State plans to boost voter registration access for Iowa Medicaid applicants

Four months after a report said the state's health department is not in compliance with federal voting law, state officials have announced steps and a rough timeline to boost voter registration access for Iowa Medicaid applicants.

The Iowa Capital Dispatch reported in January that application and renewal mailers sent out by the Iowa Department of Health and Human Services for Medicaid and state-funded health insurance plans violated federal law by failing to provide a prominent and convenient opportunity to register to vote.

The application and renewal forms for Iowa’s Medicaid, Healthy and Well Kids in Iowa (Hawki) and Iowa Health and Wellness Plan (IHAWP) contained one sentence about voter registration at the bottom of page 16 of the 27-page application. It included an online address leading to a state voter registration form that must be printed out and mailed to an election office. However, no mailing address is provided on the form.

The National Voter Registration Act of 1993 sought to expand opportunities to register to vote by creating more uniform processes and designating more places and methods to register. The law requires states offer voter registration opportunities at certain state and local offices, including public assistance and disability offices.

State Rep. Adam Zabner, a Democrat from Iowa City, has pressed state officials for details and a timeline for fixing the issue.

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Allowing Iowans who re-register for Medicaid the opportunity to register to vote “is a crucial piece of making sure that all Iowans, even those from disadvantages backgrounds are included in our voting process,” Zabner said last month during a point of privilege on the Iowa House floor.

“We are failing to engage the people who most need” that opportunity, Zabner said.

More than 400,000 Iowa adults are on Medicaid of state-funded health insurance plans.

During the 2022 general election cycle, 1,222 Iowans registered to vote via state public assistance agencies, accounting for 0.1 percent of new voter registration applications in the state, according to data from the U.S. Election Assistance Commission.

That is well below the national average of 1.4 percent. Voter rights advocates have said the non-compliant Iowa Medicaid forms are likely a reason.

Zabner noted in comparison that Kentucky — a state with a population of roughly 4.5 million people — registered more than 88,000 voters through public assistance agencies, nearly 72 times that of Iowa and its population of about 3.2 million.

Nebraska registered just 225 voters through state public assistance agencies, Missouri 13,430, Illinois 22,780 and South Dakota 4,588. Minnesota, Wisconsin, North Dakota and some other states are exempt from the federal law.

“Iowans are facing down one of the most important elections in American history, and they are being denied their federal right to register to vote,” Zabner said.

Iowa Health and Human Services Director Kelly Garcia, in an email Wednesday to Zabner, wrote the department is on track to ensure renewal forms mailed in August contain a voter registration form in the packet.

“Medicaid renewal forms, which are the only remaining change needed for the Medicaid program, are autogenerated in batches, typically in the tens of thousands, and printed and batched mailed by the Department of Administrative Services,” Garcia wrote in the email provided to The Gazette by both the department and Zabner.

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The additional pages in the packet required machine reconfiguration, a new envelope and new postage amounts, Garcia wrote.

“As of this week, we have run small batch tests, working with the machine vendor and (Iowa Department of Administrative Services), and are working with (the U.S. Postal Service) to ensure appropriate postage is applied,” she wrote. “ … We must finalize this process and complete full testing by early June, which is the cut off date to ensure a true August time frame.”

In an April 19 email to the Iowa City Democratic lawmaker, Garcia said the department was unaware of the compliance issue and was surprised to learn about it from the Iowa Capital Dispatch’s reporting.

She wrote that several technical and logistical constraints, notably a “major system upgrade” of the IT system that houses the departments forms, mean that coming into compliance “is not as nimble as I would want or certainly as you expect.”

She noted that under Gov. Kim Reynolds’ realignment of state government, the department has created a new compliance division that is working through a “major system overhaul” of the department’s forms.

“This work will include reviewing content within federal and state laws to ensure compliance, revisiting forms for overall readability and accessibility, and strengthening connections between programs,” Garcia wrote.

In addition, forms currently completed in a fillable PDF and emailed to the department will be converted to an online forms platform to increase accessibility and security, a spokesman said.

Speaking this week to The Gazette, Zabner said he was concerned by what he felt has been “a lack of urgency” by the department to address the issue. But Garcia, in her email Wednesday, told Zabner that her staff “are indeed taking this work seriously.”

Comments: (319) 398-8499; tom.barton@thegazette.com