I
119THCONGRESS
1
STSESSION H. R. 608
To amend title XIX of the Social Security Act to provide for a demonstration
project under the Medicaid program for political subdivisions of States
to provide medical assistance for the expansion population under such
program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY22, 2025
Mr. D
OGGETT(for himself, Mr. BISHOP, Mr. CASAR, Ms. CASTORof Florida,
Mr. C
ASTROof Texas, Mr. COHEN, Mr. CLYBURN, Mr. CUELLAR, Ms.
E
SCOBAR, Mr. FIGURES, Mrs. FLETCHER, Ms. LOISFRANKELof Flor-
ida, Ms. G
ARCIAof Texas, Mr. GREENof Texas, Mr. JOHNSONof Geor-
gia, Ms. J
OHNSONof Texas, Mrs. MCBATH, Mrs. CHERFILUS-MCCOR-
MICK, Mr. DAVIDSCOTTof Georgia, Ms. SEWELL, Mr. SOTO, Mr.
T
HOMPSONof Mississippi, Mr. TURNERof Texas, Mr. VEASEY, Ms.
W
ASSERMANSCHULTZ, Ms. WILLIAMSof Georgia, Ms. WILSONof Flor-
ida, Ms. A
DAMS, Mr. CLEAVER, Mr. CONNOLLY, Ms. NORTON, and Mr.
R
ASKIN) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to provide
for a demonstration project under the Medicaid program
for political subdivisions of States to provide medical
assistance for the expansion population under such pro-
gram, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
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SECTION 1. SHORT TITLE. 1
This Act may be cited as the ‘‘Cover Outstanding 2
Vulnerable Expansion-eligible Residents Now Act’’ or the 3
‘‘COVER Now Act’’. 4
SEC. 2. DEMONSTRATION PROJECT FOR POLITICAL SUB-5
DIVISIONS OF STATES TO PROVIDE MEDICAL 6
ASSISTANCE FOR MEDICAID EXPANSION POP-7
ULATION. 8
(a) I
NGENERAL.—Section 1902 of the Social Secu-9
rity Act is amended— 10
(1) in subsection (a)— 11
(A) in paragraph (86), by striking at the 12
end ‘‘and’’; 13
(B) in paragraph (87), by striking the pe-14
riod at the end and inserting ‘‘; and’’; and 15
(C) by inserting after paragraph (87) the 16
following new paragraph: 17
‘‘(88) provide, at the option of the qualifying 18
political subdivisions of a State, for a demonstration 19
project described in subsection (uu).’’; and 20
(2) by adding at the end the following new sub-21
section: 22
‘‘(uu) D
EMONSTRATION PROJECT FOR POLITICAL 23
S
UBDIVISIONS OFSTATESTOPROVIDEMEDICALASSIST-24
ANCE FOREXPANSIONPOPULATION.— 25
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‘‘(1) IN GENERAL.—Notwithstanding section 1
subsection (a)(5), the Secretary shall conduct a dem-2
onstration project under which the Secretary shall, 3
subject to paragraph (9), select qualifying political 4
subdivisions described in paragraph (2) to provide, 5
in accordance with the requirements of this sub-6
section, medical assistance for individuals described 7
in subclause (VIII) of subsection (a)(10)(A)(i) who 8
reside in such political subdivisions in accordance 9
with the timeline specified under paragraph (8). 10
‘‘(2) W
AIVER AUTHORITY.—The Secretary may 11
waive the requirements of paragraphs (1) and (5) of 12
subsection (a) relating to statewideness and relating 13
to single state agency, respectively. 14
‘‘(3) Q
UALIFYING POLITICAL SUBDIVISION .—A 15
qualifying political subdivision described in this 16
paragraph is— 17
‘‘(A) a political subdivision— 18
‘‘(i) located in a State that has not 19
elected to provide medical assistance for 20
individuals described in subclause (VIII) of 21
subsection (a)(10)(A)(i) as of the date of 22
the enactment of this subsection; and 23
‘‘(ii) submits an application to the 24
Secretary— 25
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‘‘(I) at such time, in such man-1
ner, and containing such information 2
as the Secretary may require; and 3
‘‘(II) which has undergone a 4
process for public notice and comment 5
at the political subdivision level, in-6
cluding public hearings, sufficient to 7
ensure a meaningful level of public 8
input; or 9
‘‘(B) any number of political subdivisions 10
described in subparagraph (A) which form a 11
partnership for purposes of implementing the 12
demonstration project under this subsection. 13
‘‘(4) L
ENGTH OF DEMONSTRATION PROJECT .— 14
‘‘(A) I
N GENERAL.—Subject to subpara-15
graph (B), a qualifying political subdivision se-16
lected to participate in the demonstration 17
project under this subsection or partnership de-18
scribed in paragraph (3)(B) (referred to in this 19
subsection as a ‘participating political subdivi-20
sion’) shall provide medical assistance for indi-21
