Counties can now run Medicaid without waiting for hostile state legislatures

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.
• Automatic enrollment of beneficiaries into state Medicaid if the state later expands may create administrative churn and coverage gaps if state systems are unprepared for sudden enrollment surges.
• The 100-project cap creates a lottery effect—only the first 100 qualifying subdivisions (or partnerships) can participate, leaving other counties unable to access the program regardless of local demand or readiness.

Who it affects

Uninsured low-income adults in non-expansion states gain access to health coverage without waiting for state legislatures to act. The federal cost-sharing structure incentivizes local participation while protecting participating counties from state retaliation, expanding coverage options for a vulnerable population.

Who stands to gain

• health care providers and hospitals in participating counties
• Medicaid managed care organizations
• health information technology vendors
• federally qualified health centers and rural health clinics

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Social Security Act Section 1902, Social Security Act Section 1903, Office of Management and Budget (OMB), Patient Protection and Affordable Care Act (ACA), Medicaid, NOW (stock ticker, if applicable to a health plan or provider)

Where it stands

35 cosponsors: 35 Democrats.

• Jan 22, 2025 — Introduced · Congress.gov: “Introduced in House”
• Jan 22, 2025 — Referred to House Committee on Energy and Commerce · Congress.gov: “Referred to the House Committee on Energy and Commerce”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

2 lobbying clients named this bill on 2 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $3,030,000 in lobbying spend. A filing names 94 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 41% of bills with at least one filing.

Lloyd Doggett, the sponsor, reported $142,750 in PAC receipts in the 2026 cycle.

• America's Health Insurance Plans Inc (ahip) — $3,010,000 on 1 filing
• National Alliance on Mental Illness — $20,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.