What You Need To KnowOn July 20, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a Quality and Safety Special Alert memo regarding the protection of voting rights and autonomy of vulnerable residents in long term care facilities. Additionally, CMS announced the recission of prior versions of related memos previously released in October 2020 and September 2024 (QSO-21-02-NH and QSO-24-21-NH). The July 20, 2026, memo does not create new regulatory requirements and does not update the State Operations Manual.
Why This Is Important
In this newly released memo, CMS reminds providers that residents retain all constitutional and statutory rights, including the right to vote and the right to decline participation in elections. Further, CMS outlines examples of instances that the agency has been made aware of, where the voting rights of residents, including those with diminished mental capacities, have been allegedly unlawfully violated. Providers are reminded that federal regulations prohibit facilities and their staff from interfering with, coercing, or improperly influencing the exercise of resident rights (42 C.F.R. § 483.10(b), (e), (g) ).
Next Steps
Facilities should have a plan to ensure residents can exercise their right to vote, whether in-person, by mail, absentee, or other authorized process.
- Residents should not be registered to vote without their knowledge or consent, and the process for completion of mail-in ballots should always follow any applicable federal and state rules and regulations.
- Facilities should review any applicable state regulations related to voting processes and who is authorized to provide hands-on assistance with voting on absentee ballots.
- Activities surrounding voting should not pressure residents about their voting choices or preferences.