H.R. 8585

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8585 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8585

To require the Secretary of Health and Human Services to award grants 
to support community-based coverage entities to carry out a 
comprehensive coverage program that provides qualifying individuals and 
small businesses health coverage and integrated health-related social 
need services to small business workers that promote improved health, 
long-term economic self-sufficiency, employment and retention, and for 
other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

April 29, 2026

Mr. Moolenaar (for himself and Mr. Huizenga) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Education and Workforce, for a period 
to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
committee concerned

_______________________________________________________________________

A BILL

To require the Secretary of Health and Human Services to award grants 
to support community-based coverage entities to carry out a 
comprehensive coverage program that provides qualifying individuals and 
small businesses health coverage and integrated health-related social 
need services to small business workers that promote improved health, 
long-term economic self-sufficiency, employment and retention, and for 
other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Community Multi-Share Coverage 
Program Act of 2026''.

SEC. 2. GRANTS TO ESTABLISH COMMUNITY MULTI-SHARE COVERAGE PROGRAMS TO 
ENABLE SMALL BUSINESSES TO PROVIDE AFFORDABLE HEALTH 
COVERAGE AND SUPPORT SERVICES TO EMPLOYEES WITH LIMITED 
INCOME AND ASSETS.

(a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
award at least 3 and not more than 5 grants to support Community Multi-
Share Coverage programs. Such programs shall--
(1) reduce the number of uninsured individuals through 
hospital-community partnership initiatives that provide an 
affordable health coverage option for such individuals and 
provide a coverage transition for those limited to coverage 
through government-sponsored programs;
(2) promote workforce development for small businesses by 
addressing the psycho-social barriers that directly impact 
employment success and create barriers to exiting Medicaid, 
resulting in better health and workplace success; and
(3) support small business economic recovery by allowing 
small businesses to be competitive in their hiring, and to 
provide high quality, affordable health coverage to workers who 
are otherwise hesitant to lose Medicaid eligibility.
(b) Community Multi-Share Coverage Program Requirements.--For 
purposes of this section, the term ``Community Multi-Share Coverage 
Program'' means a program that satisfies each of the following program 
requirements:
(1) Physical presence in the community.--The program 
maintains a physical presence within close geographic proximity 
to the enrollees it is serving, with a focus on mitigating 
barriers to engagement by enabling face-to-face interactions 
between the program staff, enrollees, and community 
organizations.
(2) Health coverage.--The program provides enrolled 
qualifying individuals with health coverage that satisfies the 
following:
(A) Services covered.--Provides coverage for the 
following categories of services when furnished by 
network providers and community resources:
(i) Physician services.
(ii) Inpatient and outpatient hospital 
services.
(iii) Behavioral health services, including 
services for substance use disorder prevention 
and treatment.
(iv) Preventative services.
(v) Diagnostic laboratory tests and x-rays.
(vi) Prescription drugs.
(vii) Emergency ambulance services that are 
provided by ground transportation.
(viii) Emergency services (as defined in 
section 2719A(b)(2)(B) of the Public Health 
Service Act (42 U.S.C. 300gg-1719a(b)(2)(B))).
(ix) Population health improvement 
services.
(B) Cost-sharing.--Imposes no deductible on covered 
services provided by network providers and community 
resources, and limits co-payments for in-network 
covered services to levels that do not create a barrier 
to patient access.
(C) Network providers.--Establishes agreements with 
hospitals and health care providers located within the 
community to provide care for qualifying individuals.
(3) Community collaboration and alignment.--The program is 
carried out in partnership with, or in formal coordination 
with, an existing community-based collaborative, intermediary, 
or coordinating entity that--
(A) has demonstrated experience aligning safety-net 
health, human service, and workforce-related services 
within the community;
(B) supports the identification of community-
defined needs, priorities, and service gaps through 
ongoing engagement with community stakeholders; and
(C) facilitates coordination among participating 
health care providers, community-based organizations, 
employers, and other relevant partners to avoid 
duplication and promote effective use of community 
resources.
(4) Integrated continuous health improvement services.--The 
program provides, either directly or through contract, 
integrated continuous health improvement services that satisfy 
the following:
(A) Regular assessments of community factors and 
resources that potentially impact enrollees' physical, 
emotional, and economic health.
(B) A community-based planning process to identify 
and address any negative influences identified pursuant 
to subparagraph (A), and promote well-being through 
partnerships and alignment efforts between the 
community-based coverage entity and--
(i) local small employers;
(ii) entities that provide educational and 
occupational training (including classes, 
workshops, mentorships, and apprenticeships) 
designed to enhance preparation for work and 
support economic self-sufficiency;
(iii) community health and health-related 
social need initiatives;
(iv) investors;
(v) local, State, and Federal governmental 
agencies; and
(vi) organizations described in section 
501(c)(3) of the Internal Revenue Code of 1986 
that focuses on human service needs relating to 
physical health, behavioral health, poverty, 
education, access to health care, and safety.
(C) Individualized assessment of each enrollee to 
identify any negative influences on their physical, 
emotional, and economic health, and ability to achieve 
economic self-sufficiency, which shall include--
(i) an assessment of any of the enrollee's 
psycho-social barriers, health risks, barriers 
to long-term employment, and barriers to 
increasing income; and
(ii) a determination of the enrollee's 
health domain score, which is a measurement of 
specific influences of physical, emotional, and 
financial health with respect to a qualifying 
individual.
(D) Establishment of an individualized plan to 
support each enrollee in achieving better health and 
economic self-sufficiency, which shall--
(i) identify community resources that will 
support the enrollee in improving their 
physical, behavioral, or economic health, which 
may include--
