[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 608 Introduced in House (IH)]
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119th CONGRESS
1st Session
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
January 22, 2025
Mr. Doggett (for himself, Mr. Bishop, Mr. Casar, Ms. Castor of Florida,
Mr. Castro of Texas, Mr. Cohen, Mr. Clyburn, Mr. Cuellar, Ms. Escobar,
Mr. Figures, Mrs. Fletcher, Ms. Lois Frankel of Florida, Ms. Garcia of
Texas, Mr. Green of Texas, Mr. Johnson of Georgia, Ms. Johnson of
Texas, Mrs. McBath, Mrs. Cherfilus-McCormick, Mr. David Scott of
Georgia, Ms. Sewell, Mr. Soto, Mr. Thompson of Mississippi, Mr. Turner
of Texas, Mr. Veasey, Ms. Wasserman Schultz, Ms. Williams of Georgia,
Ms. Wilson of Florida, Ms. Adams, Mr. Cleaver, Mr. Connolly, Ms.
Norton, and Mr. Raskin) introduced the following bill; which was
referred to the Committee 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 program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Cover Outstanding Vulnerable
Expansion-eligible Residents Now Act'' or the ``COVER Now Act''.
SEC. 2. DEMONSTRATION PROJECT FOR POLITICAL SUBDIVISIONS OF STATES TO
PROVIDE MEDICAL ASSISTANCE FOR MEDICAID EXPANSION
POPULATION.
(a) In General.--Section 1902 of the Social Security Act is
amended--
(1) in subsection (a)--
(A) in paragraph (86), by striking at the end
``and'';
(B) in paragraph (87), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after paragraph (87) the following
new paragraph:
``(88) provide, at the option of the qualifying political
subdivisions of a State, for a demonstration project described
in subsection (uu).''; and
(2) by adding at the end the following new subsection:
``(uu) Demonstration Project for Political Subdivisions of States
To Provide Medical Assistance for Expansion Population.--
``(1) In general.--Notwithstanding section subsection
(a)(5), the Secretary shall conduct a demonstration project
under which the Secretary shall, subject to paragraph (9),
select qualifying political subdivisions described in paragraph
(2) to provide, in accordance with the requirements of this
subsection, medical assistance for individuals described in
subclause (VIII) of subsection (a)(10)(A)(i) who reside in such
political subdivisions in accordance with the timeline
specified under paragraph (8).
``(2) Waiver authority.--The Secretary may waive the
requirements of paragraphs (1) and (5) of subsection (a)
relating to statewideness and relating to single state agency,
respectively.
``(3) Qualifying political subdivision.--A qualifying
political subdivision described in this paragraph is--
``(A) a political subdivision--
``(i) located in a State that has not
elected to provide medical assistance for
individuals described in subclause (VIII) of
subsection (a)(10)(A)(i) as of the date of the
enactment of this subsection; and
``(ii) submits an application to the
Secretary--
``(I) at such time, in such manner,
and containing such information as the
Secretary may require; and
``(II) which has undergone a
process for public notice and comment
at the political subdivision level,
including public hearings, sufficient
to ensure a meaningful level of public
input; or
``(B) any number of political subdivisions
described in subparagraph (A) which form a partnership
for purposes of implementing the demonstration project
under this subsection.
``(4) Length of demonstration project.--
``(A) In general.--Subject to subparagraph (B), a
qualifying political subdivision selected to
participate in the demonstration project under this
subsection or partnership described in paragraph (3)(B)
(referred to in this subsection as a `participating
political subdivision') shall provide medical
assistance for individuals described in subclause
(VIII) of subsection (a)(10)(A)(i) for seven years or
through the day before the date on which the State in
which such political subdivision is located provides
for medical assistance under the State plan (or a
waiver of such plan) for such individuals, whichever is
shorter.
``(B) Extension.--A participating political
subdivision that participates in the demonstration
project under this subsection for five years may extend
its participation in the demonstration project by
submitting an application to the Secretary at such
time, in such manner, and containing such information
as the Secretary may require. Under such extension,
such political subdivision shall provide medical
assistance for individuals described in subclause
(VIII) of subsection (a)(10)(A)(i) for up to an
additional five years or through the day before the
date on which the State in which such political
subdivision is located provides for medical assistance
under the State plan (or a waiver of such plan) for
such individuals, whichever is shorter.
