US Federal House Bill HB608

US Federal 2025-2026 Regular Session

• Introduced: 1/22/25
• Refer: 1/22/25

Caption

COVER Now Act

Summary

HB608, the COVER Now Act, would create a Medicaid demonstration project allowing qualifying political subdivisions of states—such as counties, cities, or other local government units—to provide Medicaid coverage to the ACA Medicaid expansion population in states that have not expanded Medicaid. The bill authorizes the Secretary of Health and Human Services to waive Medicaid’s statewideness and single-state-agency requirements so local governments can apply directly, either alone or in partnerships, after a public notice-and-comment process at the local level. The demonstration would generally run for seven years, with a possible five-year extension, and would end earlier if the state later expands Medicaid for the same population. If a state later expands coverage, the bill requires automatic enrollment of individuals already receiving coverage through the local demonstration into the state Medicaid plan or waiver. The bill also limits the Secretary to approving no more than 100 demonstration projects and requires a report to Congress on enrollment and uncompensated care effects within four years of the first project start.

Impact

The bill would amend Title XIX of the Social Security Act by adding a new Medicaid demonstration authority for political subdivisions and by modifying federal Medicaid payment rules. It would permit local governments in non-expansion states to operate Medicaid-like coverage for expansion-eligible adults, with federal matching funds calculated largely as if the subdivision were a state, including a phased-down match over time and special treatment for rural subdivisions. It also adds protections against state retaliation or interference, including prohibitions on shifting costs, blocking participation, restricting provider participation, or preventing use of state Medicaid systems. In addition, it would increase federal administrative matching payments for states based on enrollment in these local demonstrations.

Sentiment

Based on the bill text and available context, the measure appears strongly supported by its Democratic House sponsors and is framed as a coverage-expansion and access-to-care proposal. There is no recorded committee debate or vote history in the provided materials, so no formal opposition or bipartisan sentiment can be measured from the record here. The overall tone of the bill is policy-driven and remedial, emphasizing coverage for uninsured adults in states that have not expanded Medicaid and reducing uncompensated care burdens.

Contention

The main points of contention are likely to be federalism, state authority, and financing. The bill explicitly allows local political subdivisions to act even when their state has not expanded Medicaid, waives key Medicaid structural requirements, and bars states from blocking or penalizing local participation; those provisions could be viewed as intruding on state control over Medicaid administration. Another likely issue is cost: the bill provides enhanced federal matching rates, does not require budget neutrality, and creates additional administrative payments, which could draw scrutiny over federal spending. Supporters are likely to emphasize coverage gains for vulnerable residents and reduced uncompensated care, while critics may focus on the precedent of local governments operating around state Medicaid decisions and the fiscal implications.