NC Voter Registration Non-Compliance
NC Voter Registration Non-Compliance
                                	
1
 Family and Children’s Medicaid Manual for the North Carolina Department of Health and
Human Services Medicaid Division of Health Benefits, MA 3421, attached hereto as Exhibit 1.
	                                            1
        The failure to provide any voter registration services during ex-parte MAGI
recertification has significant ramifications for North Carolina’s Medicaid recipients, as
the State appears to conduct at least 75% of its Medicaid recertifications using this
automated process.2 Recipients of Medicaid must have their benefits renewed once a
year,3 and as of February 2020, more 1.4 million North Carolina residents were enrolled
in Medicaid. 4 This means that hundreds of thousands of Medicaid clients who were
potentially eligible voters have been denied the NVRA-required opportunity to register to
vote as part of this recertification process and hundreds of thousands more will be denied
their right to register unless North Carolina incorporates voter registration into the ex-
parte MAGI recertification process. Within the last 120 days, a large number of
individuals throughout North Carolina went through this process, thus engaging a
transaction with DHHS where the NVRA required a voter registration opportunity but
none was provided.5
       As North Carolina’s chief election official, you are responsible for the State’s
compliance with the NVRA. See N.C. Gen. Stat. § 163-82.2; Harkless v. Brunner, 545
F.3d 445, 450–53 (6th Cir. 2008); Action NC v. Strach, 216 F.Supp.3d 597, 624
(M.D.N.C. 2016). We urge you to take immediate steps, in conjunction with DHHS, to
bring North Carolina’s ex-parte MAGI recertification process into compliance with
Section 7 of the NVRA.
                                	
2
 Tricia Brooks, et al., Kaiser Family Foundation, “Medicaid and CHIP Eligibility, Enrollment,
and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey” at Table 10
(Mar. 2020), available at http://files.kff.org/attachment/Table-10-Medicaid-and-CHIP-Eligibility-
as-of-Jan-2020.pdf/.
3
  See supra n.1 (noting there is a “12-month certification period”); see also 42 CFR §
435.916(a)(2).
4
  Centers for Medicare & Medicaid Services, 2020 01 Preliminary applications, eligibility
determinations, and enrollment data, available at https://data.medicaid.gov/Enrollment/2020-01-
Preliminary-applications-eligibility-deter/7yxe-jcft/data.
5
  Given the large number of Medicaid clients in North Carolina, more than a hundred thousand
individuals are having their benefits renewed in a typical month.
6
 See, e.g., U.S. Department of Justice, The National Voter Registration Act of 1993 (NVRA):
Questions and Answers, Q13, http://www.justice.gov/crt/about/vot/nvra/nvra_faq.php (last visited
June 15, 2020).
	                                              2
        The NVRA mandates that public assistance offices provide voter registration
opportunities whenever an individual is engaging in a “covered transaction” (an
application, renewal, recertification, or change of address transaction). In order to fulfill
their voter registration obligations, each public assistance office must (i) distribute voter
registration application forms; (ii) assist applicants in completing the voter registration
forms, unless such assistance is refused by the applicant; and (iii) accept completed voter
registration application forms and forward them to the appropriate election official. See
52 U.S.C. § 20506(a)(4)(A). Moreover, each office must (i) inquire of the applicant, in
writing, whether he or she would like to register to vote or change his or her voter
registration address; 7 (ii) distribute a voter registration application form with each
covered transaction, unless the individual applicant or client affirmatively opts out of
voter registration by declining in writing to register to vote; (iii) inform the applicant, in
writing, that the decision to register or decline to register to vote will not affect the
amount of public assistance provided by the agency; 8 and (iv) provide assistance in
completing the voter registration forms to the same degree the agency provides assistance
in completing its own forms. See 52 U.S.C. § 20506(a)(6).
