While it appeared that after the Biden administration’s health care workforce vaccine mandate was backed by the U.S. Supreme Court states were largely ready to give up their fight against it, governors in Virginia and West Virginia are making one final push to postpone it.

In a letter sent to the head of the Centers for Medicare & Medicaid Services (CMS), Govs. Glenn Youngkin and Jim Justice asked for a “limited waiver” to help with the staffing shortages that both states are currently seeing in their health care facilities.

“We recognize the legal process has left this interim rule in place. However, rural and state health care facilities in our states are facing an urgent staffing crisis that we believe necessitates relief from the rule,” the letter states.

The waiver could “take multiple forms”, the governors suggest, including conscience exemptions, flexibility on enforcement or simply a six-month delay of the rule.

The nursing home industry has lost more than 420,000 jobs since the start of the pandemic, according to the U.S. Bureau of Labor Statistics.

The CMS-issued mandate, originally only focused on nursing homes, requires that any health care setting that receives Medicaid and Medicare reimbursement must have staff fully vaccinated.

A memo later sent out from the agency gave facilities increased flexibility for operators with widely varying vaccination statistics.

If nursing homes meet the agency’s 80% and 90% staff vaccination rate milestones by 30 and 60 days, respectively, they effectively have 90 days to get into full compliance with the CMS mandate.

West Virginia was part of a 24-state injunction, which the Supreme Court ruled on last month, and thus health care workers in the state will have until Feb. 14 to get their first shot of the vaccine and March 15 to be fully vaccinated. In Virginia, where the mandate was already in effect, nursing homes with staff vaccination rates under 100% were considered non-compliant after Jan. 28 – with opportunities to return to compliance.

Both governors fear nursing homes and hospitals in their states are at the “breaking point” and the CMS rule will only compound those problems.

A report released by the American Health Care Association last month showed that nursing homes in the U.S. experienced a spike in new COVID cases at the start of January, with over 57,000 staff infections reported on Jan. 9 compared to just 5,919 on Dec. 19.

One hospital system in Virginia, Ballad Health, saw more than 750 employees miss work one day in January after testing positive for COVID-19.

Hospital systems in both states are reportedly operating under “crisis standards of care” with staff in some cases being asked to return to work after testing positive for COVID-19.

The letter did note that both states have “turned the corner” on the omicron wave.

The fear remains, however, that a vaccine mandate will force “thousands” of health care professionals to be fired.

“The top concern we continue to hear from leaders of our healthcare systems is the pending vaccination requirement and the impact it will have on staffing,” the letter stated.

Its impact in southwest Virginia and throughout West Virginia is expected to be the worst.

“In these rural areas, access to lifesaving care could be threatened and we may displace a generation of healthcare professionals in a region already battling health disparities,” the letter added.