I 
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 Flor-
ida, Ms. GARCIA of Texas, Mr. GREEN of Texas, Mr. JOHNSON of Geor-
gia, Ms. JOHNSON of Texas, Mrs. MCBATH, Mrs. CHERFILUS-MCCOR-
MICK, 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 Flor-
ida, Ms. ADAMS, Mr. CLEAVER, Mr. CONNOLLY, Ms. NORTON, and Mr. 
RASKIN) introduced the following bill; which was referred to the Com-
mittee 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-
tives of the United States of America in Congress assembled, 
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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 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 (uu).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(uu) DEMONSTRATION PROJECT
FOR POLITICAL 
SUBDIVISIONS OF STATES TO PROVIDE MEDICAL ASSIST-
ANCE FOR EXPANSION POPULATION.— 
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‘‘(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 (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— 
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‘‘(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-
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-
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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. 
‘‘(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 
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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 
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 
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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 
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 
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‘‘(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 
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— 
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‘‘(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-
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 
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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.— 
‘‘(A) IN GENERAL.—In the case of a State 
that does any of the prohibited items described 
in subparagraph (B), the Secretary shall with-
hold from the amount otherwise payable under 
section 1903 an amount equal to 25 percent of 
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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 med-
ical assistance to individuals enrolled under 
a State plan under title XIX to a political 
subdivision that establishes a demonstra-
tion 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 sub-
division on account of the political subdivi-
sion’s establishment of a demonstration 
project; 
‘‘(iii) increase taxes on taxpayers of a 
political subdivision on account of the po-
litical subdivision’s establishment of a dem-
onstration project; 
‘‘(iv) require a political subdivision to 
increase or lower a tax rate required by the 
political subdivision on account of the po-
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litical subdivision’s establishment of a dem-
onstration 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 demonstra-
tion project, establishing or expanding a 
health coverage program, contracting or 
otherwise entering into an agreement with 
the Centers for Medicare & Medicaid Serv-
ices, 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, includ-
ing taxes, to a political subdivision; or 
‘‘(IV) participating in the State 
Medicaid program on account of par-
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