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 ‘‘Community Multi- 
Share Coverage Program Act’’. 
SEC. 2. GRANTS TO ESTABLISH COMMUNITY MULTI-SHARE 
COVERAGE PROGRAMS TO ENABLE SMALL 
BUSINESSES 
TO 
PROVIDE 
AFFORDABLE 
HEALTH COVERAGE AND SUPPORT SERVICES 
TO EMPLOYEES WITH LIMITED INCOME AND 
ASSETS. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary shall 
award at least 3 and not more than 5 grants to support 
Community Multi-Share Coverage programs. Such pro-
grams shall— 
(1) reduce the number of uninsured individuals 
through hospital-community partnership initiatives 
that provide an affordable health coverage option for 
such individuals and provide a coverage transition 
for those limited to coverage through government- 
sponsored programs; 
(2) promote workforce development for small 
business by addressing the influencers of health that 
directly impact employment success and create bar-
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riers to exiting Medicaid, resulting in better health 
and workplace success; and 
(3) support small business economic recovery by 
allowing small businesses to be competitive in their 
hiring, and to provide high quality, affordable health 
coverage to workers who are otherwise hesitant to 
lose Medicaid eligibility. 
(b) COMMUNITY MULTI-SHARE COVERAGE PROGRAM 
REQUIREMENTS.—For purposes of this section, the term 
‘‘Community Multi-Share Coverage Program’’ means a 
program that satisfies each of the following program re-
quirements— 
(1) PHYSICAL
PRESENCE
IN
THE
COMMU-
NITY.—The program maintains a physical presence 
within close geographic proximity to the enrollees it 
is serving, with a focus on mitigating barriers to en-
gagement by enabling face-to-face interactions be-
tween the program staff, enrollees, and community 
organizations. 
(2) HEALTH
COVERAGE.—The program pro-
vides enrolled qualifying individuals with health cov-
erage that satisfies the following: 
(A) SERVICES
COVERED.—Provides cov-
erage for the following categories of services 
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when furnished by network providers and com-
munity resources— 
(i) physician services; 
(ii) inpatient and outpatient hospital 
services; 
(iii) behavioral health services, includ-
ing services for substance use disorder pre-
vention and treatment; 
(iv) preventative services; 
(v) diagnostic laboratory tests and x- 
rays; 
(vi) prescription drugs; 
(vii) emergency ambulance services 
that are provided by ground transpor-
tation; 
(viii) emergency services (as defined 
in section 2719A(b)(2)(B) of the Public 
Health Service Act (42 U.S.C. 300gg– 
1719a(b)(2)(B))); and 
(ix) population health improvement 
services. 
(B) COST-SHARING.—Imposes no deduct-
ible on covered services provided by network 
providers and community resources, and limits 
co-payments for in-network covered services to 
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levels that do not create a barrier to patient ac-
cess. 
(C) NETWORK
PROVIDERS.—Establishes 
agreements with hospitals and health care pro-
viders located within the community to provide 
care for qualifying individuals. 
(3) INTEGRATED
CONTINUOUS
HEALTH
IM-
PROVEMENT SERVICES.—The program provides, ei-
ther directly or through contract, integrated contin-
uous health improvement services that satisfy the 
following: 
(A) Regular assessments of community 
factors and resources that potentially impact 
enrollees’ physical, emotional, and economic 
health. 
(B) A community-based planning process 
to identify and address any negative influences 
identified pursuant to subparagraph (A), and 
promote well-being through partnerships and 
alignment efforts between the community-based 
coverage entity and— 
(i) local small employers; 
(ii) entities that provide educational 
and occupational training (including class-
es, workshops, mentorships, and appren-
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ticeships) designed to enhance preparation 
for work and support economic self-suffi-
ciency; 
(iii) community health initiatives; 
(iv) investors; 
(v) local, State, and Federal govern-
mental agencies; and 
(vi) organizations described in section 
501(c)(3) of the Internal Revenue Code of 
1986 that focus on human service needs 
relating to physical health, behavioral 
health, poverty, education, access to health 
care, and safety. 
