CMS rescinds nursing home voting guidance and issues new memo on coercion

The Centers for Medicare and Medicaid Services rescinded two earlier memos on nursing home residents’ right to vote on July 20, 2026, and replaced them with a special alert that emphasizes avoiding coercion and violations of voting laws, according to the agency’s documents. A group of senators asked the agency in August to reverse the change.

What the old guidance said

The agency’s October 2020 memo, QSO-21-02-NH, told nursing homes they should have a plan to ensure residents can vote in person, by mail or by absentee ballot. It listed mobile polling by a bipartisan team and help registering, requesting an absentee ballot or completing a ballot from an agent of the resident’s choosing. It said nursing homes must support residents’ voting by assisting with absentee or mail-in voting or transporting residents to polling locations or ballot drop boxes.

The memo cited federal regulations at 42 C.F.R. Section 483.10, which say a resident has the right to exercise their rights as a citizen of the United States without interference, coercion, discrimination or reprisal from the facility, and to be supported by the facility in doing so. A September 2024 memo, QSO-24-21-NH, renewed the guidance, according to a letter from senators.

What the new memo says

The July 20 memo, QSSAM-26-04-NH, is titled “Protecting the Voting Rights and Autonomy of Vulnerable Residents in Long-Term Care (LTC) Facilities.” It states that it “does not create new regulatory requirements and does not update the State Operations Manual” and that it reinforces existing obligations. It says residents retain the right to vote and the right to decline to participate in elections.

The memo says nursing homes may not register residents to vote without their knowledge or consent or complete a mail-in ballot on a resident’s behalf without authorization. It says residents who need help voting should have the option of assistance from a person of their choosing and should be offered assistance from their authorized representative. It encourages nursing homes to coordinate with state election officials to use bipartisan election workers where state law allows, to reduce reliance on facility staff.

The memo’s background section cites two cases. In Texas, it says, a social worker was charged with 134 felony counts of election fraud for registering residents of the Mexia State Supported Living Center without consent. In Wisconsin, it says, a sheriff and a sergeant investigated a case in which they alleged that eight people with diminished mental capacity sent mail-in ballots from Ridgewood Care Center. The memo does not list the specific ways nursing homes can help residents vote that appeared in the 2020 memo.

The senators’ response

In an August 12 letter to CMS Administrator Mehmet Oz, Senators Elizabeth Warren and Alex Padilla, joined by other senators including Andy Kim, Richard Blumenthal, Angela Alsobrooks and Angus King, wrote that the memo appears to be an attempt to intimidate nursing home staff from helping residents vote. They wrote that it replaces language aimed at helping residents vote with language threatening staff with prosecution, and that it removes references to the regulations on voting by mail.

The senators wrote that no fraudulent votes were cast in either case the memo describes and that there is no evidence of systemic voter fraud or coercion in nursing homes. They wrote that the nation has 1.2 million nursing home residents, citing the National Center for Health Statistics. They asked CMS to rescind the July memo and reinstate the 2020 and 2024 guidance.

What experts say

Nina Kohn, a Syracuse University professor and elder law expert, told The 19th, in a story reprinted by Truthout, that the memo does not change the underlying law. “Nursing homes are governed by the Nursing Home Reform Act of 1987 and its implementing regulations,” Kohn said. “That law still requires facilities to support their residents in exercising their rights as Americans.”

Kohn said she is concerned about a chilling effect. “The language in the memo itself is intimidating, and it may understandably make staff think that they could face criminal prosecution or be in some other form of legal trouble if they help residents vote,” she said.

The memo directs residents or their representatives who believe their rights have been violated to file a complaint with their State Survey Agency. It says allegations of voter coercion or intimidation can be referred to the Justice Department’s Civil Rights Division.