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. 
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Be it enacted by the Senate and House of Representa-
tives 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 
‘‘COVER Now Act’’. 
SEC. 2. DEMONSTRATION PROJECT FOR POLITICAL SUB-
DIVISIONS OF STATES TO PROVIDE MEDICAL 
ASSISTANCE FOR MEDICAID EXPANSION POP-
ULATION. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act is amended— 
(1) in subsection (a)— 
(A) in paragraph (86), by striking at the 
end ‘‘and’’; 
(B) in paragraph (87), by striking the pe-
riod 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 (tt).’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(tt) DEMONSTRATION PROJECT
FOR POLITICAL 
SUBDIVISIONS OF STATES TO PROVIDE MEDICAL ASSIST-
ANCE FOR EXPANSION POPULATION.— 
‘‘(1) IN
GENERAL.—Notwithstanding section 
subsection (a)(5), the Secretary shall conduct a dem-
onstration 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 sub-
section, 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 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 
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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 man-
ner, 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, in-
cluding 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 subpara-
graph (B), a qualifying political subdivision se-
lected to participate in the demonstration 
project under this subsection or partnership de-
scribed in paragraph (3)(B) (referred to in this 
subsection as a ‘participating political subdivi-
sion’) shall provide medical assistance for indi-
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viduals described in subclause (VIII) of sub-
section (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 pro-
vides for medical assistance under the State 
plan (or a waiver of such plan) for such individ-
uals, whichever is shorter. 
‘‘(B) EXTENSION.—A participating polit-
ical subdivision that participates in the dem-
onstration project under this subsection for five 
years may extend its participation in the dem-
onstration project by submitting an application 
to the Secretary at such time, in such manner, 
and containing such information as the Sec-
retary may require. Under such extension, such 
political subdivision shall provide medical assist-
ance 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 polit-
ical subdivision is located provides for medical 
assistance under the State plan (or a waiver of 
such plan) for such individuals, whichever is 
shorter. 
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‘‘(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 lo-
cated 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 auto-
matically enroll under such State plan (or waiv-
er) any eligible and enrolled individual so de-
scribed receiving medical assistance from such 
political subdivision and coverage for such indi-
vidual under such State plan (or waiver) begin-
ning with the first day on which the State pro-
vides medical assistance under such State plan 
(or waiver) for individuals described in sub-
clause (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 sub-
paragraph (B) for amounts expended by such 
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political subdivision to provide medical assist-
ance 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 cal-
culation and payment of the Federal and non- 
Federal share of expenditures for medical as-
sistance 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 partici-
pating political subdivision and the demonstra-
tion project under this subsection, is— 
‘‘(i) 100 percent for calendar quarters 
in the first three years that such political 
subdivision participates in such demonstra-
tion project, if applicable; 
‘‘(ii) with respect to a participating 
political subdivision which— 
‘‘(I) includes a rural political 
subdivision (as defined by the Office 
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of Management and Budget), 100 
percent for calendar quarters in the 
fourth year that such political subdivi-
sion participates in such demonstra-
tion project, if applicable; and 
‘‘(II) does not include a rural po-
litical 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 dem-
onstration 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 per-
cent 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 po-
litical subdivision (as defined by the 
Office of Management and Budget), 
94 percent for calendar quarters in 
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the fifth year that such political sub-
division participates in such dem-
onstration 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 per-
cent 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 po-
litical subdivision (as defined by the 
Office of Management and Budget), 
93 percent for calendar quarters in 
the sixth year that such political sub-
division participates in such dem-
onstration 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 per-
cent for calendar quarters in the sev-
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enth year that such political subdivi-
sion participates in such demonstra-
tion project, if applicable; and 
‘‘(II) does not include a rural po-
litical 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 dem-
onstration project, if applicable; and 
‘‘(vi) 90 percent for calendar quarters 
in the eighth year and any subsequent 
years thereafter that such political subdivi-
sion participates in such demonstration 
project, if applicable. 
‘‘(6) COMPARABILITY OF BENEFITS TO ESSEN-
TIAL
HEALTH
BENEFITS.—The medical assistance 
made available by a participating political subdivi-
sion to individuals described in subclause (VIII) of 
subsection (a)(10)(A)(i) shall consist of coverage de-
scribed in subsection (k)(1). 
‘‘(7) REDUCTION IN FEDERAL FUNDING FOR 
MEDICAL ASSISTANCE FOR STATES THAT TAKE CER-
TAIN ACTIONS.— 
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‘‘(A) not later than 180 days after the date 
of the enactment of this subsection, the Sec-
retary to promulgate any regulations necessary 
to carry out this subsection, including— 
‘‘(i) the application requirements for a 
political subdivision to apply for a dem-
onstration project, criteria on which appli-
cations will be reviewed, and how long po-
litical subdivisions have to begin the dem-
onstration once an application is approved; 
and 
‘‘(ii) the application of all require-
ments under section 1903 to a partici-
pating political subdivision as if it was a 
State; 
‘‘(B) not later than 180 days after receiv-
ing an application from a qualifying political 
subdivision described in paragraph (3), the Sec-
retary to transmit a notice to such qualifying 
political subdivision of the application’s ap-
proval or rejection, and in case of a rejection an 
explanation for the rejection; and 
‘‘(C) not later than 7 years after the ap-
proval of an application, the Secretary to trans-
mit a notice to such qualifying political subdivi-
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sion of the application’s approval or rejection 
for an extension under this subsection. 
‘‘(9) LIMITATION ON NUMBER OF DEMONSTRA-
TION 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 polit-
ical subdivision or implemented as partnerships 
formed by multiple participating political subdivi-
sions (as described in paragraph (3)(B)). 
‘‘(10) APPLICATION
WITHOUT
REGARD
TO 
BUDGET NEUTRALITY.—The Secretary shall not re-
quire, as a condition for carrying out the demonstra-
tion project under this subsection, that the dem-
onstration 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 Sec-
retary shall submit a report to Congress on— 
‘‘(A) the effect of the demonstration 
project on— 
‘‘(i) the number of beneficiaries en-
rolled in demonstration projects under this 
subsection; and 
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‘‘(ii) the amount of uncompensated 
care costs for State Medicaid plans; and 
‘‘(B) whether any States with a dem-
onstration 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)(B), 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 per-
centage 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 partici-
pating political subdivision (as referred to in para-
graph (4)(A) of such section) during a calendar 
quarter.’’. 
Æ 
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