	                                                 3
reliable information contained in the individual’s account or other more current
information available to the agency,” such as records from the IRS. As part of this
process, DHHS must, “notify the individual . . . [o]f the eligibility determination, and
basis,” which usually occurs through a letter and/or email. See 42 C.F.R. §
435.916(a)(2)(i).11 This provides clients with the required notice about the outcome of
their renewal and informs them about the details of what information was used to make
their renewal. Id. § 435.916(a)(2). Clients are also required to immediately inform the
agency if any of that information is inaccurate. Id. § 435.916(a)(2)(ii). Therefore, the ex-
parte MAGI recertification process requires that DHHS notify Medicaid recipients when
it is able to automatically recertify benefits and provide these recipients with an
opportunity to correct any inaccurate information.
        There is no dispute that North Carolina regularly employs the ex-parte MAGI
recertification process for the large number of Medicaid recipients in the State. Nor is
there any dispute that North Carolina has failed and continues to fail to provide any voter
registration services to individuals whose Medicaid benefits it renews through the
recertification process. While DHHS sends out the required notice of these renewals it
conducts through the ex-parte recertification process to clients, it does not provide clients
with a voter registration form or any information on voter registration, and it does not
conduct any follow-up with clients about voter registration.12
	                                              4
recertification that public assistance clients must themselves complete and submit. See
52 U.S.C. § 20506(a)(6)(A). The notification form that DHHS is required to send as part
of the ex-parte MAGI recertification process unambiguously constitutes a “renewal . . .
form relating to” Medicaid assistance, covered by Section 7 of the NVRA.
        DHHS has been aware that its ex-parte MAGI recertification process violates the
NVRA for many years but has, thus far, inexplicably refused to correct the problem.
Since the ACA was enacted, several of the organizations serving as counsel here have
worked with many states to address how the requirements of Section 7 intersect with the
operation of Medicaid processes created by the ACA. The other times we have raised
this issue, states—including Arizona, Kansas, Massachusetts, Ohio, and Pennsylvania—
have agreed that these transactions are recertifications covered by the NVRA. Counsel
has made the North Carolina State Board of Elections (“SBE”) and DHHS aware that
North Carolina is an outlier in not agreeing that compliance with the NVRA is required
during ex-parte MAGI recertifications.
III. Remedy
         It is puzzling why SBE and DHHS continue to violate the NVRA in this context
when the remedy is simple. As noted, the NVRA requires that during all covered
transactions, a public assistance agency: distribute voter registration application forms;
assist applicants in completing the voter registration forms, unless such assistance is
refused by the applicant; and provide certain disclosures. 52 U.S.C. § 20506(a)(6).
These mandated steps can be achieved if DHHS were to include a blank, coded state
voter registration form and a brief cover letter with the notice clients are sent when an ex-
parte MAGI recertification is completed. DHHS is already sending a notice to these
individuals, so this step would simply involve adding several additional pieces of paper to
that mailing. Also, public assistance agencies in North Carolina are already regularly
sending similar voter registration materials to some of their clients through the mail, so
there is already an appropriate cover letter that could be used for this purpose. A copy of
that letter is attached here as Exhibit 3.
	                                               5
       DHHS and SBE have a minimum obligation to execute the following remedial
mailing:
       §     Recipients: All U.S citizen adult North Carolina Medicaid clients whose
             benefits were renewed through the ex-parte MAGI recertification process
             between June 2019 and the date when DHHS implements a change to the
             policy going forward.
       §     Timing: Mailings should be sent in sufficient time for the recipients to register
             in advance of the October 9, 2020 voter registration deadline. We recommend
             a mailing date of no later than September 1, 2020.
       §     Content: A State of North Carolina voter registration application and the cover
             letter.
IV. Conclusion
        Please let us know immediately if any information we have presented in this letter
is not correct, as we send this letter to serve as notice of the NVRA violation by SBE and
DHHS pursuant to 52 U.S.C. § 20510(b).
         North Carolina must promptly guarantee that Medicaid recipients whose benefits
are—or have been—renewed through the ex-parte MAGI recertification process are
provided with the voter registration services demanded by the NVRA. We would be
pleased to work cooperatively with the SBE and DHHS to develop a plan to address this
violation of federal law. In the absence of such a plan, we will have no alternative but to
initiate litigation after the conclusion of the statutory 20-day waiting period.
