Can I Vote if I am Unexpectedly Hospitalized Right Before an Election?

Fred Nisen

Fred Nisen

What happens if you have a medical emergency right before an election and must abandon your original plan for how to vote? Can you still make sure your voice is heard and have your vote count? Yes, you may be able to cast your vote with an Emergency Absentee Ballot, and gain access to other important accommodations as well. 

Voting with an Emergency Ballot

A health emergency can disrupt even the best laid plans, and our plans for how to vote during an election are no exception. Sudden admission to a healthcare facility may make travel to a polling location on Election Day impossible, and voters who have acquired mail-in ballots may not be able access those ballots while receiving treatment. 

If you are at an inpatient facility or hospital on Election Day, are you still eligible to cast a ballot? Yes, you are eligible to vote in most situations if you follow the procedures prescribed by your state. In fact, according to the Election Assistance Commission, over 600,000 emergency ballots were issued during the 2020 general election.

Meet Fred Nisen - He knows the ins and outs of Emergency Ballots

Fred Nisen is Managing Attorney of Disability Rights California’s Voting Rights Practice Group. In his conversation with U.S. Vote Foundation (US Vote), Mr. Nisen explains the process of safeguarding voting rights for individuals who are unexpectedly hospitalized or unable to leave their homes due to a medical emergency, and shares his experiences helping these individuals obtain an emergency ballot.


18.6 million Americans who visit emergency departments wind up being admitted to hospitals each year, and this number doesn’t take into account unplanned admissions to mental health facilities and substance abuse centers. 

In some of these cases voters may have ample time to check their registration status, register and, if need be, request an absentee or mail-in ballot. If there is not enough time to obtain a standard ballot while undergoing treatment, however, in most states voters can cast Emergency Absentee Ballots. 

Fred, could you explain under which circumstances might voters need to obtain an Emergency Absentee Ballot in your state? 

Fred Nisen

In California, any voter can request and receive a replacement ballot up to seven days prior to Election Day. A voter will need a ballot if they have a medical emergency within the six days before Election Day (and Election Day itself) that makes them unable to go to an in-person voting location, such as being admitted into a medical facility, including a hospital or a skilled nursing facility, and not being able to leave their home.


Each state makes its own rules about how to qualify for, obtain, and return a ballot. Some states have recently passed laws about who can return ballots and how many ballots a person may return on behalf of other voters. In some cases, states have added witness, signature and notary requirements. US Vote tracks each state’s requirements so that voters are aware of the rules they must follow to make their voices heard with a standard ballot. 

In your experience at Disability Rights California (DRC), how does the procedure to request and return an Emergency Absentee Ballot play out? Do you have any tips to make the process go more smoothly?

Fred Nisen

DRC’s Voting Hotline receives a lot of contact regarding emergency ballots. Even within California, the process varies depending on the county. 

As a general rule, a voter who needs an emergency ballot has to authorize another person to pick up the ballot from the county elections office in writing. There is an authorization form on the Secretary of State’s website. 

Then the completed ballot can be returned just like a vote-by-mail ballot (i.e., by mail, in a drop box, and at an in-person voting location). However, there are a few counties that drop off and pick up emergency ballots.

Also, if the voter has access to a computer (with Internet access) and a printer, they can get their ballot using the County’s Remote Accessible Vote-by-Mail (RAVBM) system. RAVBM is an online system that allows a voter to download their ballot to their own internet-connected device, such as a computer or smartphone, and mark the ballot on that device. 

The voter then must print the RAVBM ballot. The voter can return the printed RAVBM ballot any way a regular vote-by-mail ballot can be returned: by mail, in a ballot drop box, or at an in-person voting location. It is currently available to all voters beginning 29 days before Election Day.

The biggest tip would be to begin the process as soon as possible. We get calls from voters who need an emergency ballot on Election Day, which makes it very difficult for them to successfully vote using the emergency ballot process.


Although there may be extra steps involved, do you think it is important for a person undergoing treatment to vote? How highly should one prioritize voting?

Fred Nisen

I think it’s a decision for each individual to make. Of course, I feel that it is very important for everyone to vote. But I am always amazed when we get calls on the Voting Hotline from people who are dealing with serious health issues and they are adamant about wanting to vote. To be honest, I am not sure that voting would be in the front of my mind if I were in the hospital undergoing treatment.


