The COVER Now Act enables local governments in states that haven't expanded Medicaid to offer medical assistance to residents who would be eligible under Medicaid expansion, with substantial federal funding support and protections against state interference.
Lloyd Doggett
Representative
TX-37
The COVER Now Act allows local governments in states that haven't expanded Medicaid to create their own programs to provide medical assistance to those who would be eligible under Medicaid expansion. The federal government would match a percentage of the costs. States are prohibited from interfering with these local programs. The Department of Health and Human Services will oversee the demonstration project and report to Congress on its impact.
COVER Now Act: Feds Greenlight Local Medicaid Expansion in Holdout States, Starting 2025
The COVER Now Act lets cities and counties in states that haven't expanded Medicaid offer coverage to residents who would qualify if their state had. Think of it as a local workaround to a state-level roadblock, kicking off potentially as soon as the regulations are set, which the bill mandates must be within 180 days of passage.
Local Control, Federal Dollars
This bill, officially titled the "Cover Outstanding Vulnerable Expansion-eligible Residents Now Act," creates a way for local governments to step in where their states haven't. It sets up a demonstration project – basically a trial run – where cities and counties can apply to provide Medicaid-equivalent coverage. The federal government foots a big chunk of the bill, starting with 100% of the costs for the first three years. This is a big deal for places where healthcare access is limited because the state hasn't expanded Medicaid.
Real-World Rollout
Imagine a county hospital struggling with unpaid bills because many patients are uninsured. Under this Act, that county (or city) could apply to offer coverage, get federal funding, and reduce those uncompensated care costs. For a single mom working two part-time jobs but making too much for traditional Medicaid (and not enough to afford private insurance), this could be the difference between getting a check-up or skipping it. Section 2, the core of the bill, lays out the requirements for local participation, including public hearings and input – so communities have a say. The bill also prohibits states from interfering with the subdivisions that seek to offer healthcare to their citizens. If states try to prevent this, they'll face a 25% reduction in their administrative costs under Medicaid.
Potential Pitfalls, Long-Term Questions
While the bill aims to boost coverage, there are potential snags. States might try to find loopholes in the rules against cost-shifting. There's also the risk of local governments mismanaging funds or not fully complying with reporting rules. The bill tries to address this by boosting federal matching funds for administrative costs as enrollment grows – an extra 5% for every 100,000 people enrolled, incentivizing efficient administration. The bill also requires a report to Congress within 4 years to assess the impact on enrollment and uncompensated care, and whether states end up expanding Medicaid as a result.