COVER Now Act

I 118TH CONGRESS 1ST SESSION H. R. 31 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 9, 2023 Mr. DOGGETT (for himself, Mr. ALLRED, Mr. BISHOP of Georgia, Ms. BUSH, Mr. CASAR, Ms. CASTOR of Florida, Mr. CASTRO of Texas, Mr. CLEAVER, Mr. COHEN, Mr. CONNOLLY, Mr. CUELLAR, Mr. DESAULNIER, Ms. ESCOBAR, Ms. LOIS FRANKEL of Florida, Ms. GARCIA of Texas, Mr. VICENTE GONZALEZ of Texas, Mr. GREEN of Texas, Ms. JACKSON LEE, Mr. JOHNSON of Georgia, Ms. MANNING, Mrs. MCBATH, Mr. NICKEL, Ms. NORTON, Mr. POCAN, Ms. ROSS, Mr. DAVID SCOTT of Georgia, Ms. SEWELL, Mr. SOTO, Mr. THOMPSON of Mississippi, Mr. VEASEY, Ms. WASSERMAN SCHULTZ, Ms. WILLIAMS of Georgia, Ms. WILSON of Flor- ida, Ms. ADAMS, Mrs. CHERFILUS-MCCORMICK, Ms. CROCKETT, Mr. MOSKOWITZ, Mr. DAVIS of North Carolina, Mr. CLYBURN, Mr. JACKSON of North Carolina, and Mrs. FLETCHER) 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 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 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 31 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Cover Outstanding 2 Vulnerable Expansion-eligible Residents Now Act’’ or the 3 ‘‘COVER Now Act’’. 4 SEC. 2. DEMONSTRATION PROJECT FOR POLITICAL SUB- 5 DIVISIONS OF STATES TO PROVIDE MEDICAL 6 ASSISTANCE FOR MEDICAID EXPANSION POP- 7 ULATION. 8 (a) IN GENERAL.—Section 1902 of the Social Secu- 9 rity Act is amended— 10 (1) in subsection (a)— 11 (A) in paragraph (86), by striking at the 12 end ‘‘and’’; 13 (B) in paragraph (87), by striking the pe- 14 riod at the end and inserting ‘‘; and’’; and 15 (C) by inserting after paragraph (87) the 16 following new paragraph: 17 ‘‘(88) provide, at the option of the qualifying 18 political subdivisions of a State, for a demonstration 19 project described in subsection (uu).’’; and 20 (2) by adding at the end the following new sub- 21 section: 22 ‘‘(uu) DEMONSTRATION PROJECT FOR POLITICAL 23 SUBDIVISIONS OF STATES TO PROVIDE MEDICAL ASSIST- 24 ANCE FOR EXPANSION POPULATION.— 25 VerDate Sep 11 2014 01:03 Jan 12, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 31 IH ‘‘(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) WAIVER 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) QUALIFYING 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 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 31 IH ‘‘(I) at such time, in such man- 1 ner, and containing such information 2 as the Secretary may require; and 3 ‘‘(II) which has undergone a 4 process for public notice and comment 5 at the political subdivision level, in- 6 cluding public hearings, sufficient to 7 ensure a meaningful level of public 8 input; or 9 ‘‘(B) any number of political subdivisions 10 described in subparagraph (A) which form a 11 partnership for purposes of implementing the 12 demonstration project under this subsection. 13 ‘‘(4) LENGTH OF DEMONSTRATION PROJECT.— 14 ‘‘(A) IN GENERAL.—Subject to subpara- 15 graph (B), a qualifying political subdivision se- 16 lected to participate in the demonstration 17 project under this subsection or partnership de- 18 scribed in paragraph (3)(B) (referred to in this 19 subsection as a ‘participating political subdivi- 20 sion’) shall provide medical assistance for indi- 21 viduals described in subclause (VIII) of sub- 22 section (a)(10)(A)(i) for seven years or through 23 the day before the date on which the State in 24 which such political subdivision is located pro- 25 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 31 IH 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) EXTENSION.—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) AUTOMATIC 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 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 31 IH project under this subsection ends because the 1 State in which such political subdivision is lo- 2 cated elects to provide for medical assistance 3 under the State plan (or a waiver of such plan) 4 for individuals described in subclause (VIII) of 5 subsection (a)(10)(A)(i), such State shall auto- 6 matically enroll under such State plan (or waiv- 7 er) any eligible and enrolled individual so de- 8 scribed receiving medical assistance from such 9 political subdivision and coverage for such indi- 10 vidual under such State plan (or waiver) begin- 11 ning with the first day on which the State pro- 12 vides medical assistance under such State plan 13 (or waiver) for individuals described in sub- 14 clause (VIII) of subsection (a)(10)(A)(i). 15 ‘‘(5) PAYMENTS.— 16 ‘‘(A) IN GENERAL.—The Secretary shall 17 pay a participating political subdivision the 18 Federal matching percentage specified in sub- 19 paragraph (B) for amounts expended by such 20 political subdivision to provide medical assist- 21 ance for individuals described in subclause 22 (VIII) of subsection (a)(10)(A)(i). 23 ‘‘(B) CALCULATION OF FEDERAL AND 24 NON-FEDERAL SHARE.—Except as provided 25 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 31 IH 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) FEDERAL 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 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 31 IH ‘‘(II) does not include a rural po- 1 litical subdivision (as defined by the 2 Office of Management and Budget), 3 95 percent for calendar quarters in 4 the fourth year that such political 5 subdivision participates in such dem- 6 onstration project, if applicable; 7 ‘‘(iii) with respect to a participating 8 political subdivision which— 9 ‘‘(I) includes a rural political 10 subdivision (as defined by the Office 11 of Management and Budget), 95 per- 12 cent for calendar quarters in the fifth 13 year that such political subdivision 14 participates in such demonstration 15 project, if applicable; and 16 ‘‘(II) does not include a rural po- 17 litical subdivision (as defined by the 18 Office of Management and Budget), 19 94 percent for calendar quarters in 20 the fifth year that such political sub- 21 division participates in such dem- 22 onstration project, if applicable; 23 ‘‘(iv) with respect to a participating 24 political subdivision which— 25 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 31 IH ‘‘(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 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 31 IH Office of Management and Budget), 1 90 percent for calendar quarters in 2 the seventh year that such political 3 subdivision participates in such dem- 4 onstration project, if applicable; and 5 ‘‘(vi) 90 percent for calendar quarters 6 in the eighth year and any subsequent 7 years thereafter that such political subdivi- 8 sion participates in such demonstration 9 project, if applicable. 10 ‘‘(6) COMPARABILITY OF BENEFITS TO ESSEN- 11 TIAL HEALTH BENEFITS.—The medical assistance 12 made available by a participating political subdivi- 13 sion to individuals described in subclause (VIII) of 14 subsection (a)(10)(A)(i) shall consist of coverage de- 15 scribed in subsection (k)(1). 16 ‘‘(7) REDUCTION IN FEDERAL FUNDING FOR 17 MEDICAL ASSISTANCE FOR STATES THAT TAKE CER- 18 TAIN ACTIONS.— 19 ‘‘(A) IN GENERAL.—In the case of a State 20 that does any of the prohibited items described 21 in subparagraph (B), the Secretary shall with- 22 hold from the amount otherwise payable under 23 section 1903 an amount equal to 25 percent of 24 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 31 IH the amount of administrative costs under the 1 State plan under title XIX during a calendar. 2 ‘‘(B) PROHIBITED 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 VerDate Sep 11 2014 22:57 Jan 11, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H31.IH H31 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 31 IH 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 subdivisio [Text truncated for display. Full text available on Congress.gov.]