H.R. 608 — COVER Now Act

This section establishes a demonstration project under which the Secretary of Health and Human Services may select qualifying political subdivisions (or partnerships thereof) in states that have not adopted Medicaid expansion to provide medical assistance to the expansion population (i.e., adults ages 19-64 with family incomes up to 138% of the federal poverty level, per SSA §1902(a)(10)(A)(i)(VIII)). The Secretary may waive Medicaid's statewideness and single-state-agency requirements for participating political subdivisions, which must apply after public notice and hearings. Participating political subdivisions must provide coverage for seven years or until the state adopts expansion (whichever is shorter), with an option to extend participation after five years for up to five additional years upon Secretary approval. If a state later adopts expansion, it must automatically enroll individuals receiving coverage under the demonstration project. The Secretary pays participating political subdivisions at enhanced federal matching rates calculated as if the subdivision were a state: (1) 100% for the first three years; (2) for the fourth year, 100% if the subdivision includes a rural area (per OMB definition) or 95% otherwise.