protection mission and thus outside the scope of the major questions doctrine. The lower courts' injunctions failed the equitable analysis for emergency relief because the Government demonstrated a strong likelihood of success on the merits, and the balance of equities. Weighing the public health interest in preventing COVID-19 transmission in vulnerable healthcare settings against providers' administrative burden. Favored allowing the mandate to proceed during the merits litigation. By vacating both injunctions, the Court privileged the agency's judgment on public health conditions and reinstated the rule immediately rather than letting it remain blocked during what could be years of appellate review.
Conclusion
**The Supreme Court vacated both injunctions 5-4, allowing the CMS vaccination mandate to take effect.** The Court held CMS acted within statutory authority and the balance of equities favored reinstatement of the rule while merits review proceeded in the lower courts.
Notes
OT2021. Added via SCOTUS bulk import 2026-05-14
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