119-hr608

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 608 Introduced in House

    (IH) ]

<DOC>

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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