viduals described in subclause (VIII) of sub-22
section (a)(10)(A)(i) for seven years or through 23
the day before the date on which the State in 24
which such political subdivision is located pro-25
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vides for medical assistance under the State 1
plan (or a waiver of such plan) for such individ-2
uals, whichever is shorter. 3
‘‘(B) E
XTENSION.—A participating polit-4
ical subdivision that participates in the dem-5
onstration project under this subsection for five 6
years may extend its participation in the dem-7
onstration project by submitting an application 8
to the Secretary at such time, in such manner, 9
and containing such information as the Sec-10
retary may require. Under such extension, such 11
political subdivision shall provide medical assist-12
ance for individuals described in subclause 13
(VIII) of subsection (a)(10)(A)(i) for up to an 14
additional five years or through the day before 15
the date on which the State in which such polit-16
ical subdivision is located provides for medical 17
assistance under the State plan (or a waiver of 18
such plan) for such individuals, whichever is 19
shorter. 20
‘‘(C) A
UTOMATIC ENROLLMENT IN CASE 21
OF STATES THAT ELECT TO PROVIDE MEDICAL 22
ASSISTANCE FOR EXPANSION POPULATION .—In 23
the case of a participating political subdivision 24
whose participation in the demonstration 25
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project under this subsection ends because the 1
State in which such political subdivision is lo-2
cated elects to provide for medical assistance 3
under the State plan (or a waiver of such plan) 4
for individuals described in subclause (VIII) of 5
subsection (a)(10)(A)(i), such State shall auto-6
matically enroll under such State plan (or waiv-7
er) any eligible and enrolled individual so de-8
scribed receiving medical assistance from such 9
political subdivision and coverage for such indi-10
vidual under such State plan (or waiver) begin-11
ning with the first day on which the State pro-12
vides medical assistance under such State plan 13
(or waiver) for individuals described in sub-14
clause (VIII) of subsection (a)(10)(A)(i). 15
‘‘(5) P
AYMENTS.— 16
‘‘(A) I
N GENERAL.—The Secretary shall 17
pay a participating political subdivision the 18
Federal matching percentage specified in sub-19
paragraph (B) for amounts expended by such 20
political subdivision to provide medical assist-21
ance for individuals described in subclause 22
(VIII) of subsection (a)(10)(A)(i). 23
‘‘(B) C
ALCULATION OF FEDERAL AND 24
NON-FEDERAL SHARE .—Except as provided 25
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under clause (ii) and subparagraph (C), the cal-1
culation and payment of the Federal and non- 2
Federal share of expenditures for medical as-3
sistance under a demonstration described in 4
paragraph (1) shall be calculated in accordance 5
with section 1903 as if the qualifying political 6
subdivision was a State. 7
‘‘(C) F
EDERAL MATCHING PERCENTAGE .— 8
The Federal matching percentage specified in 9
this subparagraph, with respect to a partici-10
pating political subdivision and the demonstra-11
tion project under this subsection, is— 12
‘‘(i) 100 percent for calendar quarters 13
in the first three years that such political 14
subdivision participates in such demonstra-15
tion project, if applicable; 16
‘‘(ii) with respect to a participating 17
political subdivision which— 18
‘‘(I) includes a rural political 19
subdivision (as defined by the Office 20
of Management and Budget), 100 21
percent for calendar quarters in the 22
fourth year that such political subdivi-23
sion participates in such demonstra-24
tion project, if applicable; and 25
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‘‘(II) does not include a rural po-1
litical subdivision (as defined by the 2
Office of Management and Budget), 3
95 percent for calendar quarters in 4
the fourth year that such political 5
subdivision participates in such dem-6
onstration project, if applicable; 7
‘‘(iii) with respect to a participating 8
political subdivision which— 9
‘‘(I) includes a rural political 10
subdivision (as defined by the Office 11
of Management and Budget), 95 per-12
cent for calendar quarters in the fifth 13
year that such political subdivision 14
participates in such demonstration 15
