Some workers supporting people with developmental disabilities across the nation will still be required to be vaccinated against COVID-19 despite a recent ruling from the U.S. Supreme Court blocking a wider mandate.

The high court struck down a sweeping Biden administration plan earlier this month that sought to require vaccinations or regular testing for workers at businesses with at least 100 employees.

At the same time, however, the court upheld a mandate for health care workers at facilities receiving funding from Medicare or Medicaid.

The rule from the Centers for Medicare & Medicaid Services covering health care workers includes hospitals and long-term care facilities as well as staff at intermediate care facilities for individuals with intellectual disabilities, psychiatric residential treatment facilities, home health agencies and other providers.

However, CMS has said that staff at group homes and other home and community-based services settings will not be affected by the vaccine mandate because the agency lacks regulatory authority.

The rule is already in effect in about half of states. Now, CMS said that two dozen other states must establish plans and procedures to ensure staff are vaccinated.

Agencies providing home and community-based services could have been subject to the regulation covering large employers depending on the size of their workforce, disability advocates said, but after the court ruling that regulation is no longer in force. However, COVID-19 vaccines are being required for some of these workers at the state or local level.

“Making COVID vaccination optional for direct support workers harms people with disabilities who rely on direct support every day,” said Zoe Gross, director of advocacy at the Autistic Self Advocacy Network. “People who use HCBS may need assistance with tasks such as bathing, eating or transferring from a wheelchair — assistance that cannot be provided from six feet away. Vaccine mandates make it safer to receive these kinds of services by reducing the chance that a direct support worker will transmit COVID to the person they support.”

The push to require COVID-19 vaccines comes as many disability providers have struggled to attract and retain staff. In Maine, which imposed a mandate for group home workers last fall, for example, there were reports that resulting staff shortages could lead to closures and displace residents with developmental disabilities.

“We understand the Supreme Court’s reasoning in allowing CMS’s vaccination requirements to move forward and fully embrace the importance of vaccination for those who care for people with intellectual and developmental disabilities,” said Lydia Dawson, director of policy, regulatory and legal analysis at the American Network of Community Options and Resources, or ANCOR, which represents disability service providers across the country. “At the same time, the impact of this ruling on providers will ultimately depend on how the requirements are implemented given the dire direct support workforce crisis that has been amplified by the pandemic.”

Gross from the Autistic Self Advocacy Network said that the implications of the Supreme Court’s actions for people with disabilities will extend well beyond the requirements for support staff and into the general community.

“The ruling is bad news for people with disabilities,” Gross said. “Many people with disabilities work, and by eliminating vaccine mandates in some workplaces, this ruling makes it harder for us to be protected in those workplaces.”