Counties can now run Medicaid without waiting for hostile state legislatures
H.R. 608 — COVER Now Act · Filed by Lloyd Doggett (D-TX) · 35 cosponsors · Introduced Jan 22, 2025 · Referred to committee
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What it does
The COVER Now Act allows counties and local governments in non-Medicaid-expansion states to run their own Medicaid programs for low-income adults, with the federal government covering 100% of costs for the first three years, then gradually declining to 90%. The bill aims to extend health coverage to vulnerable residents in states that have refused federal Medicaid expansion, while preventing state governments from punishing or blocking local participation.
Why we flagged it
The bill creates a mechanism for local governments to bypass state-level Medicaid expansion refusals by establishing independent demonstration projects. It is functionally a federal-local partnership to extend coverage, not a traditional state-administered program.
What the text implies
- Creates a two-tier Medicaid system where coverage availability depends on local political will rather than state policy, potentially fragmenting eligibility and benefits across counties within the same state.
- The 100-day federal cost-share cliff (from 100% to 90% in year 4) may force participating counties to raise local taxes or cut benefits after initial federal subsidy ends, shifting long-term costs to local taxpayers.
The full analysis lists 4 implications of this text.
Who stands to gain
health care providers and hospitals in participating counties; Medicaid managed care organizations; health information technology vendors