       Please advise us promptly of the steps you intend to take to remedy North
Carolina’s violation of Section 7 of the NVRA.
Sincerely,
Sarah Brannon*
Managing Attorney for the Voting Rights Project
American Civil Liberties Union
915 15th Street, NW
                                                                                                 	
details of that mailing is attached hereto as Exhibit 4. Such mailings have also been ordered in
cases where NVRA-designated voter registration agencies have failed to provide required
registration services. See, e.g., League of Women Voters of Missouri v. Ashcroft, 336 F. Supp.3d
998, 1006 (W.D. MO, Sept. 2018) (ordering that as a remedy for ongoing violations of Section 5
of the NVRA a mailing with a voter registration application be sent to all potential impacted
individuals).
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Washington, DC 20005-2313
202-675-2337 (office)
202-210-7287 (cell)
sbrannon@aclu.org
* Not admitted in the District of Columbia; practice limited pursuant to D.C. App. R
___Naila S. Awan________
Naila S. Awan
Dēmos
80 Broad Street, 4th Floor
New York, NY 10004
212-485-6065
nawan@demos.org
___Allison Riggs____________
Allison Riggs
Southern Coalition for Social Justice
1415 West Highway 54, Suite 101
Durham, NC 27707
Allison@southerncoalition.org
____Dorian L. Spence______________
Dorian L. Spence
Lawyers’ Committee for Civil Rights Under Law
1500 K Street NW, Suite 900
Washington, D.C., 20005
Dspence@lawyerscommittee.org
____Jaclyn Maffetore______________
Jaclyn Maffetore
Staff Attorney
ACLU of North Carolina
Legal Foundation, Inc.
PO Box 28004, Raleigh NC 27611
(919) 666-7032
jmaffetore@acluofnc.org
cc via email:
       Mandy Cohen
       Secretary
       North Carolina Department of Health and Human Services
       2001 Mail Service Center
       Raleigh, NC 27699-200o
       mandy.cohen@dhhs.nc.gov
Paul M. Cox
	                                           7
    Special Deputy Attorney General
    Phone: (919)716-6932
    pcox@ncdoj.gov
    114 W. Edenton St., Raleigh, NC 27603
    Michael T. Wood
    Special Deputy Attorney General
    Special Litigation Section
    919-716-0186
    mwood@ncdoj.gov
    P. O. Box 629, Raleigh, NC 27602-0629
    ncdoj.gov
	                                    8
EXHIBIT 1
North Carolina Department of Health and Human Services
North Carolina Medicaid
Division of Health Benefits
FAMILY AND CHILDREN’S MEDICAID MANUAL                                                   MA-3421
                              MAGI RECERTIFICATION
                         REVISED 12/05/18 – CHANGE NO. 06-18
II.    Begin the recertification process at the beginning of the 10th month of the current
       12-month certification period or 2 months prior to last month of the MPW
       certification period.
III.   Ex-parte process means determining eligibility based on available records, prior to
       contacting or requesting information from the client.
   4.     The DSS 8113, Wage Verification Form may be sent to the employer when it
          is known that the information is not available to the local agency at the same
          time a NCFAST-20020 is sent.
   1.     Telephone
   2.     Mail
   3.     In person
   4.     Electronic/fax
C. Once the needed information/verification is received:
D. If the beneficiary no longer meets the eligibility criteria under the current
   program category, evaluate eligibility in all other Medicaid/ NCHC programs,
   including medically needy.
E. If the beneficiary is eligible for NC Health Choice, do not re-enroll the case when
   a fee is required.
   3.     If the fee is not paid within 12 calendar days, do not update the certification
          period. Send a timely notice proposing termination.
   4.     If the fee is paid and the case terminated because the 12th calendar day falls
          after “pull check” refer to reopen procedures.
   5.     If a MIC child is being added to an active NCHC case during the NCHC
          certification period, do not charge an enrollment fee for the child being added.
          Refer to MA-3306, Household Composition.
VI.      RECERTIFICATION NOT COMPLETED TIMELY
         If the recertification is not completed by the end of the certification period, extend the
         certification one month at a time to allow for timely notice requirements.
