On Thursday, the U.S. Supreme Court issued two highly anticipated rulings that will shape the landscape of workplace safety, public health, and the federal government’s role in regulating the COVID-19 response. The Court upheld the Biden administration’s vaccine mandate for health care workers in facilities that participate in Medicare and Medicaid programs but struck down the administration’s broader “vax-or-test” requirement for large employers. The decisions reflect the justices’ efforts to balance federal authority, workplace safety, and individual liberties in the context of a pandemic that has tested every corner of the health care system. For behavioral health providers — many of whom rely heavily on Medicaid funding — the Supreme Court vaccine mandate health care workers ruling carries significant consequences.
The Health Care Worker Mandate
In a 5–4 ruling, the Supreme Court found that the U.S. Department of Health and Human Services (HHS) acted within its authority in requiring COVID-19 vaccinations for staff at health care facilities that receive Medicare or Medicaid reimbursement.
The majority opinion noted that the requirement is consistent with the basic mission of the medical profession: “After all, ensuring 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.”
This ruling gives HHS the green light to move forward with enforcement. The Centers for Medicare & Medicaid Services (CMS), the agency responsible for administering the programs, has previously estimated that the mandate applies to 76,000 providers and more than 17 million health care workers nationwide.
The Supreme Court vaccine mandate health care workers decision confirms that facilities participating in federal programs must comply to continue receiving Medicare and Medicaid funding.
Why This Matters for Behavioral Health Providers
Medicaid is the single largest payer of mental health services in the United States, covering a large percentage of clients who receive treatment in community-based programs, inpatient facilities, and outpatient centers. That means most behavioral health providers fall under the umbrella of this mandate.
For many providers, the Supreme Court vaccine mandate health care workers ruling reinforces the need to:
- Implement clear vaccination policies for staff, with exemptions for medical or religious reasons
- Prepare for staffing challenges, as some employees may resign or shift jobs in response to vaccine requirements
- Focus on compliance infrastructure, since failure to meet CMS standards could jeopardize eligibility for federal reimbursement
Behavioral health leaders have raised concerns throughout the pandemic that vaccine mandates often overlook the realities of their workforce. For example, many behavioral health organizations already face chronic staffing shortages, high turnover, and lower pay compared to general health care providers. The Supreme Court vaccine mandate health care workers decision provides clarity but also increases the urgency for careful workforce planning.
The Road to the Mandate
The Biden administration first announced in August 2021 that it would implement a vaccine mandate targeting the nursing home industry. At the time, the goal was to protect vulnerable populations who are at the highest risk of severe outcomes from COVID-19.
Only a few weeks later, the administration broadened the scope, announcing that all health care providers who receive Medicare and Medicaid reimbursement would also be subject to the requirement.
By November 4, CMS and the Occupational Safety and Health Administration (OSHA) announced the pending release of interim final rules. These rules formalized the expectation that facilities would ensure staff were vaccinated unless eligible for medical or religious exemptions.
The Supreme Court vaccine mandate health care workers ruling confirmed that these rules fall within HHS’s regulatory authority, giving providers a clear legal framework.
The Employer Vaccine-or-Test Mandate
In contrast, the Court struck down a separate OSHA rule targeting large private employers. This mandate would have required companies with 100 or more employees to enforce vaccination or implement weekly COVID-19 testing combined with masking.
But in a 6–3 decision, the Court ruled that OSHA exceeded its statutory authority. While OSHA has the power to regulate workplace hazards, the majority emphasized that it does not have sweeping power to regulate public health broadly.
“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 stated. “OSHA has never before imposed such a mandate. Nor has Congress.”
Divided Court, Divided Authority
The split decisions reflect the ideological divides on the Court but also highlight nuanced interpretations of federal authority.
- In the health care case, Chief Justice John Roberts and Justice Brett Kavanaugh joined the Court’s three liberal justices — Stephen Breyer, Elena Kagan, and Sonia Sotomayor — in upholding the mandate
- In the employer case, the Court’s six conservative justices united to strike down OSHA’s rule, leaving states and private companies free to establish their own policies
Both mandates provided exemptions for medical or religious reasons, a key consideration in mitigating legal challenges.
Implications for the Health Care Sector
For health care facilities, the Supreme Court vaccine mandate health care workers ruling brings clarity — but also urgency. Providers that rely on Medicare and Medicaid funding must comply, or risk losing their eligibility for federal reimbursement.
Compliance requires:
- Documentation systems to verify employee vaccination status
- Processes for exemption requests to ensure they are handled fairly and lawfully
- Contingency planning for potential staffing disruptions
In behavioral health specifically, compliance could be especially difficult. The sector faces workforce shortages, lower wages, and high burnout rates, all of which make staff retention a pressing issue. Leaders will need to balance the demands of compliance with the realities of recruitment and retention.
Looking Ahead
The Supreme Court’s rulings mark a turning point in the federal response to COVID-19. For health care providers, the path forward is clear: compliance with the Supreme Court vaccine mandate health care workers ruling is mandatory. For large employers, however, the door remains open for state governments and individual businesses to shape their own approaches.
Ultimately, these decisions highlight the ongoing tension between public health imperatives and the limits of federal regulatory power. As the nation continues to navigate the pandemic, providers — particularly those in behavioral health — must balance regulatory compliance, workforce realities, and the mission of care for vulnerable populations.
The Supreme Court vaccine mandate health care workers ruling ensures that patient safety remains a top priority, even as broader public health regulations face new limits.
