## Facts

- The Secretary of Health and Human Services, acting through the Centers for Medicare & Medicaid Services (CMS), issued an interim final rule in November 2021 requiring Medicare- and Medicaid-participating facilities to ensure staff vaccination against COVID-19, subject to medical and religious exemptions.
- The rule applied broadly to healthcare providers participating in the programs, including hospitals, nursing homes, ambulatory surgical centers, hospices, and rehabilitation facilities.
- Coalitions of states filed separate suits challenging the rule, and two federal district courts issued preliminary injunctions barring enforcement in the plaintiff states.
- The federal government sought stays of the injunctions in the Eighth and Fifth Circuits; both courts of appeals denied stays.
- The government filed emergency applications in the Supreme Court to stay the preliminary injunctions pending appeal; the Court consolidated the applications and heard argument on January 7, 2022.

## Issues

1. Whether the Secretary was likely authorized by statute to condition Medicare and Medicaid participation on facilities ensuring staff COVID-19 vaccination.
2. Whether the government satisfied the criteria for a stay of the preliminary injunctions pending appeal, including likelihood of success and irreparable harm.

## Decision

- The Court (per curiam) granted the government’s applications and stayed the preliminary injunctions.
- The Court determined the Secretary was likely acting within statutory authority to impose health-and-safety conditions on participating facilities.
- The stay permitted enforcement of the CMS vaccination requirement while appellate proceedings continued.
- The vote was 5–4; Justices Thomas, Alito, Gorsuch, and Barrett dissented.

## Legal Principles

- The Secretary may issue regulations necessary to administer HHS functions and may impose conditions of participation in Medicare and Medicaid tied to patient health and safety.
- A vaccination requirement for staff in Medicare/Medicaid facilities can qualify as a health-and-safety condition where the agency reasonably finds it protects vulnerable patient populations from infectious disease risks.
- On a stay application, the Court assesses likelihood of success on the merits and equitable factors (including irreparable harm and public interest); granting a stay reflects a determination that these considerations favor the applicant in the interim posture.
- Dissents emphasized the need for clear congressional authorization for a vaccine mandate of this scope and raised concerns about agency power and emergency rulemaking.

## Conclusion

The Court allowed CMS to enforce its COVID-19 vaccination condition for Medicare- and Medicaid-participating facilities by staying lower-court injunctions, concluding that the Secretary was likely acting within statutory authority to protect patient health and safety pending final resolution on the merits.


Biden v. Missouri, 142 S. Ct. 647 (2022)