Three months after Iowa Capital Dispatch reported that the state’s health department is likely violating federal voting law and leaving thousands of low-income Iowans off the rolls, the department has publicly acknowledged the problem but remains vague on the plan for fixing it.

Multiple voting advocates told the Capital Dispatch in January that application and renewal mailers created by the Department of Health and Human Services for Medicaid and state-funded health insurance violate federal voting law by failing to offer a prominent and convenient opportunity to register to vote.

In an April 19 email to a Democratic state lawmaker, HHS Director Kelly Garcia wrote that she was surprised to learn of a “compliance issue” from the Capital Dispatch’s reporting — the first time, it appears, that the department has publicly acknowledged in writing that it’s violating federal law.

Garcia added that several technical and logistical constraints stand in the way of an immediate fix to the forms, but pledged: “For the IT system that houses our paper forms, we have narrowed the timeframe for the planned release this summer — as of now, the month of August.”

Garcia also wrote that a new HHS compliance division was planning to do a “major system overhaul” of the department’s forms.

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

Registration forms in packets

Garcia’s email to the lawmaker, Rep. Adam Zabner, came a day after both Zabner and the Capital Dispatch separately pressed HHS for a timeline on fixing the issue.

The email was provided to the Capital Dispatch by both HHS and Zabner, who has launched a public pressure campaign urging HHS to address the voter registration problem since the Capital Dispatch’s January report.

But Zabner, an Iowa City Democrat elected in 2022 at the age of 23, didn’t sound satisfied by Garcia’s response.

“I find it frustrating that we are now three months out from the initial reporting, and it doesn’t seem like much has been done,” Zabner told the Capital Dispatch via email. “A problem of this magnitude deserves urgent attention.”

“I’d also like to know what compliance looks like to the department.” Zabner added. “It is not clear to me from that email that they are committing that by August they will include a voter registration form in the application packet.”

Advocates have said including a voter registration form in the packet, as is done in many other states, would be the simplest and easiest way to ensure Iowa is complying with federal law.

Asked to clarify what HHS was committing to do by August, a department spokesperson did not immediately respond.

Over 400,000 adult Iowans are on Medicaid or state-funded health insurance programs.

Iowa’s application and renewal forms for these programs contain only one sentence on voter registration, near the end. They also include a URL leading to a state voter registration form that must be printed out and mailed to an election office, though no mailing address is provided.

Four separate experts on the requirements of the NVRA confirmed to the Capital Dispatch in January that HHS’s approach violates the National Voter Registration Act of 1993, which requires that states offer robust voter registration opportunities at public-assistance agencies.

Registering to vote via agencies

Just 1,222 Iowans registered to vote in the last cycle via public assistance agencies — well below the national average, even when adjusting for Iowa’s size. Advocates said the noncompliant Medicaid forms are likely one reason for Iowa’s low numbers.

States that have made the issue a priority have boosted registration rates from public assistance agencies.

Alabama’s numbers went up from 5,000 in 2011-12 to 120,000 in 2014-16, after the state signed an agreement with advocacy groups committing to improve accessibility.

And last cycle, Kentucky — whose population is around 4.5 million, compared to Iowa’s 3.2 million — took in over 88,000 registration applications from public assistance agencies. That’s around 72 times as many as Iowa.

Sometimes these improvements have come after advocacy groups or the U.S. Justice Department filed or threatened lawsuits. In an April 18 phone interview, Zabner suggested Iowa could ultimately see the same thing.

“When it’s public that you’re not complying with federal law and nothing’s been done for over two-and-a-half months, that’s just not good enough,” Zabner said. “When we’re talking about 700,000 Iowans who are potentially being denied the right to register to vote, that’s not good enough.”

HHS Director Kelly Garcia’s full April 19 email to Rep. Adam Zabner is below:

Good afternoon, Representative —

Iowa Department of Health and Human Services