(C) Individualized assessment of each en-
rollee to identify any negative influences on 
their physical, emotional, and economic health, 
and ability to achieve economic self-sufficiency. 
This shall include— 
(i) an assessment of any of the enroll-
ee’s social determinants of health, health 
risks, barriers to long-term employment, 
and barriers to increasing income; and 
(ii) a determination of the enrollee’s 
health domain score, which is a measure-
ment of specific influences of physical, 
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emotional, and financial health with re-
spect to a qualifying individual. 
(D) Establishment of an individualized 
plan to support each enrollee in achieving better 
health and economic self-sufficiency. Each indi-
vidualized plan shall— 
(i) identify community resources that 
will support the enrollee in improving their 
physical, behavioral, or economic health. 
These may include, but are not limited 
to— 
(I) group classes that address 
barriers to physical, emotional, and 
economic health; and 
(II) educational and occupational 
training opportunities that enhance 
work preparedness and support eco-
nomic self-sufficiency; and 
(ii) contain engagement milestones, 
with a goal of identifying and overcoming 
obstacles to engagement in personal health 
improvement and mitigation of root-cause 
barriers. These milestones shall include, 
but are not limited to— 
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(I) participation in individualized 
health coaching services to address 
the enrollee’s social determinants of 
health and to support their physical, 
emotional, and financial health; and 
(II) engagement with community 
resources, such as participating in 
group classes, as recommended by the 
health coach. 
(4) FUNDING STRUCTURE.—The direct costs of 
the program are shared among the following entities, 
each of which makes a direct financial contribu-
tion— 
(A) the public sector; 
(B) local health care providers; 
(C) enrollees; and 
(D) enrollees’ employers or skilled trade 
organizations. 
(5) ENROLLEES.— 
(A) In the event that a Program is unable 
to provide services to all qualifying individuals 
in its catchment area, the Program has a writ-
ten policy for determining which qualifying indi-
viduals are offered enrollment. This policy is 
publicly available and does not discriminate 
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based on age, race, ethnicity, religion, gender, 
or sexual orientation. 
(B) The program may rescind a qualifying 
individual’s enrollment due to sustained failure 
to meet minimum engagement thresholds, which 
shall be participatory and not health-contingent, 
and provide for reasonable alternatives, in their 
individual 
plan 
described 
in 
subsection 
(b)(2)(C). 
(6) EVALUATION.—The program formally eval-
uates its impact on enrollees’ employment status, 
physical and behavioral health, income, and eco-
nomic self-sufficiency. 
(c) QUALIFYING INDIVIDUAL.—The term ‘‘qualifying 
individual’’ means an individual who— 
(1) resides or works within the catchment area 
of a partner hospital described in subsection 
(e)(1)(A); 
(2) subject to any modification made by such 
program to narrow the income eligibility range, has 
a household income that exceeds the Medicaid eligi-
bility limit applicable to the qualifying individual in 
their State of residence but does not exceed 400 per-
cent of the Federal poverty line applicable to their 
household size; 
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(3) is not enrolled in a qualified health plan 
during the 180-day period preceding the date on 
which such qualifying individual seeks to enroll in 
the Community Multi-Share Coverage Program, un-
less a such coverage is terminated due to a quali-
fying special event; 
(4) is ineligible for enrollment in a Federal 
health care program other than Affordable Care Act 
Plans, (including but not limited to ineligibility to 
receive health services through the Indian Health 
Service or Veterans Administration); 
(5) works for a small employer which does not 
offer its employees coverage in a qualified health 
plan under which the combined premium plus de-
ductible cost to cover the employee’s household is 
less than seven percent of the employee’s household 
income; and 
(6) other requirements the Secretary deter-
mines appropriate. 
(d) GRANT TERMS.— 
(1) DURATION.—A grant awarded under this 
section shall be made for a period of 4 years. 
