Newest Election Battleground Is Your Nursing Home

It took nearly a month, but Senate Democrats have responded to a CMS “Special Alert” issued in mid-July warning about coercion of residents during the voting process.

U.S. Sens. Elizabeth Warren (D-Mass.) and Alex Padilla (D-Calif.), along with 11 of their colleagues, wrote to CMS Administrator Mehmet Oz urging him to repeal the new July guidance that they say threatens nursing home residents’ right to vote by overturning previous related guidance issued in 2020 and 2024. 

“We write with concern that the recent guidance issued to nursing homes by the Centers for Medicare and Medicaid Services may intimidate nursing home staff from helping residents exercise their constitutional right to vote and ultimately prevent nursing home residents from voting,” wrote the senators. 

Senators Angela Alsobrooks (D-Md.), Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.), Mazie Hirono (D-Hawaii), Andy Kim (D-N.J.), Angus King (I-Maine), Jeff Merkley (D-Ore.), Mark Warner (D-Va.), Raphael Warnock (D-Ga.), and Ron Wyden (D-Ore.) joined in signing the letter. 

CMS Has Different View

Called the “Protecting the Voting Rights and Autonomy of Vulnerable Residents in Long-Term Care (LTC) Facilities,” the CMS Special Alert memo focuses on cautioning nursing homes about voting and registering to vote.

CMS said in the July guidance it was also rescinding in a separate memo the October 2020 and September 2024 Quality, Safety and Oversight (QSO) memoranda titled “Compliance with Residents’ Rights Requirement related to Nursing Home Residents’ Right to Vote” (QSO-21-02-NH and QSO-24-21-NH).

“In this QSSAM, we reiterate nursing homes’ responsibility to preserve residents’ rights to vote and to promote participation in the democratic process. However, this activity should not violate federal or state voting laws, and CMS is reminding facilities and their staff that they cannot engage in inappropriate coercion or other violations of residents’ rights,” the agency said.

Not So Fast, Say Senators

The Senate Dems said the previous CMS guidance, including under the first Trump administration, provided nursing home staff with a list of specific ways nursing homes can make it easier for residents to vote, like assisting with absentee and mail-in voting or transporting residents to polling locations and ballot drop-off boxes.

But the new guidance eliminated these recommendations, replacing them with language warning nursing home staff not to “violate federal or state voting laws” and telling staff that “they cannot engage in inappropriate coercion or other violations of residents’ rights.”

“[This memo] appears to be an attempt to intimidate nursing home staff from assisting residents in the voting process,” said the senators. 

Fraud?

To reiterate this threat of investigation or prosecution, CMS’s July 2026 memo mentions two investigations of supposed election fraud occurring at nursing homes. However, no fraudulent votes were cast in either of these cases, and there is no evidence of any systemic or significant voter fraud or coercion in nursing homes, the Democrats said in their letter.  

“The lawmakers also raised concerns that the Trump administration’s decision to highlight examples of prior voter fraud investigations and threaten criminal penalties may be an attempt to intimidate legal immigrants who work in nursing homes, who have already been targeted by the administration’s policies.” 

“Ultimately, we are concerned that the changes to CMS’s guidance will result in the disenfranchisement of nursing home residents,” the senators said. 

“The right to vote is guaranteed by the Constitution to all adult Americans, including nursing home residents…In order to protect nursing home residents’ voting rights, we request that you immediately rescind the July 2026 memo and reinstate the 2020 and 2024 guidance,” they concluded.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.