The Centers for Medicare & Medicaid Services (CMS) on July 20, 2026, rescinded earlier guidance that affirmed nursing home residents’ voting rights and replaced it with a new memorandum that places significantly greater emphasis on preventing voter fraud, coercion, and undue influence in long-term care settings. The new memo to state survey agency directors reiterates that nursing home residents retain their constitutional right to vote, but frames that obligation alongside extensive warnings about compliance with federal and state election laws and concerns about improper influence by facility staff.

The rescinded 2024 memo directed nursing homes to have a plan to help residents vote, including assisting with voter registration, absentee ballots, transportation to polling locations, and coordination with election officials. It encouraged nursing homes to coordinate with state and local programs to enable residents to vote but reminded communities that they are required to support residents in exercising their rights regardless of whether external assistance is available to come into the facility. By contrast, the new memorandum rescinds both the 2024 and earlier 2020 guidance and shifts the focus toward preventing potential misconduct. CMS cites allegations of election-related violations involving long-term care residents in Texas and Wisconsin and warns facilities against activities such as registering residents without their knowledge or consent or completing ballots on a resident’s behalf without authorization. The memo also encourages the use of bipartisan election workers, where permitted by state law, to reduce reliance on facility staff in the voting process.

While CMS states that the new memorandum creates no new regulatory requirements and simply reinforces existing obligations, the change in tone suggests federal survey and enforcement attention may increasingly center on how nursing homes balance voting access with safeguards against fraud and coercion. Providers should expect increased attention to documentation, resident consent, staff training, and adherence to state election laws when assisting residents with voting. Facilities may also review existing voting-support policies to ensure assistance is resident-directed, properly documented, and clearly separated from any activity that could be perceived as coercive or partisan. At the same time, providers continue to have obligations under federal residents’ rights regulations to support residents in exercising their rights as citizens without interference, discrimination, coercion, or reprisal.

As the 2026 election cycle approaches, LeadingAge and our members remain committed to ensuring all eligible older adults and people with disabilities have resources to vote. To help our mission-driven and nonprofit members serve their communities, we have compiled a list of Voting Information and Election Resources, and an accompanying downloadable one-pager. We will continue to monitor these developments and provide updated resources as necessary.