      A. Do not authorize case for an additional month if the case is in deductible status
         at the end of the certification period.
         1.       Use the electronic match sources from the original certification period if the
                  beneficiary remains eligible, or
         2.       If the electronic match sources from the original certification period makes the
                  beneficiary ineligible, use the most current electronic match sources to
                  determine eligibility.
         If a beneficiary provides the NCFAST- 20020 and/or the necessary information for
         recertification within 90 calendar days from termination effective date:
              •   Determine eligibility as if the information was received timely, from the first
                  day of the month following the termination date.
EXHIBIT 2
                                 SETTLEMENT AGREEMENT
COMMON TERMS
I. INTRODUCTION
         WHEREAS, on December 15, 2015, Plaintiffs Action NC, Democracy North Carolina,
North Carolina A. Philip Randolph Institute, Sherry Denise Holverson, Isabel Najera and
Alexandria Marie Lane (collectively, “Plaintiffs”), through their undersigned counsel, brought
Civil Action No. 15-cv-1063 in the United States District Court for the Middle District of
North Carolina against Kim Westbrook Strach, in her official capacity as Executive Director of
the North Carolina State Board of Elections; Rick Brajer, in his official capacity as Secretary of
the North Carolina Department of Health and Human Services (succeeded by Mandy K. Cohen);
Kelly Thomas, in his official capacity as Commissioner of the North Carolina Division of Motor
Vehicles (succeeded by Torre J. Jessup); and Nick Tennyson, in his official capacity as Secretary
of the North Carolina Department of Transportation (succeeded by James Trogdon III)
(collectively, “Defendants”), alleging violations of Section 5 and Section 7 of the National Voter
Registration Act of 1993 (“NVRA”), 52 U.S.C. § 20501, et seq.
       WHEREAS, Plaintiffs allege systemic past and ongoing violations of Section 5 and
Section 7 of the NVRA and have sought declaratory and injunctive relief from the Court.
         WHEREAS, Defendants have denied each and every one of Plaintiffs’ allegations of
unlawful conduct or wrongdoing, denied all liability, and have asserted a number of defenses to
Plaintiffs’ claims. Defendants specifically deny: (1) any and all alleged violations of Section 5
or Section 7 or other provisions of the NVRA; (2) that the NVRA applies to remote transactions,
including transactions conducted through state agency website online portals; and (3) that
Plaintiffs have asserted viable claims for relief or are entitled to relief as demanded in this action.
The state officials for the agencies sued in this action acknowledge the importance of voter
registration in the State of North Carolina and said officials are committed to robust
implementation of the NVRA.
        WHEREAS, the Plaintiffs and Defendants (together, “Parties”) now desire to resolve this
action without further litigation and expense and to avoid the further delay, inconvenience,
burden and uncertainty of continued litigation of this matter (including appeals from any
verdict).
       WHEREAS, the Parties have agreed to settle this lawsuit on terms set forth in this
Settlement Agreement (“Agreement”). By entering into this Agreement, Defendants do not
II. TERMS:
         The Parties agree that the terms and provisions in Schedules I and II attached hereto are
         incorporated herein and are part of this Settlement Agreement. Schedule I pertains to the
         North Carolina Division of Motor Vehicles (“DMV”), and Schedule II pertains to the
         Department of Health and Human Services (“DHHS”).
        B.     One of the Defendants named in this matter is Kim Westbrook Strach, in her
               official capacity as Executive Director of the North Carolina State Board of
               Elections. Now that entity has become the North Carolina Bipartisan State Board
               of Elections & Ethics Enforcement (“SBE”). Director Strach agrees that the Office
               of the North Carolina Bipartisan State Board of Elections & Ethics Enforcement
               shall ensure the compliance of any of its employees, agents, representatives,
               successors and assigns of the Executive Director of the SBE, acting in their official
               capacities, with the terms of this Agreement as to the obligations of the
               SBE. Additionally, each Defendant, including any legal successor(s) or assign(s),
               acting in their official capacities, is bound by the terms of this Agreement.
