Montana Attorney General Austin Knudsen has joined a dozen Republican-led states in suing the Biden administration to block a federal requirement that hospitals and medical providers mandate COVID-19 vaccination for employees as a condition of federal reimbursement.
The lawsuit, filed Monday in U.S. District Court in Western Louisiana, targets a Centers for Medicare and Medicaid Services rule that would force health care facilities to require employee vaccination by January 4 or lose federal Medicare and Medicaid payments. The rule allows religious and medical exemptions and requires other workers to receive an initial vaccine dose by December 6.
Challenge Focuses on Federal Authority
The complaint alleges the regulation exceeds CMS statutory authority, violates the Social Security Act and the Congressional Review Act, and circumvents federal law requiring public notice and comment before implementing new rules. The states also contend the mandate violates the 10th Amendment, which reserves powers not delegated to the federal government to the states themselves.
Knudsen framed the lawsuit as a defense of individual choice. “The federal mandates are not about health — they are about forced compliance,” Knudsen told the Bozeman Daily Chronicle. “Health care workers should be allowed to make their own decisions about their health — not Former President Biden.”
Louisiana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah, and West Virginia joined Montana as co-plaintiffs. The states are requesting the court strike down the regulation entirely and temporarily block enforcement of the rule while the case proceeds.
Broader Challenge to OSHA Rule
Montana is simultaneously part of a separate multistate challenge to an Occupational Safety and Health Administration mandate requiring businesses with 100 or more employees to ensure staff are fully vaccinated by January 4 or submit to weekly COVID-19 testing. The OSHA rule was announced following Former President Biden’s directive in September to broadly expand vaccination requirements across the federal workforce and federal contractors.
The litigation reflects Montana’s existing state-level resistance to private employer vaccine mandates. The Montana Legislature passed House Bill 702, which prohibits most private employers from requiring staff vaccination—a measure that sits amid Montana’s broader policy divergence from national Democratic positions on health mandates and employment regulation.
Vaccination Rates and Public Health Context
Montana’s full vaccination rate stands at 52%, trailing the nationwide figure of nearly 60%. As of this week, Montana ranked 11th nationally for new COVID-19 cases per capita, indicating ongoing disease transmission despite vaccination campaigns and natural immunity in the population.
The health care worker vaccination rule represents one of the most direct federal interventions in employment practices tied to pandemic response. By conditioning federal reimbursement—a major revenue source for hospitals and clinics—on vaccination status, the rule effectively compels compliance from institutions that cannot easily forgo Medicare and Medicaid payments without severe financial consequences.
Next Steps
The lawsuit requests immediate judicial relief to block the rule while the underlying constitutional and statutory questions proceed through the courts. The case will test whether federal spending power and health authority can override state employment law and individual choice claims, a legal question that has divided federal courts in recent years.