(2) AMOUNT.—The Secretary shall determine 
the maximum amount of each grant awarded under 
subsection (a). 
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(3) NUMBER.—At least one award must be 
made to a Community Multi-Share Coverage Pro-
gram that is operating at the time that this section 
is enacted. 
(e) APPLICATIONS.— 
(1) IN GENERAL.—To be eligible to be awarded 
a grant under subsection (a), an applicant must— 
(A) be a nonprofit entity with documented 
commitments from local partner hospitals and 
small employers to participate in a Community 
Multi-Share Coverage Plan; and 
(B) submit to the Secretary an application 
at such time, in such manner, and containing 
the certification described in paragraph (2) and 
such other information as the Secretary may re-
quire. 
(2) CERTIFICATION.—To be eligible for funding 
under this section, an application described in para-
graph (1) shall include certifications that the pro-
gram— 
(A) will not impose any preexisting condi-
tion exclusion (as such term is defined in sec-
tion 2704(b)(1)(A)) of the Public Health Serv-
ice Act (42 U.S.C. 300gg–3(b)(1)(A)) with re-
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spect to the health coverage described in sub-
section (b)(2); 
(B) has or will establish a network of 
health care providers and community resources 
sufficient to provide services to qualifying indi-
viduals enrolled under the health coverage de-
scribed in subsection (b)(2); 
(C) will seek to enroll eligible individuals 
whose household income is less than the basic 
cost of living (as determined in a manner con-
sistent with the ‘‘Asset Limited, Income Con-
strained, Employed’’ or ‘‘ALICE’’ method-
ology); 
(D) select an entity to carry out adminis-
trative and accounting responsibilities (includ-
ing monthly billing, verification of eligibility of 
qualifying individuals, enrollment of qualifying 
individuals, maintenance of a list of active en-
rollees, and operation of a benefit utilization 
management program) necessary with respect 
to the health coverage described in subsection 
(b)(2); and 
(E) shall submit written reports to the 
Secretary on an annual basis evaluating the 
progress on advancing access to health care, in-
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creasing economic self-sufficiency, and other 
elements that the Secretary requires. 
(f) DEFINITIONS.—In this section: 
(1) AGENCY.—The term ‘‘agency’’ means a 
local, State, or Federal agency. 
(2) FEDERAL HEALTH CARE PROGRAM.—The 
term ‘‘Federal health care program’’ has the mean-
ing given such term in section 1128B(f) of the So-
cial Security Act (42 U.S.C. 1320a–7b(f)). 
(3) HEALTH COACH.—The term ‘‘health coach’’ 
means an individual who is a member of the staff 
of the community-based coverage entity that has re-
ceived training to provide health coaching services 
(including health improvement program services). 
(4) HOSPITAL.—The term ‘‘hospital’’ means an 
institution that— 
(A) meets the requirements of section 
1861(e) of the Social Security Act (42 U.S.C. 
1395x(e)); and 
(B) is an organization described in sub-
sections (c)(3) and (r)(3) of section 501 of the 
Internal Revenue Code of 1986 and is exempt 
from taxation under section 501(a) of such 
Code. 
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(5) QUALIFIED
HEALTH
PLAN.—The term 
‘‘qualified health plan’’ has the meaning given such 
term in section 1301(a) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18021(a)). 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(7) SMALL EMPLOYER.—The term ‘‘small em-
ployer’’ has the meaning given such term in section 
1304(b)(2) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18024(b)(2)). 
(8) SOCIAL DETERMINANTS OF HEALTH.—The 
term ‘‘social determinants of health’’ has the mean-
ing given such term by the Director of the Centers 
for Disease Control and Prevention. 
(g) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section— 
(1) $4,800,000 for fiscal year 2022; 
(2) $7,200,000 for fiscal year 2023; and 
(3) $12,000,000 for each of fiscal years 2024 
and 2025. 
Æ 
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