        D.     The Parties agree that as far as they are aware the steps outlined in this Agreement
               do not violate any applicable state or federal laws.
        E.     Effective upon execution of this Agreement by all Parties, the Parties agree to
               notify the Court and request that all pending deadlines and hearing dates be
               vacated and this action be dismissed with prejudice.
-2-
       H.    Notwithstanding the Release contained herein, the Parties agree that this
             Agreement does not resolve the dispute between the Parties as to whether the
             NVRA applies to ex parte Medicaid renewal transactions and, if so, the
             responsibilities of DHHS and Director Strach allegedly relating thereto. Any past
             or future NVRA claims arising from or related to ex parte Medicaid renewal
             transactions are not included in the Release provided here.
       C.    The compromise and settlement of Plaintiffs’ claim for attorneys’ fees and
             litigation expenses and costs against Defendants shall not establish, or be evidence
             of: (1) a “reasonable” hourly rate for Plaintiffs’ counsel or any other counsel;
             (2) the “reasonableness” of any legal services or activities performed by Plaintiffs’
             counsel in this or any other action; or (3) the “reasonableness” of any item of
             litigation expenses or costs in this or any other action.
       D.    The Plaintiffs’ Counsel agree to make available within fifteen (15) days of the
             Order of Dismissal the necessary documentation of expenses and itemized attorney
             time to assist with payment. If full payment from Defendants to Plaintiffs is not
-3-
-38-
I. DEFINITIONS
The following definitions apply for the limited purposes of this Agreement only and for no other
purpose unrelated to this Agreement. Neither Plaintiffs nor Defendants admit or agree that these
definitions constitute full, complete or accurate statements of applicable law under the National
Voter Registration Act of 1993 (“NVRA”), its regulations or other law. Defendants reserve all of
their legal and equitable rights under the NVRA and any other applicable law, notwithstanding
this Agreement.
       C.      “Days” means calendar days. If an action must take place within a certain
               number of days and the deadline would fall on a weekend or holiday, it is
               sufficient to take the required action on the first business day after the weekend or
               holiday.
       D.      “DHHS” means the North Carolina Department of Health and Human Services,
               and includes, without limitation, its authorized agents, officers and employees.
       E.      “Director” means the Executive Director of the SBE acting as the Chief Election
               Official for North Carolina.
       F.      “County DSS Office” means any county Department of Social Services office
               within the state of North Carolina that provides Public Assistance Benefits as
               defined herein through Covered Transactions, including County DSS Office
               employees and agents. This shall include any such county office even if its formal
               name does not include the term “Department of Social Services.”
       G.     “Local WIC Agency” shall mean any local office providing Special Supplemental
              Nutrition Program for Women, Infants, and Children (“WIC”) services within the
              State of North Carolina that provides WIC Program Benefits as defined herein
              through Covered Transactions, including the employees and agents of those
              offices. This shall include any such office even if its formal name does not include
-39-
  K.    “NVRA” means the National Voter Registration Act of 1993, 52 U.S.C. § 20501,
        et seq.
  L.    “Public Assistance Benefits” means those benefits that are subject to Section 7 of
        the NVRA which are administered by DHHS, including, but not limited to: the
        Supplemental Nutrition Assistance Program (SNAP, formerly the food-stamp
        program), the Special Supplemental Nutrition Program for Women, Infants and
        Children (WIC), the Temporary Assistance for Needy Families (TANF) program
        (formerly the Aid to Families with Dependent Children or AFDC program), the
        Medicaid program and the State Children’s Health Insurance Program (CHIP).
  N.    “Remote Transaction” means any interaction wherein a Client applies for Public
        Assistance Benefits, renews or recertifies Public Assistance Benefits or submits a
        change of address for Public Assistance Benefits via the telephone, facsimile,
        mail or electronically.
  O.    “Ex Parte Medicaid Renewal” shall mean the renewals of Medicaid benefits that
        are conducted through an automatic review of Clients’ eligibility and
        communicated to Clients through a confirmation letter.
  P.    “SBE” shall mean the North Carolina State Board of Elections, which is now
        known as the North Carolina Bipartisan State Board of Election and Ethics
        Enforcement, and any officials, employees, agents, representatives, successors
        and assigns of the North Carolina State Board of Elections.
