HR 608119th CongressIn Committee

COVER Now Act

Introduced: Jan 22, 2025

Sponsor: Rep. Doggett, Lloyd [D-TX-37] (D-Texas)

Standard Summary

Comprehensive overview in 1-2 paragraphs

The COVER Now Act would authorize a new Medicaid demonstration program that lets certain political subdivisions (sub-state governments such as counties or municipalities) implement medical assistance for the ACA Medicaid expansion population even if their state has not elected to expand. The program would waive some standard state-wideness rules, require public input, and set a multi-year funding and administration framework designed to encourage local-level expansion coverage. Participating subdivisions would receive a higher federal match for administrative costs and would administer benefits that align with essential health benefits, with the possibility of extending participation and automatic enrollment if the parent state later expands. The bill also imposes guardrails (limits on the number of demonstrations, reporting requirements, and penalties for certain state actions) and would cap the number of projects at 100.

Key Points

1Creation of a Demonstration Project for Political Subdivisions to Cover Expansion Population
2- Enables qualifying political subdivisions in states that have not expanded Medicaid to provide medical assistance to the expansion population, via a new demonstration program described in a new subsection (uu) of 1902.
3Qualification and Implementation Rules
4- A qualifying subdivision is in a non-expansion state and must apply with required information and have conducted public notice and hearings to gather input; may form partnerships with other subdivisions to implement the project.
5Duration, Extensions, and Automatic Enrollment
6- Default duration is seven years, or until the state provides expansion (whichever is shorter). After five years, a subdivision may apply for an extension for up to five more years. If the state later expands, eligible individuals served by the subdivision are automatically enrolled in the state plan/waiver beginning on the first day of that expansion.
7Benefits, Coverage, and Administration
8- Coverage for expansion-population individuals must be comparable to essential health benefits, delivered through the subdivision’s program as described in 1902(k)(1). The demonstration can waive certain federal requirements (statewideness and single-state agency) as described.
9Funding and Federal Matching
10- Federal matching for medical expenditures is calculated as if the subdivision were a state, with a separate provision to boost federal support for administrative costs: an additional 5 percentage points of federal matching for every 100,000 expansion-population individuals enrolled in a participating subdivision’s demonstration each calendar quarter (applied through 1903(a)(8)).
11- The schedule for federal administrative match starts at 100% for the first three years for participating rural and non-rural subdivisions per the specified tier system and then gradually declines over years 4–8, with slightly higher rates for rural subdivisions.
12Budget Neutrality and Limits
13- The demonstration is not required to be budget-neutral initially. The Secretary may not approve more than 100 total demonstrations (whether by single subdivisions or partnerships).
14State Protections and Penalties
15- States may face a 25% reduction in certain federal administrative cost payments if they take specified punitive or obstructive actions against the subdivision’s demonstration (e.g., disenrolling beneficiaries from the state plan to the subdivision, restricting participation of providers, or withholding state Medicaid system support).
16Timeline for Implementation
17- Regulations and application rules must be published within 180 days of enactment; decisions on applications must be made within 180 days of submission; extension decisions must be made within seven years of approval.
18Reporting and Evaluation
19- The Secretary must report to Congress within four years on enrollment changes, uncompensated care costs, and whether any participating states with demonstrations have expanded Medicaid under the ACA.

Impact Areas

Primary group/area affected- Expansion-eligible adults (roughly ages 19–64 with income up to 138% of the federal poverty level) living in participating political subdivisions within non-expansion states.Secondary group/area affected- Sub-state governments (counties/municipalities) that participate, along with local healthcare providers and health systems serving these populations.Additional impacts- States: potential shifts in administration and costs, with protections against punitive actions; potential for future state expansion to be more likely as subdivisions demonstrate viability.- Federal/CMS: increased oversight and administration of multiple sub-state programs; need to evaluate cost-sharing changes and administrative infrastructure.- Beneficiaries: potential access to expanded Medicaid coverage at the local level, with coverage aligned to essential health benefits and potential for smoother transition if their state later expands.The “expansion population” refers to adults newly covered under the ACA expansion (typically adults up to 138% FPL). The bill’s language ties the demonstration to those individuals described in the relevant Medicaid expansion category.The 1115(g) reference relates to a specific demonstration waiver framework; the bill offers a targeting boost to federal matching for admin costs based on enrollment levels in the demonstration.

Generated by gpt-5-nano on Nov 19, 2025