project, if applicable; and 16
‘‘(II) does not include a rural po-17
litical subdivision (as defined by the 18
Office of Management and Budget), 19
94 percent for calendar quarters in 20
the fifth year that such political sub-21
division participates in such dem-22
onstration project, if applicable; 23
‘‘(iv) with respect to a participating 24
political subdivision which— 25
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‘‘(I) includes a rural political 1
subdivision (as defined by the Office 2
of Management and Budget), 94 per-3
cent for calendar quarters in the sixth 4
year that such political subdivision 5
participates in such demonstration 6
project, if applicable; and 7
‘‘(II) does not include a rural po-8
litical subdivision (as defined by the 9
Office of Management and Budget), 10
93 percent for calendar quarters in 11
the sixth year that such political sub-12
division participates in such dem-13
onstration project, if applicable; 14
‘‘(v) with respect to a participating 15
political subdivision which— 16
‘‘(I) includes a rural political 17
subdivision (as defined by the Office 18
of Management and Budget), 93 per-19
cent for calendar quarters in the sev-20
enth year that such political subdivi-21
sion participates in such demonstra-22
tion project, if applicable; and 23
‘‘(II) does not include a rural po-24
litical subdivision (as defined by the 25
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Office of Management and Budget), 1
90 percent for calendar quarters in 2
the seventh year that such political 3
subdivision participates in such dem-4
onstration project, if applicable; and 5
‘‘(vi) 90 percent for calendar quarters 6
in the eighth year and any subsequent 7
years thereafter that such political subdivi-8
sion participates in such demonstration 9
project, if applicable. 10
‘‘(6) C
OMPARABILITY OF BENEFITS TO ESSEN -11
TIAL HEALTH BENEFITS .—The medical assistance 12
made available by a participating political subdivi-13
sion to individuals described in subclause (VIII) of 14
subsection (a)(10)(A)(i) shall consist of coverage de-15
scribed in subsection (k)(1). 16
‘‘(7) R
EDUCTION IN FEDERAL FUNDING FOR 17
MEDICAL ASSISTANCE FOR STATES THAT TAKE CER -18
TAIN ACTIONS.— 19
‘‘(A) I
N GENERAL.—In the case of a State 20
that does any of the prohibited items described 21
in subparagraph (B), the Secretary shall with-22
hold from the amount otherwise payable under 23
section 1903 an amount equal to 25 percent of 24
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the amount of administrative costs under the 1
State plan under title XIX during a calendar. 2
‘‘(B) P
ROHIBITED ITEMS.—For purposes 3
of subparagraph (A), a State may not— 4
‘‘(i) shift the costs of providing med-5
ical assistance to individuals enrolled under 6
a State plan under title XIX to a political 7
subdivision that establishes a demonstra-8
tion project under this subsection by 9
disenrolling such individuals from the 10
State plan to the demonstration project of 11
the political subdivision; 12
‘‘(ii) withhold or reduce any kind of 13
funding or State support to political sub-14
division on account of the political subdivi-15
sion’s establishment of a demonstration 16
project; 17
‘‘(iii) increase taxes on taxpayers of a 18
political subdivision on account of the po-19
litical subdivision’s establishment of a dem-20
onstration project; 21
‘‘(iv) require a political subdivision to 22
increase or lower a tax rate required by the 23
political subdivision on account of the po-24
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litical subdivision’s establishment of a dem-1
onstration project; 2
‘‘(v) prohibit a political subdivision 3
from participating in a demonstration 4
project pursuant to this subsection; 5
‘‘(vi) prohibit a political subdivision 6
from participating in a Federal demonstra-7
tion project, establishing or expanding a 8
health coverage program, contracting or 9
otherwise entering into an agreement with 10
the Centers for Medicare & Medicaid Serv-11
ices, or receiving Federal funding directly 12
from a Federal agency; 13
‘‘(vii) prohibit a health care provider, 14
hospital, federally qualified health center, 15
or rural health clinic from— 16
‘‘(I) accepting patients with 17
health coverage provided by a political 18
subdivision; 19
‘‘(II) accepting payments from a 20
