As states hunt for new voters, Massachusetts adds thousands via Medicaid applications
The Oregon Legislature passed a bill this session to automatically register residents through the Oregon Health Authority, which manages Medicaid. Pictured here: Election office employees put away sample ballots during the conclusion of a during a ballot-counting test at the Multnomah County Elections Office in Portland on Tuesday, October 25, 2022. (Jordan Gale/Oregon Capital Chronicle)
Massachusetts saw a more-than-five-fold jump in voter registration applications through social service agencies in the last election cycle, new federal data shows.
The striking increase comes after the state implemented an automatic voter registration system that includes Medicaid applicants. Any eligible voter in the state who applies for Medicaid is automatically added to the rolls, unless they opt out.
During the 2021-22 election cycle, 166,539 people in Massachusetts applied to be registered to vote through social service agencies in the state, according to U.S. Election Assistance Commission data on voting and voter registration for all 50 states, released June 29. In the 2019-20 cycle, that number for Massachusetts was just 30,202, EAC data released in 2021 show.
The EAC data, known as the Election Administration and Voting Survey, is the most comprehensive data available on voting and voter registration.
With many states hunting for new ways to expand access to voting, especially for groups with lower participation rates, voter advocates describe using Medicaid to boost registration rates as a hugely promising avenue. Indeed, some states are looking to create their own systems that go even further than the one in Massachusetts in getting Medicaid applicants, as well as their family members, onto the rolls.
“Based on the size of Medicaid, the characteristics of the population Medicaid serves, and results from states that adopted best practices in (motor vehicle department) AVR, Medicaid AVR, if adopted nationally, could generate millions of new and updated registrations each election cycle,” a report released June 22 by the Institute for Responsive Government, a good government group, found. AVR refers to automatic voter registration.
“Considering that several states have passed legislation that goes beyond Massachusetts’ reforms, then Medicaid AVR strikes me as the next big, new thing in voter registration outreach,” said the report’s author, Doug Hess, an independent researcher and political scientist who has worked with states to implement the 1993 National Voter Registration Act since not long after its passage.
Hess flagged the dramatic Massachusetts spike for States Newsroom, after conducting an analysis comparing the EAC data for this cycle to past cycles.
Massachusetts’ increase was by far the largest jump in registration applications through social service agencies in any of the 44 states required to report data to the EAC, Hess’ analysis shows. (The District of Columbia saw a slightly larger rate of increase, from 197 in 2019-20 to 1,225 last cycle, but experts said D.C’s small total numbers make it hard to draw conclusions.)
Debra O’Malley, a spokesperson for Massachusetts Secretary of the Commonwealth William Galvin, said the state’s Medicaid AVR system largely explains the jump.
“I would think that’s a huge contributing factor,” O’Malley said.
Underscoring the across-the-board impact of AVR, the other state agency that automatically registers voters in Massachusetts, the Registry of Motor Vehicles, saw an increase in registration applications that was similar to the social service agencies. In the 2019-20 cycle, the RMV generated 575,093 applications. Last cycle, that figure more than quadrupled to 2,370, 248.
A seamless process
Twenty-two states — almost all Democratic-controlled — as well as the District of Columbia have created automatic voter registration systems since Oregon first did so through 2015 legislation.
In states with AVR, eligible voters are automatically added to the rolls whenever they have contact with certain state agencies, almost always including the state motor vehicles department. The reform, which takes advantage of the NVRA’s mandate that states offer people a chance to register to vote at motor vehicle departments and social service agencies, has been successful at increasing the number of registered voters.
Massachusetts’ AVR system, which was passed in 2018 and implemented in 2020, allows any state agency that collects enough data from residents to determine voting eligibility — address, age, and citizenship status — to offer AVR. Currently, the two agencies doing so are the Registry of Motor Vehicles, and Mass Health, which allows residents to apply for Medicaid.
When an eligible voter in Massachusetts applies online for health insurance through Mass Health, a pop-up appears informing them that the information they submitted will also be used to add them to the voter rolls. If they want to opt out of registering, they can do so by checking a box.
The relative seamlessness of the Massachusetts process may explain why the state’s numbers spiked, while the only other state to have fully implemented a Medicaid AVR system, Washington, didn’t see a similar boost. (Maryland has a Medicaid AVR system that’s similar to that in Massachusetts, but it is not yet fully implemented.)
In Washington’s system, users who are eligible voters are shown an online voter registration form that’s mostly pre-filled, but still requires the user to take a few more steps.
The difference in results, said Daniel Meuse of Princeton University’s Center for Health and Wellbeing, underscores that how an AVR system is set up, and how easy it makes registration, can be a crucial factor in its effectiveness.
“Just that little difference of administrative burden on a person can lead to the types of variations that we’re seeing with the data,” added Meuse. “We know that when AVR systems are the easiest for a person to engage with, that the highest levels of registration occur.”
The gold standard
But several states are working to stand up systems that experts say will be even more effective than the Massachusetts version.
Colorado, New Mexico, Minnesota, Nevada and the District of Columbia all have passed legislation to create Medicaid AVR systems that use what’s known as a “back-end opt-out,” and are currently in discussions with the federal government about implementation. Similar legislation passed by the Legislature in Oregon this session, House Bill 2107, awaits Gov. Tina Kotek’s signature.
What’s back-end opt-out? Instead of the pop-up box that allows users to opt out of voter registration while they’re still applying for Medicaid, the new systems will let users apply for Medicaid without any mention of voter registration. Weeks later, all eligible voters in the user’s household will receive a letter informing them that they’ll be registered to vote based on the information provided during the recent transaction.
If they don’t want to be registered, they must respond to the letter. But if they take no action, they’ll be added to the rolls.
Back-end opt-out AVR systems have already been adopted at motor vehicles departments by a number of states, and today the system is considered the gold standard for implementing AVR. It creates a more seamless process for adding people to the rolls, making it less likely that they’ll opt out. Perhaps even more important, it brings into the system eligible household members who can’t be included in a front-end opt-out system because they don’t have the chance to opt out.
That’s why advocates think that, as welcome as the Massachusetts numbers are, they may only be the tip of the iceberg when it comes to using Medicaid to boost voting rates.
“The Massachusetts system is certainly an improvement over Section 7 compliance,” said Neal Ubriani, the Institute for Responsive Government’s policy and research director, referring to the plank of the NVRA that requires states to offer voter registration opportunities at social service agencies. “But there’s still a lot more meat on the bone.”
To be sure, registration applications through social service agencies make up only a small share of all new registrations — in Massachusetts, which had one of the highest rates of any state, it was still only 5.8%.
But advocates say that making registration easier through social service agencies is one of the most effective ways to reach low-income and non-white voters, who tend to have lower registration and voting rates than other groups.
“We know there are folks engaging with these state agencies who otherwise aren’t registered to vote, so this is a great way to ensure they’re getting on the voter rolls,” said Geoff Foster, the executive director of Common Cause Massachusetts, which played a key role in getting the state’s Medicaid AVR system passed.
“AVR was a huge win to address … the disconnect keeping a certain part of our population who are otherwise eligible to vote from getting on the voter rolls. And Medicaid recipients are certainly part of that community.”
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