COVER Now Act

I 117TH CONGRESS 1ST SESSION H. R. 3961 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 JUNE 17, 2021 Mr. DOGGETT (for himself, Ms. ADAMS, Mr. ALLRED, Mr. BISHOP of Georgia, Ms. BOURDEAUX, Ms. BUSH, Mr. BUTTERFIELD, Ms. CASTOR of Florida, Mr. CASTRO of Texas, Mr. CLEAVER, Mr. CLYBURN, Mr. COHEN, Mr. COOPER, Mr. CRIST, Mr. CUELLAR, Mrs. DEMINGS, Mr. DEUTCH, Ms. ESCOBAR, Mrs. FLETCHER, Ms. LOIS FRANKEL of Florida, Ms. GARCIA of Texas, Mr. VICENTE GONZALEZ of Texas, Mr. GREEN of Texas, Ms. JACKSON LEE, Ms. JOHNSON of Texas, Mr. JOHNSON of Georgia, Mr. LAWSON of Florida, Ms. MANNING, Mrs. MCBATH, Mrs. MURPHY of Florida, Mr. POCAN, Mr. PRICE of North Carolina, Ms. ROSS, Ms. SE- WELL, Mr. DAVID SCOTT of Georgia, Mr. SOTO, Mr. THOMPSON of Mis- sissippi, Mr. VEASEY, Mr. VELA, Ms. WASSERMAN SCHULTZ, Ms. WIL- LIAMS of Georgia, Ms. WILSON of Florida, and Mr. CONNOLLY) intro- duced 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 pro- gram, and for other purposes. VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 3961 IH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Cover Outstanding 4 Vulnerable Expansion-eligible Residents Now Act’’ or 5 ‘‘COVER Now Act’’. 6 SEC. 2. DEMONSTRATION PROJECT FOR POLITICAL SUB- 7 DIVISIONS OF STATES TO PROVIDE MEDICAL 8 ASSISTANCE FOR MEDICAID EXPANSION POP- 9 ULATION. 10 (a) IN GENERAL.—Section 1902 of the Social Secu- 11 rity Act is amended— 12 (1) in subsection (a)— 13 (A) in paragraph (86), by striking at the 14 end ‘‘and’’; 15 (B) in paragraph (87), by striking the pe- 16 riod at the end and inserting ‘‘; and’’; and 17 (C) by inserting after paragraph (87) the 18 following new paragraph: 19 ‘‘(88) provide, at the option of the qualifying 20 political subdivisions of a State, for a demonstration 21 project described in subsection (tt).’’; and 22 (2) by adding at the end the following new sub- 23 section: 24 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 3961 IH ‘‘(tt) DEMONSTRATION PROJECT FOR POLITICAL 1 SUBDIVISIONS OF STATES TO PROVIDE MEDICAL ASSIST- 2 ANCE FOR EXPANSION POPULATION.— 3 ‘‘(1) IN GENERAL.—Notwithstanding section 4 subsection (a)(5), the Secretary shall conduct a dem- 5 onstration project under which the Secretary shall, 6 subject to paragraph (9), select qualifying political 7 subdivisions described in paragraph (2) to provide, 8 in accordance with the requirements of this sub- 9 section, medical assistance for individuals described 10 in subclause (VIII) of subsection (a)(10)(A)(i) who 11 reside in such political subdivisions in accordance 12 with the timeline specified under paragraph (8). 13 ‘‘(2) WAIVER AUTHORITY.—The Secretary may 14 waive the requirements of paragraphs (1) and (5) of 15 subsection relating to statewideness and relating to 16 single state agency, respectively. 17 ‘‘(3) QUALIFYING POLITICAL SUBDIVISION.—A 18 qualifying political subdivision described in this 19 paragraph is— 20 ‘‘(A) a political subdivision— 21 ‘‘(i) located in a State that has not 22 elected to provide medical assistance for 23 individuals described in subclause (VIII) of 24 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 3961 IH subsection (a)(10)(A)(i) as of the date of 1 the enactment of this subsection; and 2 ‘‘(ii) submits an application to the 3 Secretary— 4 ‘‘(I) at such time, in such man- 5 ner, and containing such information 6 as the Secretary may require; and 7 ‘‘(II) which has undergone a 8 process for public notice and comment 9 at the political subdivision level, in- 10 cluding public hearings, sufficient to 11 ensure a meaningful level of public 12 input; or 13 ‘‘(B) any number of political subdivisions 14 described in subparagraph (A) which form a 15 partnership for purposes of implementing the 16 demonstration project under this subsection. 17 ‘‘(4) LENGTH OF DEMONSTRATION PROJECT.— 18 ‘‘(A) IN GENERAL.—Subject to subpara- 19 graph (B), a qualifying political subdivision se- 20 lected to participate in the demonstration 21 project under this subsection or partnership de- 22 scribed in paragraph (3)(B) (referred to in this 23 subsection as a ‘participating political subdivi- 24 sion’) shall provide medical assistance for indi- 25 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 3961 IH viduals described in subclause (VIII) of sub- 1 section (a)(10)(A)(i) for seven years or through 2 the day before the date on which the State in 3 which such political subdivision is located pro- 4 vides for medical assistance under the State 5 plan (or a waiver of such plan) for such individ- 6 uals, whichever is shorter. 