Why Is Biden’s Medicaid Office Holding Out on Voter Registration?

Recent efforts to expand access to automatic voter registration are again calling attention to old promises by the Biden administration to enhance the accessibility of civic engagement and continued failures by the Centers for Medicare and Medicaid Services to actualize them. Even this week, a piece in the magazine Bolts highlighted how a holdout by Biden officials continues to stall efforts to support low-income residents in registering to vote, despite recent Oregon legislation to automatically register Medicaid enrollees.

A 2021 Executive Order by President Joe Biden sought to promote access to voting, particularly by “expanding access to voter registration and election information,” in a directive to agencies to provide additional access to voter registration with services that directly engage with the public. Automatic voter registration through Medicaid enrollment offices is a common-sense way to expand opportunity for civic engagement among those most likely to be excluded by current voter registration infrastructure and enables the National Voter Registration Act to move towards achieving its full potential.

Automatic voter registration (AVR) has proven effective in increasing voter registrations across a myriad of states—and not just by the number of voters registered, but in ensuring that the registered voter population is more diverse. And states like Oregon, Massachusetts, and Colorado have worked to take this even further, through AVR for Medicaid recipients.

The holdout by Brooks-LaSure, and CMS more broadly, stands in stark contrast with explicit steps set out by President Biden to improve accessibility to voter engagement.

And despite what the wishy-washy response from the Centers for Medicare and Medicaid Services (CMS) on the issue might indicate, AVR based on Medicaid enrollment has tremendous potential:

• Medicaid already verifies the core information used in voter registration records, such as name, date of birth, address, and citizenship status, and can therefore easily process existing information for registering voters, without introducing additional questions, paperwork, or tricky-to-navigate processes.
• AVR through Medicaid enrollment also maximizes potential for all eligible voters in a household to be registered. Compare this to singular voter registrations processed at the Departments of Motor Vehicle (DMV) which might exclude eligible voters within a household as the DMV only interfaces with the individual there, rather than a whole household’s information like with Medicaid enrollment.
• Historically, Medicaid enrollment has been negatively correlated with voter registration and voting; here’s an easy way to address that disparity to increase civic engagement access for low-income Americans.
• Using Medicaid enrollment for AVR has the potential to make voter registration significantly more diverse, as Medicaid beneficiaries are more likely to be people of color, female, and low-income than the rest of the eligible voter population. While AVR at DMVs has been successful in the past, it still misses many eligible voters who don’t interact with the DMV, particularly low-income folks and people of color.
• In many states, Medicaid does annual enrollment updates, which results in voter information being more regularly updated and a registered voter population that is more accurate, compared to data from the DMV that is updated much less frequently.

Despite the overwhelming positive evidence of improvements to voter registration infrastructure, CMS has taken no action to enable states that have passed legislation to actually use Medicaid for automatic voter registration. In a response to a letter from Sen. Michael Bennet (D-Colo.) in support of Colorado’s Medicaid efforts, CMS Administrator Chiquita Brooks-LaSure expressed aversion to the use of Medicaid for voter registration, citing conflict with Medicaid privacy concerns. CMS rules currently prevent Medicaid agencies from using enrollment data for non-Medicaid purposes, but CMS can waive these provisions to implement certain proposals at the state level. Even prior CMS officials have indicated support for state-based health insurance exchanges facilitating voter registration.

The holdout by Brooks-LaSure, and CMS more broadly, stands in stark contrast with explicit steps set out by President Biden to improve accessibility to voter engagement. And CMS has resisted fully stepping into its authority in a number of other Executive Orders and actions called for by President Biden—notably, but not limited to the Executive Order on Competition in its calls for coverage for generic drugs and biosimilars. The far-reaching authorities and impacts of CMS, and its role in healthcare for all Americans, deserve additional scrutiny and oversight from the Department of Health and Human Services.