Oregon Wants to Register Medicaid Recipients to Vote. Will Biden Officials Allow It? - Bolts
Lawmakers in Oregon, a state that already leads the nation in electoral engagement, adopted legislation this summer that would make voting even more inclusive. If it is signed into law... Read More
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The federal government has for years been stalling similar efforts to automatically register lower-income residents to vote in Colorado and other states.
Alex Burness | July 11, 2023
Multnomah County Election staff helping a voter (Photo from Multnomah County Elections / Facebook)
July 11, 2023
Oregon Wants to Register Medicaid Recipients to Vote. Will Biden Officials Allow It?
Alex Burness
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Lawmakers in Oregon, a state that already leads the nation in electoral engagement, adopted legislation this summer that would make voting even more inclusive. If it is signed into law by the state’s Democratic governor, House Bill 2107 would instruct state Medicaid offices to automatically register people to vote when they open or renew a health plan.
The bill could add tens of thousands of people to voter rolls by allowing the Oregon Health Authority to forward basic information it collects from people applying for Medicaid coverage—age, residence, and citizenship status—to election officials. These officials would then use it to register anyone who is eligible to vote and but not already signed up to do so.
This process, which would still give people the chance to decline being registered, is nearly identical to Oregon’s existing system of automatically registering people. But that system only applies at the Driver and Motor Vehicle Services department, leaving out Oregonians who don’t visit the DMV.
“Voter registration shouldn’t be dependent on going to the DMV, because not everybody does,” said Isabela Villarreal, policy director for Next Up Action Fund, a group that helped bring automatic voter registration to Oregon in 2015, explaining that lower-income and younger Oregonians are less likely to use DMV services. “We just want to make sure we’re capturing every single person and allowing them to participate.”
According to the secretary of state’s office, 85 percent of all Oregonians who are not registered are enrolled in Medicaid, a program that serves people living near or below the federal poverty line. That’s roughly 170,000 people in this state of 4.2 million who could be added to the voter rolls if the state began automatically registering Medicaid recipients.
“This is a critical opportunity to register people that have been historically and currently excluded from our electoral systems,” Villarreal said.
The reform, however, comes with a catch: It would not actually change anything unless Oregon wins the blessing of the federal government, which for years has held up similar proposals in other states and told Bolts it’s still reviewing the issue. Medicaid is a program administered by states but regulated by the federal government, which largely bars a state’s Medicaid office from disclosing information to other agencies without the U.S. Department of Health and Human Services’ authorization.
Colorado, for one, adopted a reform similar to Oregon’s in 2019, only to see the federal agency that administers Medicaid stall its application over privacy concerns. Colorado’s secretary of state, Democrat Jena Griswold, shared her frustration with Bolts last week, saying she struggles to even get answers from federal officials. “It would be great for Colorado to implement it,” she said. “We should be working to streamline people’s interactions with the government.”
Advocates for expanding voter registration hope that the growing number of states seeking to automatically register Medicaid recipients will motivate the Biden administration to revisit its stance and greenlight new reforms in Colorado, Oregon, and elsewhere.
Oregon eight years ago became the first state to adopt automatic voter registration, or AVR, and today similar systems exist in almost half of U.S. states. The design differs greatly by state, but the core idea is simple: Instead of expecting people to take proactive steps to register, a government agency uses the information they already collect to register people, while still giving them an opportunity to opt out.
AVR has been proven to boost registration and turnout, and make the electorate more diverse. In Oregon, roughly 94 percent of eligible residents are now registered to vote.
But in Oregon, as in many states, AVR is limited to people who visit the DMV, an agency with which many people, especially low-income residents, just don’t interact. Oregon voting rights advocates say this helps explain why nearly 200,000 eligible voters in the state—roughly 6 percent of the voting-eligible population—remain unregistered. They’re hoping that reaching Medicaid recipients gets the state closer to universal registration.
Sylvia Albert, director of voting and elections at Common Cause, a national voter advocacy organization, says including Medicaid recipients would make AVR systems far more inclusive.
“These are the people who generally fall through the cracks in our voter registration system: people who might be more transient, people who are less affluent, people who are unable to take time off work to go vote, older individuals who don’t have their documentation in order,” she told Bolts. “These are the type of people that, in general, face more barriers to the ballot. If we can reach those people with something like this, I don’t see a reason why we wouldn’t.”
Oregon Governor Tina Kotek, who has until late July to take action on HB 2107, did not respond to questions for this story. Local observers told Bolts they expect she will sign the legislation.
Several other states, including Colorado, Massachusetts, Nevada and New Mexico, have already had the same idea and passed legislation to extend AVR systems to government health programs. “The DMV seemed like the big first place to get the most people registered,” Griswold, the secretary of state of Colorado, told Bolts. “We believe Medicaid is that second place.”
But the Centers for Medicare and Medicaid Services (CMS), the federal agency housed within HHS that oversees the Medicaid program, has left most of those states in limbo for years. Oregon may be next, as state officials there say HB 2107 cannot be implemented without CMS authorization.
CMS rules bar state Medicaid agencies from using or disclosing client data for purposes that are not directly connected to the Medicaid program, but a state can request a waiver to implement a specific proposal, or ask CMS to determine that the way in which it plans to use the data is indeed legitimately connected to health care administration. Medicaid law experts say the prohibition exists to protect people from having their information used against them—police can’t turn to Medicaid for a person’s last known address, for instance, nor can prosecutors in states that punish abortion patients.
Colorado’s attempt to implement AVR through Medicaid has gone nowhere since 2019, first under the Trump administration through early 2021, and then under the Biden administration. When Colorado U.S. Senator Michael Bennet wrote a letter to CMS last year imploring the agency to green-light Colorado’s reform, CMS Administrator Chiquita Brooks-LaSure wrote back that the agency “had previously concluded that [the state’s proposal] appears to be inconsistent with the Medicaid privacy protections in current laws and regulations.”