7 ‘‘(B) EXTENSION.—A participating polit- 8 ical subdivision that participates in the dem- 9 onstration project under this subsection for five 10 years may extend its participation in the dem- 11 onstration project by submitting an application 12 to the Secretary at such time, in such manner, 13 and containing such information as the Sec- 14 retary may require. Under such extension, such 15 political subdivision shall provide medical assist- 16 ance for individuals described in subclause 17 (VIII) of subsection (a)(10)(A)(i) for up to an 18 additional five years or through the day before 19 the date on which the State in which such polit- 20 ical subdivision is located provides for medical 21 assistance under the State plan (or a waiver of 22 such plan) for such individuals, whichever is 23 shorter. 24 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 3961 IH ‘‘(C) AUTOMATIC ENROLLMENT IN CASE 1 OF STATES THAT ELECT TO PROVIDE MEDICAL 2 ASSISTANCE FOR EXPANSION POPULATION.—In 3 the case of a participating political subdivision 4 whose participation in the demonstration 5 project under this subsection ends because the 6 State in which such political subdivision is lo- 7 cated elects to provide for medical assistance 8 under the State plan (or a waiver of such plan) 9 for individuals described in subclause (VIII) of 10 subsection (a)(10)(A)(i), such State shall auto- 11 matically enroll under such State plan (or waiv- 12 er) any eligible and enrolled individual so de- 13 scribed receiving medical assistance from such 14 political subdivision and coverage for such indi- 15 vidual under such State plan (or waiver) begin- 16 ning with the first day on which the State pro- 17 vides medical assistance under such State plan 18 (or waiver) for individuals described in sub- 19 clause (VIII) of subsection (a)(10)(A)(i). 20 ‘‘(5) PAYMENTS.— 21 ‘‘(A) IN GENERAL.—The Secretary shall 22 pay a participating political subdivision the 23 Federal matching percentage specified in sub- 24 paragraph (B) for amounts expended by such 25 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 3961 IH political subdivision to provide medical assist- 1 ance for individuals described in subclause 2 (VIII) of subsection (a)(10)(A)(i). 3 ‘‘(B) CALCULATION OF FEDERAL AND 4 NON-FEDERAL SHARE.—Except as provided 5 under clause (ii) and subparagraph (C), the cal- 6 culation and payment of the Federal and non- 7 Federal share of expenditures for medical as- 8 sistance under a demonstration described in 9 paragraph (1) shall be calculated in accordance 10 with section 1903 as if the qualifying political 11 subdivision was a State. 12 ‘‘(C) FEDERAL MATCHING PERCENTAGE.— 13 The Federal matching percentage specified in 14 this subparagraph, with respect to a partici- 15 pating political subdivision and the demonstra- 16 tion project under this subsection, is— 17 ‘‘(i) 100 percent for calendar quarters 18 in the first three years that such political 19 subdivision participates in such demonstra- 20 tion project, if applicable; 21 ‘‘(ii) with respect to a participating 22 political subdivision which— 23 ‘‘(I) includes a rural political 24 subdivision (as defined by the Office 25 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 3961 IH of Management and Budget), 100 1 percent for calendar quarters in the 2 fourth year that such political subdivi- 3 sion participates in such demonstra- 4 tion project, if applicable; and 5 ‘‘(II) does not include a rural po- 6 litical subdivision (as defined by the 7 Office of Management and Budget), 8 95 percent for calendar quarters in 9 the fourth year that such political 10 subdivision participates in such dem- 11 onstration project, if applicable; 12 ‘‘(iii) with respect to a participating 13 political subdivision which— 14 ‘‘(I) includes a rural political 15 subdivision (as defined by the Office 16 of Management and Budget), 95 per- 17 cent for calendar quarters in the fifth 18 year that such political subdivision 19 participates in such demonstration 20 project, if applicable; and 21 ‘‘(II) does not include a rural po- 22 litical subdivision (as defined by the 23 Office of Management and Budget), 24 94 percent for calendar quarters in 25 