Iowa’s health department is reportedly failing to adhere to federal requirements making voter registration accessible to those applying for Medicaid, leading to concerns that many low-income Iowans might be excluded from the rolls. Advocates argue that Iowa’s Department of Health and Human Services (HHS) isn’t effectively fulfilling its legal obligation to offer Medicaid recipients and applicants the opportunity to register to vote, potentially impacting voter registration efforts in the state.
The National Voter Registration Act (NVRA) of 1993 mandates that state agencies provide clients with the chance to register to vote. According to figures from the 2021-22 election cycle, Iowa had only 0.1% of new voter registrations coming through public assistance programs, significantly lower than the average state. Advocates attribute this to issues with how Iowa’s HHS handles voter registration for Medicaid recipients.
Medicaid recipients, around 860,000 individuals in Iowa, must renew their coverage annually. While the NVRA requires voter registration opportunities at all transactions with the agency, Iowa’s renewal mailer, sent to recipients, places the voter registration opportunity toward the end of an 11-page document. Critics argue that this violates the NVRA by not providing adequate assistance to potential voters.
In response, HHS spokesperson Alex Carfrae highlighted that voter registration questions are asked during interviews for other government assistance programs, but such interviews are not generally required for Medicaid applicants. Critics argue that HHS needs to offer a written opportunity for voter registration and provide a registration form unless declined in writing.
This issue isn’t new, as the state has faced concerns about non-compliance with voter registration services for nearly a decade. In 2015, the ACLU of Iowa and Disability Rights Iowa sent a letter warning about the state’s failure to provide required voter registration services. Advocates argue that Iowa’s low numbers of registration applications from public assistance agencies are linked to the problems with the Medicaid signup process.
While several states have faced accusations of NVRA violations, others have successfully boosted registration rates when implementing appropriate steps. Alabama witnessed a significant jump from 5,000 to 120,000 registration applications after signing an agreement with advocacy groups, while Kentucky, with a focus on voter access, processed over 88,000 applications from public assistance agencies in the last cycle.
Advocates anticipate that increased scrutiny, including inquiries from news outlets, may prompt organizations like the U.S. Department of Justice to examine Iowa’s compliance with the NVRA. The U.S. Department of Justice declined to comment on the matter.