A federal judge on Tuesday issued a nationwide injunction, blocking CMS' mandate requiring workers in most health care settings participating in Medicare and Medicaid to be fully vaccinated against Covid-19 by Jan. 4, arguing CMS doesn't have the authority to enact such a mandate.

The Covid-19 vaccine mandate: Here's what's in CMS' new rule

Federal judges block CMS mandate

Previously, on Monday, the U.S. District court for the Eastern District of Missouri had blocked CMS' mandate from taking effect in 10 states.

U.S. District Judge Matthew Schelp in the ruling said that the mandate violates the Administrative Procedure Act, among other laws, and is unconstitutional.

Resource library: How health care organizations can navigate vaccine mandates

"CMS seeks to overtake an area of traditional state authority by imposing an unprecedented demand to federally dictate the private medical decisions of millions of Americans," Schelp wrote. "Such action challenges traditional notions of federalism."

Schelp added that, while a vaccine mandate might be appropriate in long-term care facilities, CMS doesn't have enough evidence to impose it on other health care providers and did not incorporate evidence suggesting the mandate might reduce staffing at understaffed facilities. CMS also bypassed public notice and comment requirements, Schelp said, which "feeds into the very vaccine hesitancy CMS acknowledged is so daunting."

Then, on Tuesday, U.S. District Judge Terry Doughty in Louisiana blocked the mandate in all remaining states until the court is able to resolve legal challenges to the rule.

Doughty in his ruling said CMS doesn't have the authority to enact its vaccine mandate, arguing that "mandating a vaccine to 10.3 million health care workers is something that should be done by Congress, not a government agency."

The ruling comes after a three-judge panel in New Orleans earlier in November blocked a separate mandate from the Occupational Safety and Health Administration requiring companies with at least 100 employees to test unvaccinated workers weekly starting in January.

In a statement Monday, CMS said "[s]taff in any health care setting who remain unvaccinated pose both direct and indirect threats to patient safety and population health. That is why it is critical for health care providers to ensure their staff are vaccinated against Covid-19." (AHA News, 11/29; Lieb, Associated Press, 11/30; Heyward, New York Times, 11/29; Hals, Reuters, 11/30)