-40-
The following provisions in this Section VIII will only apply to issues that both took place after
the date of dismissal and were identified after the date of dismissal.
               2.      Within fourteen (14) days of receiving such notice, the SBE NVRA
                       Coordinator shall direct the Local NVRA Point Person to send a remedial
                       mailing to the Client and enclose a Voter Registration Form and
                       explanatory notice. The explanatory notice shall advise the Client that
                       (i) he/she is receiving the mailing because (s)he may not have been offered
                       the opportunity to apply to register to vote, (ii) the mailing does not affect
                       the individual’s registration status if the individual is already registered to
                       vote at the individual’s current address, (iii) receipt of the mailing does not
                       indicate any information about the individual’s eligibility to register to
                       vote, (iv) it provides a clear explanation of the eligibility rules for
                       registering to vote and (v) assistance in completing the form is available
                       from the SBE or the Client’s Local WIC Agency or County DSS Office.
                       A copy of the letter shall be maintained consistent with the relevant
                       office’s document retention polices.
       B.      DHHS shall forward any complaints it receives made by the public regarding the
               provision of voter registration by any Local WIC Agency or County DSS Office
               to the NVRA Point Person for that Local WIC Agency or County DSS Office, if
               known, and also forward it to the SBE NVRA Coordinator, subject to applicable
               confidentiality laws.
-59-
You are receiving this letter because of your recent interaction with a county DSS office. The
National Voter Registration Act requires the county DSS office to provide the client with an
opportunity to register to vote.
During your interaction with the county DSS office, you may have indicated that you would like
to register to vote at the address at which you currently live. Enclosed is a voter registration
application. Once completed, you may send the form directly to the State Board of Elections at
the address provided on the back of the voter registration form or you may return it to your local
county DSS office.
Only U.S. citizens are eligible to register to vote. You must meet all the qualifications listed at
the top of the enclosed voter registration application and in the signature block of the application.
If you do not meet these qualifications, do not return the enclosed application.
If you wish to be registered to vote, please complete and sign the enclosed form confirming,
under penalty of perjury, that you meet the qualifications to vote and that the information
on the application is correct.
Please contact the State Board of Elections at 1-866-522-4723 if you desire assistance in
completing the application or if you have questions concerning this notice.
If you would prefer a copy of the enclosed voter registration form in Spanish, please visit
https://www.ncsbe.gov/NVRA/01. You may also call 1-866-522-4723.
Si desea una copia del formulario de inscripción de votante en español, por favor visite
https://www.ncsbe.gov/NVRA/01 o también puede llamar al 1-866-522-4723.
NCSBOE                                                                                           2019.03
EXHIBIT 4
Exhibit A
                ARIZONA DEPARTMENT OF ECONOMIC SECURITY (DES)
We are sending you the attached mail-in voter registration form to ensure that you receive an
opportunity to register to vote and/or ensure that the State has your current voting address. You are
receiving this notice because you recently interacted with a state agency such as the Department of
Economic Security (DES), Arizona Health Care Cost Containment System (AHCCCS), and/or the
Health-e-Arizona Plus web portal.
If you are not registered to vote where you live now, and you want to vote in the upcoming
federal election on November 6, 2018, you must return or mail this application to one of the
locations described below or complete the online registration by October 9, 2018.
If you want to register to vote or update your voter registration address, please complete the enclosed
Voter Registration Application and put it in the mail. After you have registered to vote you will receive
a voter registration card in the mail within 4-6 weeks.
Please carefully read the instructions about registering to vote, eligibility to register to vote and proof
of citizenship requirements.
If you are already registered to vote at your current address, you do not need to re-register to vote.
You can check your voter registration at: https://voter.azsos.gov/VoterView/RegistrantSearch.do.
Applying to register or declining to register to vote will not affect the amount of assistance that you will
be provided, or your eligibility. If you would like help filling out the voter registration form, need more
voter registration forms, or have any questions, you can call 1-877-THE VOTE (843-8683).