Summary#
This bill would create a grant program at the Department of Health and Human Services to fund local nonprofit-run "Community Multi-Share Coverage" programs. Those programs must keep a local office, partner with hospitals and community groups, and offer health coverage plus coaching and help for health-related social needs. Covered services include doctor care, hospital care, behavioral health and substance use services, preventive care, lab tests, prescription drugs, emergency ambulance and emergency services, and population health services. Plans would impose no deductibles for in-network services and limit co-payments. Programs must assess enrollees, create individualized plans, offer health coaching, connect people with job training and community resources, and evaluate effects on health and employment.
What it means for you#
- Who can enroll: People who live or work in a program's catchment area, whose household income is above their State Medicaid limit but at or below 400% of the federal poverty line, who are not enrolled in a qualified health plan in the prior 180 days, and who are not eligible for Federal health care programs. Enrollees must work for a small employer that does not offer affordable coverage (defined in the bill as combined premium plus deductible equal to 7% or more of household income).
- For small employers and hospitals: Local nonprofit programs must have commitments from partner hospitals and small employers. Employers and hospitals are listed among entities expected to share program costs.
- Service and engagement rules: Programs must maintain a local presence, provide no-deductible in-network care, offer health coaching and individualized plans, and may set written rules for enrollment priority if capacity is limited. Programs may remove an enrollee for sustained failure to meet engagement milestones, but removals must be participatory (not tied to health status) and include reasonable alternatives in the enrollee's plan.
Expenses#
- The bill authorizes federal appropriations of $4,800,000 for fiscal year 2026; $7,200,000 for fiscal year 2027; and $12,000,000 for each of fiscal years 2028 and 2029.
- The Secretary must award between 3 and 5 grants, each for up to 4 years. The Secretary will set the maximum grant amount for each award. At least one award must go to an already-operating program.
- The bill requires programs to use a shared funding model. Direct costs must be shared among the public sector, local health care providers, enrollees, and enrollees' employers or skilled trade organizations. Programs must plan for multi-year financial transition toward sustained State, local, and hospital contributions and avoid reliance on a single funding source.
Proponents' View#
The bill describes its goals as reducing the number of uninsured individuals, promoting workforce development by addressing psycho-social barriers to employment, and helping small businesses offer affordable, high-quality coverage so they can hire and retain workers who might otherwise stay on Medicaid.
Opponents' View#
No publicly available information.