CMS to Surveyors: Nursing Homes Must Ensure Residents Can Vote, Even with COVID-19 Restrictions

Nursing home residents cannot have their voting rights impeded in any way, and facilities must have a plan to ensure that residents can exercise that right, the Centers for Medicare & Medicaid Services (CMS) warned in a memo to surveyors this week.

The memo to state survey agency directors is meant to provide clarification on the existing requirement of long-term care facilities certified by Medicare and Medicaid to affirm and support the right of residents to vote, the agency said in the document.

Election Day is scheduled for November 3, and concerns have been raised about how residents in the nursing home setting will be able to vote amid COVID-19.


The current regulations for residents exercising the right to vote stipulate that the facility must ensure that residents can exercise their rights as residents and U.S. citizens without interference, coercion, discrimination, or reprisal from the facility.

Facilities are also required to support residents in the exercise of their rights, the memo noted. Nursing homes have to ensure that residents can exercise the right to vote even though the public health emergency from the COVID-19 pandemic has limited visitor entry into the facilities.

The requirement to support residents with exercising their right to vote holds “whether or not external assistance is available to come to the facility,” the memo said.


“A resident’s rights, including the right to vote, must not be impeded in any way by the nursing home and its facility staff,” the memo said. “Nursing homes should have a plan to ensure residents can exercise their right to vote, whether in-person, by mail, absentee, or other authorized process. If a state has specific programs to enable nursing home residents to vote, the facility should coordinate and engage with those programs, as appropriate.”

Those programs might include mobile polling, or help with registering to vote, requesting an absentee ballot, or completing a ballot from “an agent of the Resident’s choosing.” The nursing home should also help with mail-in voting or by safely transporting residents to polling places or ballot drop-boxes; nursing homes must ensure the right to receive and send ballots through the U.S. Postal Service or other authorized means for residents who cannot cast ballots in person.

There are CMS regulations specific to mail that would apply for voting, including:

  • The requirement that facilities protect and facilitate the resident right to communicate with individuals and entities outside the facility, including reasonable access to a telephone, the internet, and the tools and ability to send mail.
  • The requirement to respect a resident’s right to personal privacy, including through communications — which encompasses the right to send and “promptly” receive unopened mail and materials delivered to the facility for a resident.

The memo defined “promptly” as: Delivery of mail or other materials to the resident within 24 hours of delivery by the postal service (including a post office box) and delivery of outgoing mail to the postal service within 24 hours, except when there is no regularly scheduled postal delivery and pick-up service.

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