COVER Now Act

This bill lets cities, counties, or groups of local governments in states that haven’t expanded Medicaid offer health coverage to the adults who would qualify under expansion. The federal government would pay all costs for the first three years, then step down to still very high support after that, with rural areas getting a bit more help in years 4–7. Coverage must be comprehensive, similar to essential health benefits. If the state later expands Medicaid, people in the local program are automatically moved into the state’s coverage so they don’t lose care .

The bill sets guardrails so states can’t punish localities for taking part. States may not block participation, shift costs to local programs, withhold funding, or restrict providers because they work with the local program; if a state does, a portion of its Medicaid administrative funding is cut. Up to 100 local programs can be approved. Federal rules must be issued within 180 days, and applications must be decided within 180 days. Programs generally run up to 7 years, with the option to extend up to 10 years, or end sooner if the state expands Medicaid .

Key points

• Who is affected: Uninsured adults in non‑expansion states; local governments and local health providers.
• What changes: Local governments can run a program to cover the Medicaid expansion population, with strong federal funding and comprehensive benefits; people transition to state Medicaid if the state later expands .
• Protections: States cannot block or penalize local participation; violations trigger federal funding cuts to the state’s Medicaid administration.
• Funding: Federal share is 100% for the first 3 years, then phases down but stays high (at least 90% from year 8 onward; rural areas get slightly higher rates in years 4–7).
• Limits: No more than 100 local programs; applications don’t have to be budget‑neutral to be approved.
• Timing: HHS must issue rules within 180 days and decide applications within 180 days; programs last up to 7 years with a possible extension up to 10 years, or until the state expands Medicaid .