Some voters in a health crisis may have a qualifying disability which entitles them to receive assistance and accommodations when voting after the emergency event concludes. 

What types of assistance and accommodations have you found are most helpful for voters with disabilities? Could you identify 3-5 valuable options?

Fred Nisen

Ballot marking devices (BMD) at in-person voting locations

BMDs are important for voters with temporary or permanent disabilities because they have features that enable voters with disabilities to exercise their right to vote privately and independently. 

“Privately and independently” means these devices enable them to vote without having to rely on another person to help them read and mark their ballot and without having to reveal how they are voting to anyone else, protecting their right to cast a secret ballot. 

These features include a touchscreen; a handheld controller with Braille and buttons in different shapes and colors; options to change text size and color contrast on the screen; headphones for listening to an audio version of the ballot and audio instructions for navigating and marking the ballot electronically; and ports for connecting other assistive technology, such as a sip-and-puff device.

Remote Accessible Vote-by-Mail (RAVBM), sometimes referred to as “electronic ballot delivery”:

RAVBM system allows voters to access, read, and mark an electronic version of their ballot on their own device, such as a personal computer. Because they are using their own device, they also can use their own assistive technology, such as a screen reader, to navigate, read, and mark their ballot. 

In order to use RAVBM, a voter must have access to the necessary equipment, including an internet-connected computer or similar device, and a printer. 

Once a voter marks the ballot using the RAVBM system, the voter must print the ballot on paper and return the printed ballot to elections officials using the same return methods that apply to paper vote-by-mail ballots–by mail, at a drop off box, or at an in-person voting location in a signed return envelope. 

This is what differentiates electronic ballot delivery only, which is what California and several other states offer voters with disabilities, from electronic ballot delivery and return, which allows voters with disabilities that do not allow them to read or handle paper and put it in an envelope to vote privately and independently. Currently, approximately 13 states offer some form of electronic ballot return for this subset of voters with disabilities.

Curbside voting

Curbside voting allows voters who cannot get out of their vehicle or have health- or disability-related reasons for not entering a voting location to vote outside of the voting location. Signage will tell voters where the curbside voting area is and how to request help from there (either a call box, a phone number for the voter to use, or both).

Auxiliary aids

All ballot return envelopes have two holes punched to allow voters who are blind or have low vision to know where they are supposed to sign the envelope. Similarly, in-person voting locations have signature guides. In addition, the voting locations have magnifying sheets.


If a person’s signature has changed or is erratic, they can sign the return envelope with a mark, such as an “X,” if it is also signed by a witness. Also, subject to certain conditions, a voter may sign using a signature stamp.


Over the course of your career, have you been inspired or uplifted by anyone’s will to vote under exceptional circumstances? If so, would you share the success story and any lessons we can take away from it?

Fred Nisen

I am constantly amazed and impressed by how important voting is to some people who are in the middle of life-or-death moments. 

For example, I remember that we received a call from a gentleman who was in the hospital receiving treatment for stage 4 cancer, and he desperately wanted to vote because he never missed an election. We walked him and his wife through the emergency ballot process. I have been a voting rights advocate for over a decade, and I do not know if I would be so adamant about voting at a time like that.

During the November 2022 election, we were contacted by an elderly woman who was blind. She could not leave her home, but really wanted to vote. It was Election Day and she did not have her ballot because she recently moved. One of our community partners donated a volunteer to help her register to vote online with the help of the county elections office, obtained the voter’s ballot, and returned the completed ballot right before the polls closed. It reinforced the importance of maintaining good relationships with elections officials and community partners.


If a citizen who needs an Emergency Absentee Ballot also needs professional advocacy to be able to vote, where do you suggest this person turn?

Fred Nisen

I would say the state’s protection and advocacy system for people with disabilities (“P&A agency”). Click here to find your state’s P&A agency.

Disability Rights California, California’s P&A agency, hosts a year-round Voting Hotline for voters with disabilities.


Is there anything else you’d like to share about how to vote when unexpectedly hospitalized before an election?

Fred Nisen

I think that covers it. But I would recommend consulting your state’s laws regarding emergency ballots.

Voters who are unexpectedly hospitalized right before an election can check US Vote’s State-by-State Voting Rules, Election Dates and Deadlines and Ways to Vote to learn about the voting laws in their state before requesting an emergency ballot if reasonable. Contact the US Vote Voter Help Desk if you need more information about how to vote in your personal circumstance.