``(C) Automatic enrollment in case of states that
elect to provide medical assistance for expansion
population.--In the case of a participating political
subdivision whose participation in the demonstration
project under this subsection ends because the State in
which such political subdivision is located elects to
provide for medical assistance under the State plan (or
a waiver of such plan) for individuals described in
subclause (VIII) of subsection (a)(10)(A)(i), such
State shall automatically enroll under such State plan
(or waiver) any eligible and enrolled individual so
described receiving medical assistance from such
political subdivision and coverage for such individual
under such State plan (or waiver) beginning with the
first day on which the State provides medical
assistance under such State plan (or waiver) for
individuals described in subclause (VIII) of subsection
(a)(10)(A)(i).
``(5) Payments.--
``(A) In general.--The Secretary shall pay a
participating political subdivision the Federal
matching percentage specified in subparagraph (B) for
amounts expended by such political subdivision to
provide medical assistance for individuals described in
subclause (VIII) of subsection (a)(10)(A)(i).
``(B) Calculation of federal and non-federal
share.--Except as provided under clause (ii) and
subparagraph (C), the calculation and payment of the
Federal and non-Federal share of expenditures for
medical assistance under a demonstration described in
paragraph (1) shall be calculated in accordance with
section 1903 as if the qualifying political subdivision
was a State.
``(C) Federal matching percentage.--The Federal
matching percentage specified in this subparagraph,
with respect to a participating political subdivision
and the demonstration project under this subsection,
is--
``(i) 100 percent for calendar quarters in
the first three years that such political
subdivision participates in such demonstration
project, if applicable;
``(ii) with respect to a participating
political subdivision which--
``(I) includes a rural political
subdivision (as defined by the Office
of Management and Budget), 100 percent
for calendar quarters in the fourth
year that such political subdivision
participates in such demonstration
project, if applicable; and
``(II) does not include a rural
political subdivision (as defined by
the Office of Management and Budget),
95 percent for calendar quarters in the
fourth year that such political
subdivision participates in such
demonstration project, if applicable;
``(iii) with respect to a participating
political subdivision which--
``(I) includes a rural political
subdivision (as defined by the Office
of Management and Budget), 95 percent
for calendar quarters in the fifth year
that such political subdivision
participates in such demonstration
project, if applicable; and
``(II) does not include a rural
political subdivision (as defined by
the Office of Management and Budget),
94 percent for calendar quarters in the
fifth year that such political
subdivision participates in such
demonstration project, if applicable;
``(iv) with respect to a participating
political subdivision which--
``(I) includes a rural political
subdivision (as defined by the Office
of Management and Budget), 94 percent
for calendar quarters in the sixth year
that such political subdivision
participates in such demonstration
project, if applicable; and
``(II) does not include a rural
political subdivision (as defined by
the Office of Management and Budget),
93 percent for calendar quarters in the
sixth year that such political
subdivision participates in such
demonstration project, if applicable;
``(v) with respect to a participating
political subdivision which--
``(I) includes a rural political
subdivision (as defined by the Office
of Management and Budget), 93 percent
for calendar quarters in the seventh
year that such political subdivision
participates in such demonstration
project, if applicable; and
``(II) does not include a rural
political subdivision (as defined by
the Office of Management and Budget),
90 percent for calendar quarters in the
seventh year that such political
subdivision participates in such
demonstration project, if applicable;
and
``(vi) 90 percent for calendar quarters in
the eighth year and any subsequent years
thereafter that such political subdivision
participates in such demonstration project, if
applicable.
``(6) Comparability of benefits to essential health
benefits.--The medical assistance made available by a
participating political subdivision to individuals described in
subclause (VIII) of subsection (a)(10)(A)(i) shall consist of
coverage described in subsection (k)(1).
``(7) Reduction in federal funding for medical assistance
for states that take certain actions.--
``(A) In general.--In the case of a State that does
any of the prohibited items described in subparagraph
(B), the Secretary shall withhold from the amount
otherwise payable under section 1903 an amount equal to
25 percent of the amount of administrative costs under
the State plan under title XIX during a calendar.