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 3961 IH the fifth year that such political sub- 1 division participates in such dem- 2 onstration project, if applicable; 3 ‘‘(iv) with respect to a participating 4 political subdivision which— 5 ‘‘(I) includes a rural political 6 subdivision (as defined by the Office 7 of Management and Budget), 94 per- 8 cent for calendar quarters in the sixth 9 year that such political subdivision 10 participates in such demonstration 11 project, if applicable; and 12 ‘‘(II) does not include a rural po- 13 litical subdivision (as defined by the 14 Office of Management and Budget), 15 93 percent for calendar quarters in 16 the sixth year that such political sub- 17 division participates in such dem- 18 onstration project, if applicable; 19 ‘‘(v) with respect to a participating 20 political subdivision which— 21 ‘‘(I) includes a rural political 22 subdivision (as defined by the Office 23 of Management and Budget), 93 per- 24 cent for calendar quarters in the sev- 25 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 3961 IH enth year that such political subdivi- 1 sion participates in such demonstra- 2 tion project, if applicable; and 3 ‘‘(II) does not include a rural po- 4 litical subdivision (as defined by the 5 Office of Management and Budget), 6 90 percent for calendar quarters in 7 the seventh year that such political 8 subdivision participates in such dem- 9 onstration project, if applicable; and 10 ‘‘(vi) 90 percent for calendar quarters 11 in the eighth year and any subsequent 12 years thereafter that such political subdivi- 13 sion participates in such demonstration 14 project, if applicable. 15 ‘‘(6) COMPARABILITY OF BENEFITS TO ESSEN- 16 TIAL HEALTH BENEFITS.—The medical assistance 17 made available by a participating political subdivi- 18 sion to individuals described in subclause (VIII) of 19 subsection (a)(10)(A)(i) shall consist of coverage de- 20 scribed in subsection (k)(1). 21 ‘‘(7) REDUCTION IN FEDERAL FUNDING FOR 22 MEDICAL ASSISTANCE FOR STATES THAT TAKE CER- 23 TAIN ACTIONS.— 24 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 3961 IH ‘‘(A) IN GENERAL.—In the case of a State 1 that does any of the prohibited items described 2 in subparagraph (B), the Secretary shall with- 3 hold from the amount otherwise payable under 4 section 1903 an amount equal to 25 percent of 5 the amount of administrative costs under the 6 State plan under title XIX during a calendar. 7 ‘‘(B) PROHIBITED ITEMS.—For purposes 8 of subparagraph (A), a State may not— 9 ‘‘(i) shift the costs of providing med- 10 ical assistance to individuals enrolled under 11 a State plan under title XIX to a political 12 subdivision that establishes a demonstra- 13 tion project under this subsection by 14 disenrolling such individuals from the 15 State plan to the demonstration project of 16 the political subdivision; 17 ‘‘(ii) withhold or reduce any kind of 18 funding or State support to political sub- 19 division on account of the political subdivi- 20 sion’s establishment of a demonstration 21 project; 22 ‘‘(iii) increase taxes on taxpayers of a 23 political subdivision on account of the po- 24 VerDate Sep 11 2014 22:50 Jul 16, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3961.IH H3961 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 3961 IH litical subdivision’s establishment of a dem- 1 onstration project; 2 ‘‘(iv) require a political subdivision to 3 increase or lower a tax rate required by the 4 political subdivision on account of the po- 5 litical subdivision’s establishment of a dem- 6 onstration project; 7 ‘‘(v) prohibit a political subdivision 8 from participating in a demonstration 9 project pursuant to this subsection; 10 ‘‘(vi) prohibit a political subdivision 11 from participating in a Federal demonstra- 12 tion project, establishing or expanding a 13 health coverage program, contracting or 14 otherwise entering into an agreement with 15 the Centers for Medicare & Medicaid Serv- 16 ices, or receiving Federal funding directly 17 from a Federal agency; 18 ‘‘(vii) prohibit a health care provider, 19 hospital, federally qualified health center, 20 or rural health clinic from— 21 ‘‘(I) accepting patients with 22 health coverage provided by a political 23 subdivision; 24 VerDate Sep 11 2014 22:50 Jul 16, 2021 [Text truncated for display. 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