political subdivision; 21
‘‘(III) making payments, includ-22
ing taxes, to a political subdivision; or 23
‘‘(IV) participating in the State 24
Medicaid program on account of par-25
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ticipation in a demonstration project 1
pursuant to this subsection; 2
‘‘(viii) refuse to allow a political sub-3
division to rely on State Medicaid systems 4
and State Medicaid agency staff to imple-5
ment a demonstration project, including— 6
‘‘(I) the State’s Medicaid eligi-7
bility check and enrollment system; 8
‘‘(II) provider payment system; 9
‘‘(III) claims processing system; 10
‘‘(IV) fair hearing system; and 11
‘‘(V) Federal reporting require-12
ment system; or 13
‘‘(ix) take any other punitive action 14
against a political subdivision that estab-15
lish a demonstration project. 16
‘‘(8) T
IMELINE SPECIFIED.—For purposes of 17
paragraph (1), the timeline specified in this para-18
graph shall require— 19
‘‘(A) not later than 180 days after the date 20
of the enactment of this subsection, the Sec-21
retary to promulgate any regulations necessary 22
to carry out this subsection, including— 23
‘‘(i) the application requirements for a 24
political subdivision to apply for a dem-25
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onstration project, criteria on which appli-1
cations will be reviewed, and how long po-2
litical subdivisions have to begin the dem-3
onstration once an application is approved; 4
and 5
‘‘(ii) the application of all require-6
ments under section 1903 to a partici-7
pating political subdivision as if it was a 8
State; 9
‘‘(B) not later than 180 days after receiv-10
ing an application from a qualifying political 11
subdivision described in paragraph (3), the Sec-12
retary to transmit a notice to such qualifying 13
political subdivision of the application’s ap-14
proval or rejection, and in case of a rejection an 15
explanation for the rejection; and 16
‘‘(C) not later than 7 years after the ap-17
proval of an application, the Secretary to trans-18
mit a notice to such qualifying political subdivi-19
sion of the application’s approval or rejection 20
for an extension under this subsection. 21
‘‘(9) L
IMITATION ON NUMBER OF DEMONSTRA -22
TION PROJECTS.—The Secretary may not approve 23
more than 100 demonstration projects under this 24
subsection, which may consist of demonstration 25
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projects implemented by a single participating polit-1
ical subdivision or implemented as partnerships 2
formed by multiple participating political subdivi-3
sions (as described in paragraph (3)(B)). 4
‘‘(10) A
PPLICATION WITHOUT REGARD TO 5
BUDGET NEUTRALITY .—The Secretary shall not re-6
quire, as a condition for carrying out the demonstra-7
tion project under this subsection, that the dem-8
onstration project ensure that such model is budget 9
neutral initially with respect to expenditures under 10
the applicable title. 11
‘‘(11) R
EPORT.—Not later than 4 years after 12
the first date of the demonstration project, the Sec-13
retary shall submit a report to Congress on— 14
‘‘(A) the effect of the demonstration 15
project on— 16
‘‘(i) the number of beneficiaries en-17
rolled in demonstration projects under this 18
subsection; and 19
‘‘(ii) the amount of uncompensated 20
care costs for State Medicaid plans; and 21
‘‘(B) whether any States with a dem-22
onstration project under this subsection have 23
expanded Medicaid coverage under the Patient 24
Protection and Affordable Care Act.’’. 25
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(b) PAYMENT TOSTATES.—Section 1903(a) of the 1
Social Security Act (42 U.S.C. 1396b(a)) is amended— 2
(1) in paragraph (6), by striking at the end 3
‘‘plus’’; 4
(2) in paragraph (7), by striking the period at 5
the end and inserting ‘‘; plus’’; and 6
(3) by adding at the end the following new 7
paragraph: 8
‘‘(8) an amount equal to an increase of 5 per-9
centage points to Federal matching percentage for 10
administrative costs for every 100,000 individuals 11
described in paragraph (1) of section 1115(g) who 12
are enrolled in a demonstration project of a partici-13
pating political subdivision (as referred to in para-14
graph (4)(A) of such section) during a calendar 15
quarter.’’. 16
Æ
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