In a Quality & Safety Special Alert Memo (QSSAM) dated July 20, 2026, the Centers for Medicare & Medicaid Services (CMS) reminded nursing homes of their obligation to promote a resident’s right to vote – while complying with all federal and state laws and avoiding resident rights violations. This Alert is not intended to create new regulatory obligations – just reinforce existing provider obligations – but rescinds the QSO Memo, “Compliance with Residents’ Rights Requirement related to Nursing Home Residents’ Right to Vote.”
The Impetus for this Alert
CMS previously addressed resident voting-related requirements in a QSO Memo issued in October 2020 (QSO-21-02-NH) and reissued as a reminder in September 2024 (QSO-24-21-NH). In this Alert, CMS reminds nursing homes that they are expected to preserve residents’ rights to vote and promote their participation in the democratic process . . . but within lawful requirements.
The QSSAM highlights several allegations where resident rights were unlawfully violated related to voting, including a felony charge against a social worker related to election fraud for unlawfully registering residents of the facility where they worked. As such, CMS is clarifying Medicare/Medicaid certified facilities’ existing responsibilities related to affirming and supporting the right of residents to vote.
Requirements
The following regulatory requirements provide the basis for these responsibilities:
- Residents have the right to exercise their rights as facility residents and as citizens of the United States
- Facilities must ensure that residents can exercise their rights without interference, coercion, discrimination or reprisal from the facility
- Residents have the right to be free of interference, coercion, discrimination and reprisal from the facility in exercising their rights and to be supported by the facility in the exercise of these rights
CMS also provides the following reminders:
- Nursing homes may not engage in any activity which violates state or federal voting laws, such as registering residents as voters without their knowledge or consent or completing a mail-in ballot on a resident’s behalf without their authorization.
- Facilities are expected to notify the resident’s representative when a change occurs in a resident’s legal or civil rights related to voting.
What’s Changed in Practice
CMS states in the Alert that any resident who requires assistance with voting should have the option to receive assistance from their authorized representative.
This is an important distinction, as routine practice in many facilities is to have Social Workers or Recreation staff assist with the voting process. In fact, when we covered the September 2024 QSO Memo, we noted that many facilities had Social Work and Therapeutic Recreation staff running this process.
The Alert also indicates that nursing homes should, where possible, coordinate with state election officials to encourage the use of bipartisan election workers (in authorized states) to facilitate voting and reduce the risk of undue influence, rather than relying on facility staff.
The 2024 QSO Memo emphasized facilitating access; this Alert emphasizes guarding against undue influence. Facilities that default to staff-led voting assistance should revisit that practice and confirm residents are offered the option of their authorized representative.
Reporting Alleged Concerns
- Residents and/or their representatives who believe their voting rights may have been violated can file a complaint with the State Survey Agency.
- For allegations related to voter coercion or intimidation, a referral to the Department of Justice Civil Rights Division can be made by calling 800-253-3931, sending an email, or submitting an online form on the DOJ website.
For full details, please see the July 20, 2026 QSSAM, “Protecting the Voting Rights and Autonomy of Vulnerable Residents in Long-Term Care (LTC) Facilities” (QSSAM-26-04-NH).
