COVER Now Act
Sponsored By: Representative Doggett, Lloyd [D-TX-37]
Introduced
Summary
Authorizes local governments to run Medicaid expansion demonstrations so counties, cities, and other political subdivisions in states that have not expanded Medicaid can provide coverage to the expansion population under a time‑limited, federally funded program. The law sets who can apply, how long demonstrations run, minimum coverage standards, funding rules, and limits on state interference.
Show full summary
- Residents eligible for the Medicaid expansion can get coverage through a participating political subdivision. Demonstrations last 7 years with up to a 5‑year extension, and enrollees automatically move to the State plan if the state later expands.
- Local governments may apply alone or in partnerships, must hold public notice and comment, and must provide benefits comparable to essential health benefits. Federal funding uses a special matching schedule that includes 100% federal matching for administrative costs in the first 3 years and a phase down with a 90% match in year 8 and beyond.
- States face penalties if they block or punish subdivisions, including up to 25% withholding of certain administrative payments. The Secretary may approve up to 100 demonstrations and may not require budget neutrality.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
High federal funding for local Medicaid coverage
If enacted, the federal government would pay 100% of medical costs for the first three years. In year four it would pay 100% if a rural area is included, otherwise 95%. Year five: 95% if rural, otherwise 94%; year six: 94% if rural, otherwise 93%; year seven: 93% if rural, otherwise 90%; year eight and later: 90%. The federal share for admin costs would also rise by 5 percentage points for each 100,000 people enrolled in a quarter. Example: 200,000 enrollees adds 10 percentage points.
Local Medicaid expansion by cities and counties
This bill would let cities or counties in non‑expansion States run their own Medicaid expansion. Eligible low‑income adults could get coverage similar to essential health benefits. Local governments would apply and hold public hearings, and they could partner with nearby areas. Demos could run up to 7 years, with up to 5 more on approval. If the State later expands Medicaid, the State would automatically enroll eligible people on day one. HHS would issue rules within 180 days, allow up to 100 projects, and not require budget neutrality.
Penalties for states that block local coverage
If a State punishes a local area for running a demo, HHS would withhold 25% of the State’s Medicaid admin payments for that time. Banned actions include shifting people off the State plan to the local demo, cutting local funding, raising local taxes because of the demo, blocking participation, or denying access to State Medicaid systems. This would protect local coverage efforts.
Sponsors & CoSponsors
Sponsor
Doggett, Lloyd [D-TX-37]
TX • D
Cosponsors
Bishop
GA • D
Sponsored 1/22/2025
Rep. Casar, Greg [D-TX-35]
TX • D
Sponsored 1/22/2025
Rep. Castor, Kathy [D-FL-14]
FL • D
Sponsored 1/22/2025
Castro (TX)
TX • D
Sponsored 1/22/2025
Cohen
TN • D
Sponsored 1/22/2025
Clyburn
SC • D
Sponsored 1/22/2025
Cuellar
TX • D
Sponsored 1/22/2025
Escobar
TX • D
Sponsored 1/22/2025
Rep. Figures, Shomari [D-AL-2]
AL • D
Sponsored 1/22/2025
Fletcher
TX • D
Sponsored 1/22/2025
Rep. Frankel, Lois [D-FL-22]
FL • D
Sponsored 1/22/2025
Rep. Garcia, Sylvia R. [D-TX-29]
TX • D
Sponsored 1/22/2025
Rep. Green, Al [D-TX-9]
TX • D
Sponsored 1/22/2025
Johnson (GA)
GA • D
Sponsored 1/22/2025
Rep. Johnson, Julie [D-TX-32]
TX • D
Sponsored 1/22/2025
McBath
GA • D
Sponsored 1/22/2025
Cherfilus-McCormick
FL • D
Sponsored 1/22/2025
Scott, David
GA • D
Sponsored 1/22/2025
Sewell
AL • D
Sponsored 1/22/2025
Soto
FL • D
Sponsored 1/22/2025
Thompson (MS)
MS • D
Sponsored 1/22/2025
Turner (TX)
TX • D
Sponsored 1/22/2025
Rep. Veasey, Marc A. [D-TX-33]
TX • D
Sponsored 1/22/2025
Rep. Wasserman Schultz, Debbie [D-FL-25]
FL • D
Sponsored 1/22/2025
Rep. Williams, Nikema [D-GA-5]
GA • D
Sponsored 1/22/2025
Wilson (FL)
FL • D
Sponsored 1/22/2025
Adams
NC • D
Sponsored 1/22/2025
Rep. Cleaver, Emanuel [D-MO-5]
MO • D
Sponsored 1/22/2025
Connolly
VA • D
Sponsored 1/22/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 1/22/2025
Rep. Raskin, Jamie [D-MD-8]
MD • D
Sponsored 1/22/2025
Crockett
TX • D
Sponsored 1/23/2025
Rep. Frost, Maxwell [D-FL-10]
FL • D
Sponsored 2/4/2025
Rep. DeSaulnier, Mark [D-CA-10]
CA • D
Sponsored 2/4/2025
Gonzalez, V.
TX • D
Sponsored 7/21/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov