Since 2019, the Responsive Gov team has been working with advocates, experts, lawmakers, and bureaucrats at the state and federal level to advance a policy with the potential to dramatically expand participation in our democracy and register millions of eligible American voters: Secure Automatic Voter Registration (SAVR) at Medicaid.

Voter registration rates are disproportionately low among Medicaid enrollees. Medicaid enrollment is actually negatively correlated with voter registration, even after adjusting for other factors like race, age, income, or education status.

More than 31 million women are enrolled in Medicaid around the country. As of this Women’s History Month, seven states — Colorado, Massachusetts, Michigan, Minnesota, New Mexico, Nevada, and Oregon — and Washington, D.C. all have passed laws instructing state Medicaid offices to automatically register eligible U.S. citizens to vote when they apply for Medicaid. These states have been patiently waiting for guidance from the Centers for Medicare and Medicaid Services (CMS) and the Biden Administration to implement this policy.

Thanks to some progress over the past few decades, more women — especially in younger generations — are turning out to vote. However, there is still room for our nation to improve when it comes to women’s access to the ballot box: Women continue to face daily adversity from reproductive health services to affordable child care to access to paid leave, which continues to make it challenging for some women to register to vote, let alone cast a ballot on Election Day.

As we continue to examine how historic inequities in U.S. voter registration continue to impact American women across different demographics and geographies, Responsive Government is working to identify ways to improve women’s representation in our democracy — both at the ballot box and in public office.

So this Women’s History Month, our team is taking a moment to explore what SAVR at Medicaid could mean for women’s voter participation in the U.S.

SAVR at Medicaid

SAVR systems use information already collected by a government agency — such as name, address, date of birth, and citizenship status — to automatically register eligible voters or update voter registration information when people apply for or renew their driver’s license or change their address. SAVR significantly increases the accuracy and completeness of voter rolls while decreasing workloads for agency employees, lowering costs for agencies, shortening transaction times, and avoiding confusion for the public.

Building on successful AVR policies at the DMV, Colorado, Massachusetts, Michigan, Minnesota, New Mexico, Nevada, Oregon and Washington, D.C. all passed laws that instruct their state Medicaid offices to automatically register eligible U.S. citizens to vote when they apply for Medicaid. Using SAVR would maximize registration rates among eligible individuals while remaining most protective of ineligible voters by automatically excluding them from AVR.

SAVR at Medicaid is expected to help some states reach nearly all remaining unregistered eligible citizens. In Oregon, for example, SAVR at Medicaid is expected to reach 85% of the remaining eligible but unregistered population, about 171,000 voters. In Colorado, it could register 429,000 eligible voters. The voters reached with SAVR at Medicaid typically come from historically underrepresented communities, including voters of color, voters with disabilities, and low-income voters.

Women and Medicaid Enrollment

Implementing SAVR at Medicaid would have undeniable implications for women’s voter registration rates. Medicaid offers millions of low-income women across the nation an opportunity for health care coverage, and the majority of Medicaid enrollees are women. 31 million adult women were enrolled in the program in 2019.

Medicaid enrollment among American women significantly overlaps with historically disenfranchised and/or underrepresented communities. In 2020, Medicaid covered 16% of nonelderly adult women, with coverage higher among specific demographics, such as women of color, single mothers, low-income women, and women who haven’t finished high school.

Nearly one in three (31%) American Indian and Alaska Native (AIAN) women ages 18-64 rely on Medicaid for health care coverage. Medicaid covers 44% of nonelderly American women with disabilities, ranging from physical disabilities to severe mental illnesses. In 2021, more than one in four Black nonelderly adults and one in five Latino nonelderly adults relied on Medicaid for health coverage.

Many women also rely on Medicaid for reproductive health coverage. Medicaid financed 41% of births in the U.S. in 2021 and accounted for 75% of all publicly-funded family planning services. In four states, Medicaid covers more than 50% of all births—including in New Mexico, which passed SAVR at Medicaid in 2023.

States Waiting to Implement SAVR at Medicaid

All seven states awaiting guidance from CMS to implement SAVR at Medicaid expanded their state Medicaid programs under the Affordable Care Act, which widened eligibility to cover most adults with incomes up to 138% of the Federal Poverty Level, or $20,783 for an individual in 2024.

According to Kaiser Family Foundation demographics data from 2022, at least 2.4 million women are enrolled in Medicaid in the seven states that have passed SAVR at Medicaid — Colorado, Massachusetts, Michigan, Minnesota, New Mexico, Nevada, and Oregon — and Washington, D.C.

What’s Next

SAVR at Medicaid is a smart, highly effective policy with growing momentum across the country, and it has the potential to bring millions more eligible women voters into our democratic process. Women make up a majority of Medicaid enrollees, and women from historically underrepresented or disenfranchised communities are disproportionately represented in the program, including women of color, women with disabilities, and low-income working women. At a time when women’s rights and gender equity are increasingly up for political debate, these are communities with much to benefit from making their voices heard at the polls.

Several states and Washington, D.C. are ready and waiting to begin securely registering voters at Medicaid. It’s urgent that CMS and the Biden Administration issue clear guidance to ensure effective implementation, with a system that maximizes both registrations and protections for Medicaid applicants.