The vaccine mandate for healthcare workers: Questions and answers

With the U.S. Supreme Court upholding a vaccine mandate for healthcare workers, most hospitals and providers must ensure their workers get the COVID-19 shots.

The federal government has offered new guidance in the wake of the court’s decision on Jan. 13. The court ruled the government can compel providers receiving federal funds to vaccinate their workers.

Under the Biden administration’s order, hospitals and healthcare providers that receive money from Medicare and Medicaid are required to have their workers vaccinated. There are limited medical and religious exemptions.

Here’s a breakdown on what’s happening.

What’s the latest guidance from the federal government?

The Centers for Medicare & Medicaid Services have now set out a COVID-19 vaccine schedule for 24 states affected by the ruling.

CMS has set a vaccination schedule for these 24 states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

Healthcare providers in these states must ensure workers have had at least one COVID-19 vaccine dose by Feb. 14. They must be fully vaccinated by March 15.

Texas was not a part of the Supreme Court case. A federal court dismissed a lawsuit over the order in Texas, Bloomberg Law reported. So the vaccine mandate will be enforced nationwide.

Healthcare workers in Texas must have at least received their first COVID-19 vaccine dose by Feb. 22, CMS says. They must be fully vaccinated by March 21.

Does this change the deadline for any other states?

No. The federal government is sticking by its vaccination deadlines previously established for 25 states. Healthcare employees in those states must get their first vaccine dose by Jan. 27 and must be fully vaccinated by Feb. 28.

Those deadlines apply in the following states: California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, Minnesota, North Carolina, Oregon, Rhode Island, Tennessee, Pennsylvania, Vermont, Virginia, Washington state, and Wisconsin.

Washington, D.C. and other U.S. territories are also subject to these deadlines.

Is there flexibility in the deadlines?

Healthcare providers will be determined to be compliant by the deadlines if they have all of their workers vaccinated, or have been granted a qualifying exemption.

For the first dose deadlines, providers won’t face any penalties if they have ensured at least 80% of the staff have had a first dose and the facility has a plan to reach 100% within 60 days.

For the deadlines for full vaccination, 100% of workers must have completed both doses, unless the facility has some who have been granted exemptions or there has been some other delay, such as a lack of vaccine.

Again, there is some latitude for those falling short but moving in the right direction. Providers won't face additional enforcement action if they have had 90% of their workers fully vaccinated and have a plan to reach full vaccination within 30 days.

What teeth does the government have?

CMS has spelled out enforcement measures in its guidance.

For nursing homes, home health agencies and hospice providers, the penalties could include fines, denial of payment for new admissions and ultimately, ending participation in the Medicare and Medicaid agreement. The penalties will depend on the lack of compliance and the type of facility.

For hospitals and other acute care providers, the CMS said the sole enforcement remedy is ending participation in Medicare and Medicaid, a crucial lifeline for providers.

The agency has made clear it intends to work with providers to bring them into compliance, particularly those showing good faith efforts toward compliance.

“Termination would generally occur only after providing a facility with an opportunity to make corrections and come into compliance,” CMS said.

How are hospitals reacting?

The American Hospital Association has been urging all healthcare workers to get vaccinated. Rick Pollack, the AHA's president, said the association “will work with the hospital field to find ways to comply that balances that requirement with the need to retain a sufficient workforce to meet the needs of their patients.”

He added he hoped the government will “continue to work closely with us to ensure that compliance is measured in a thoughtful and careful way that recognizes current circumstances.”

More than 2,500 hospitals - 40% of the nation's hospitals - have imposed a vaccine requirement, the White House has said.

Some organizations held off on vaccine requirements until the Supreme Court ruling. The Cleveland Clinic said Friday it is now requiring its healthcare workers to be vaccinated. HCA Healthcare also said it will comply with the order and added 90% of the system's workers are vaccinated or have been approved for an exemption.

"Given the recent Supreme Court ruling, we will implement, in accordance with the CMS mandate rules, the requirement to vaccinate our healthcare workers who are covered by this policy, unless they qualify for an exemption," HCA said in a statement. "If we do not comply with the CMS mandate, we could compromise our ability to serve our communities and provide care to patients under the Medicare and Medicaid programs."

What about nursing homes?

The American Health Care Association, which represents thousands of nursing homes and long-term care facilities, has expressed concerns that it will make it harder to retain workers, already a daunting problem in the pandemic. The association said 83% of nursing home staff are fully vaccinated and long-term care providers have been urging staff to get the shots, said Mark Parkinson, president and CEO of the ACHA.

“When we are in the midst of another COVID surge, caregivers in vaccine hesitant communities may walk off the job because of this policy, further threatening access to care for thousands of our nation's seniors,” he said in a statement. “We continue to ask that CMS and state surveyors show leniency during this critical time as well as consider a regular testing option for unvaccinated staff members to prevent worsening staff shortages.”

Editor's note: This story was updated to reflect the vaccination deadlines for Texas.