Michigan is on the verge of approving Secure Automatic Voter Registration (SAVR) for Medicaid enrollment transactions as part of an upgrade to its AVR system.¹ While full implementation of this system must await final passage, approval by Governor Whitmer, and approval from the federal Centers for Medicare & Medicaid Services (CMS), Medicaid SAVR in Michigan represents an exciting opportunity to substantially improve voter registration rates among low-income citizens. We estimate that Michigan’s Secure AVR system at Medicaid could register at least 383,000 additional eligible citizens in Michigan and likely many more.

Michigan’s proposed SAVR system utilizes existing Medicaid verification procedures, relying on the fact that all Medicaid enrollees have their citizenship status externally verified by the Social Security Administration.² With SAVR, if an adult Medicaid enrollee is verified as a U.S. citizen as part of the application process, the information needed for voter registration (name, address, date of birth, etc.) is automatically shared with election officials. Election officials use this information to register any unregistered eligible people and to update the information of any existing registered voters. Newly registered or updated voters are then sent a mailer informing them of the new registration or update and providing an opportunity to decline.

Medicaid SAVR has the potential to significantly streamline voter registration during Medicaid enrollment, ensuring that the maximum number of eligible citizens are registered to vote or have their registration updated based on information provided during a Medicaid transaction, while also maximally protecting non-citizens from unintentional registration.

This change, once implemented, can ensure that almost all eligible Medicaid enrollees in a state are registered to vote, creating a process to add more than 383,000 eligible Medicaid enrollees to the rolls in Michigan.

Michigan currently has roughly 1.97 million adult Medicaid enrollees³, of whom approximately 1.88 million are U.S. citizens.⁴ Medicaid beneficiaries re-enroll annually, meaning each of these Medicaid enrollees will engage in an annual Medicaid transaction where they could be registered to vote by AVR, if eligible.

Data from Oregon indicates that roughly 20.4% of eligible Medicaid enrollees are not registered to vote.⁵ Notably, this estimate of the share of Medicaid enrollees who are not registered to vote is likely significantly lower than the actual number in most other states. This is because Oregon has had a robust SAVR system at its DMV for nearly a decade, which has significantly improved overall registration rates in the state more than other states. Data from other states indicates that a much higher share of eligible Medicaid enrollees are not registered to vote.

Nevertheless, relying on the Oregon data, if the same share of eligible Medicaid enrollees are not currently registered to vote in Michigan, that would result in an additional 383,000 registrations. Medicaid SAVR thus represents a significant opportunity to enfranchise low-income Americans who are less likely to be registered by traditional methods.

<sup>1. See Michigan HB 4983 (2023)
2. See Centers for Medicare and Medicaid Services, Federal Data Services Hub (Oct. 2014), https://www.medicaid.gov/state-resource-center/mac-learning-collaboratives/downloads/acct-trnsfr-bsns-serv-def.pdf.
3. See Medicaid.gov, July 2023 Medicaid & CHIP Enrollment Data Highlights, https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html (1,969,893 adult Medicaid enrollees in Michigan calculated by subtracting Total Medicaid Child and CHIP Enrollment (1,143,956) from Total Medicaid and CHIP Enrollment (3,113,849)).
4. In 2022, 7.5% of Americans were non-citizens, while 9.9% of Medicaid enrollees nationally were non-citizens. U.S. Elections Project, 2022 November General Election Turnout Rates, https://www.electproject.org/2022g (providing non-citizenship rates nationally and by state); Medicaid and CHIP Payment and Access Commission, MACStats: Medicaid and CHIP Data Book (Dec. 2022), https://www.macpac.gov/wp-content/uploads/2022/12/MACSTATS_Dec2022_WEB-508.pdf. (Exhibit 44, identifying 90.1% of Medicaid and CHIP enrollees as citizens). Using this same ratio (9.9%: 7.5%) in Michigan, where 3.3% of the overall population was non-citizen in 2022, implies a 4.36% non-citizen rate among Michigan Medicaid enrollees in 2022. If we assume that 4.36% of Michigan’s 1.97 million adult Medicaid enrollees are non-citizens, this results in an estimated adult citizen Medicaid enrollee population in Colorado of 1,884,006.
5. Ore. Secy’ of State, Testimony in Support of HB 2107 (Feb. 10, 2023), https://olis.oregonlegislature.gov/liz/2023R1/Downloads/PublicTestimonyDocument/47680 (finding that approximately 171,000 people on the Oregon Health Plan are eligible to vote but are not registered). The same data and calculations used in footnotes 3 and 4 to estimate the adult citizen Medicaid enrollee population in Michigan yields an estimate of 837,502 adult citizen Medicaid enrollees for Oregon as of February 2023, when the Secretary of State released its estimates. If 171,000 out of these enrollees are not registered to vote, that would mean 20.4% of eligible enrollees are not registered.</sup>