``(B) Prohibited items.--For purposes of
subparagraph (A), a State may not--
``(i) shift the costs of providing medical
assistance to individuals enrolled under a
State plan under title XIX to a political
subdivision that establishes a demonstration
project under this subsection by disenrolling
such individuals from the State plan to the
demonstration project of the political
subdivision;
``(ii) withhold or reduce any kind of
funding or State support to political
subdivision on account of the political
subdivision's establishment of a demonstration
project;
``(iii) increase taxes on taxpayers of a
political subdivision on account of the
political subdivision's establishment of a
demonstration project;
``(iv) require a political subdivision to
increase or lower a tax rate required by the
political subdivision on account of the
political subdivision's establishment of a
demonstration project;
``(v) prohibit a political subdivision from
participating in a demonstration project
pursuant to this subsection;
``(vi) prohibit a political subdivision
from participating in a Federal demonstration
project, establishing or expanding a health
coverage program, contracting or otherwise
entering into an agreement with the Centers for
Medicare & Medicaid Services, or receiving
Federal funding directly from a Federal agency;
``(vii) prohibit a health care provider,
hospital, federally qualified health center, or
rural health clinic from--
``(I) accepting patients with
health coverage provided by a political
subdivision;
``(II) accepting payments from a
political subdivision;
``(III) making payments, including
taxes, to a political subdivision; or
``(IV) participating in the State
Medicaid program on account of
participation in a demonstration
project pursuant to this subsection;
``(viii) refuse to allow a political
subdivision to rely on State Medicaid systems
and State Medicaid agency staff to implement a
demonstration project, including--
``(I) the State's Medicaid
eligibility check and enrollment
system;
``(II) provider payment system;
``(III) claims processing system;
``(IV) fair hearing system; and
``(V) Federal reporting requirement
system; or
``(ix) take any other punitive action
against a political subdivision that establish
a demonstration project.
``(8) Timeline specified.--For purposes of paragraph (1),
the timeline specified in this paragraph shall require--
``(A) not later than 180 days after the date of the
enactment of this subsection, the Secretary to
promulgate any regulations necessary to carry out this
subsection, including--
``(i) the application requirements for a
political subdivision to apply for a
demonstration project, criteria on which
applications will be reviewed, and how long
political subdivisions have to begin the
demonstration once an application is approved;
and
``(ii) the application of all requirements
under section 1903 to a participating political
subdivision as if it was a State;
``(B) not later than 180 days after receiving an
application from a qualifying political subdivision
described in paragraph (3), the Secretary to transmit a
notice to such qualifying political subdivision of the
application's approval or rejection, and in case of a
rejection an explanation for the rejection; and
``(C) not later than 7 years after the approval of
an application, the Secretary to transmit a notice to
such qualifying political subdivision of the
application's approval or rejection for an extension
under this subsection.
``(9) Limitation on number of demonstration projects.--The
Secretary may not approve more than 100 demonstration projects
under this subsection, which may consist of demonstration
projects implemented by a single participating political
subdivision or implemented as partnerships formed by multiple
participating political subdivisions (as described in paragraph
(3)(B)).
``(10) Application without regard to budget neutrality.--
The Secretary shall not require, as a condition for carrying
out the demonstration project under this subsection, that the
demonstration project ensure that such model is budget neutral
initially with respect to expenditures under the applicable
title.
``(11) Report.--Not later than 4 years after the first date
of the demonstration project, the Secretary shall submit a
report to Congress on--
``(A) the effect of the demonstration project on--
``(i) the number of beneficiaries enrolled
in demonstration projects under this
subsection; and
``(ii) the amount of uncompensated care
costs for State Medicaid plans; and
``(B) whether any States with a demonstration
project under this subsection have expanded Medicaid
coverage under the Patient Protection and Affordable
Care Act.''.
(b) Payment to States.--Section 1903(a) of the Social Security Act
(42 U.S.C. 1396b(a)) is amended--
(1) in paragraph (6), by striking at the end ``plus'';
(2) in paragraph (7), by striking the period at the end and
inserting ``; plus''; and
(3) by adding at the end the following new paragraph:
``(8) an amount equal to an increase of 5 percentage points
to Federal matching percentage for administrative costs for
every 100,000 individuals described in paragraph (1) of section
1115(g) who are enrolled in a demonstration project of a
participating political subdivision (as referred to in
paragraph (4)(A) of such section) during a calendar quarter.''.
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