(I) group classes that address 
barriers to physical, emotional, and 
economic health; and
(II) educational and occupational 
training opportunities that enhance 
work preparedness and support economic 
self-sufficiency; and
(ii) contain engagement milestones, with a 
goal of identifying and overcoming obstacles to 
engagement in personal health improvement and 
mitigation of root-cause barriers, which shall 
include--
(I) participation in individualized 
health coaching services to address the 
enrollee's health-related social needs 
and to support their physical, 
emotional, and financial health; and
(II) engagement with community 
resources, such as participating in 
group classes, as recommended by the 
health coach.
(5) Funding structure.--
(A) In general.--The direct costs of the program 
are shared among the following entities, each of which 
makes a direct financial contribution:
(i) The public sector.
(ii) Local health care providers.
(iii) Enrollees.
(iv) Enrollees' employers or skilled trade 
organizations.
(B) Shared financial responsibility and long-term 
sustainability.--The program shall be structured to 
support long-term financial sustainability through a 
shared financial responsibility framework that--
(i) relies on coordinated and ongoing 
contributions from multiple levels of 
government, local resources, and hospital 
community benefit investment;
(ii) avoids dependence on a single funding 
source by establishing a defined, multi-year 
transition toward a stable allocation of 
financial responsibility across participating 
sectors; and
(iii) demonstrates measurable progress 
toward a mature financing structure in which 
Federal support is supplemented by sustained 
contributions from State and local government 
and hospital community benefit resources.
(6) Enrollees.--
(A) In the event that a Program is unable to 
provide services to all qualifying individuals in its 
catchment area, the Program has a publicly available 
written policy for determining which qualifying 
individuals are offered enrollment.
(B) The program may rescind a qualifying 
individual's enrollment due to sustained failure to 
meet minimum engagement and personal growth thresholds, 
which shall be participatory and not health-contingent, 
and provide for reasonable alternatives, in their 
individual plan described in subsection (b)(2)(D).
(7) Evaluation.--The program formally evaluates its impact 
on enrollees' employment status, physical and behavioral 
health, income, and economic self-sufficiency.
(c) Qualifying Individual.--The term ``qualifying individual'' 
means an individual who--
(1) resides or works within the catchment area of a partner 
hospital described in subsection (e)(1)(A);
(2) subject to any modification made by such program to 
narrow the income eligibility range, has a household income 
that exceeds the Medicaid eligibility limit applicable to the 
qualifying individual in their State of residence but does not 
exceed 400 percent of the Federal poverty line applicable to 
their household size;
(3) is not enrolled in a qualified health plan during the 
180-day period preceding the date on which such qualifying 
individual seeks to enroll in the Community Multi-Share 
Coverage Program, unless a such coverage is terminated due to a 
qualifying special event;
(4) is ineligible for enrollment in a Federal health care 
program, including ineligibility to receive health services 
through the Indian Health Service or Veterans Administration;
(5) works for a small employer which does not offer its 
employees coverage in a qualified health plan under which the 
combined premium plus deductible cost to cover the employee's 
household is less than seven percent of the employee's 
household income; and
(6) meets other requirements the Secretary determines 
appropriate.
(d) Grant Terms.--
(1) Duration.--A grant awarded under this section shall be 
made for a period of 4 years.
(2) Amount.--The Secretary shall determine the maximum 
amount of each grant awarded under subsection (a).
(3) Number.--At least one award must be made to a Community 
Multi-Share Coverage Program that is operating at the time that 
this section is enacted.
(e) Applications.--
(1) In general.--To be eligible to be awarded a grant under 
subsection (a), an applicant must--
(A) be a non-profit entity with documented 
commitments from local partner hospitals and small 
employers to participate in a Community Multi-Share 
Coverage Plan; and
(B) submit to the Secretary an application at such 
time, in such manner, and containing the certification 
described in paragraph (2) and such other information 
as the Secretary may require.
(2) Certification.--To eligible for funding under this 
section, an application described in paragraph (1) shall 
include certifications that the program--
(A) will not impose any preexisting condition 
exclusion (as such term is defined in section 
2704(b)(1)(A)) of the Public Health Service Act (42 
U.S.C. 300gg-3(b)(1)(A)) with respect to the health 
coverage described in subsection (b)(1);
(B) has or will establish a network of health care 
providers and community resources sufficient to provide 
services to qualifying individuals enrolled under the 
health coverage described in subsection (b)(2);
(C) will seek to enroll individuals whose household 
income is less than the basic cost of living (as 
determined in a manner consistent with the ``Asset 
Limited, Income Constrained, Employed'' or ``ALICE'' 
methodology);
(D) select an entity to carry out administrative 
and accounting responsibilities (including monthly 
billing, verification of eligibility of qualifying 
individuals, enrollment of qualifying individuals, 
maintenance of a list of active enrollees, and 
operation of a benefit utilization management program) 
necessary with respect to the health insurance coverage 
described in subsection (b)(2); and
(E) shall submit written reports to the Secretary 
on an annual basis evaluating the progress on advancing 
access to health care, increasing economic self-
sufficiency, and other elements that the Secretary 
requires.
(f) Definitions.--In this section:
(1) Agency.--The term ``agency'' means a local, State, or 
Federal agency.
(2) Federal health care program.--The term ``Federal health 
care program'' has the meaning given such term in section 
1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)).
(3) Health coach.--The term ``health coach'' means an 
individual who is a member of the staff of the community-based 
coverage entity that has received training to provide health 
coaching services (including health improvement program 
services).
(4) Hospital.--The term ``hospital'' means an institution 
that--
(A) meets the requirements of section 1861(e) of 
the Social Security Act (42 U.S.C. 31395x(e)); and
(B) is an organization described in subsections 
(c)(3) and (r)(3) of section 501 of the Internal 
Revenue Code of 1986 and is exempt from taxation under 
section 501(a) of such code.
(5) Qualified health plan.--The term ``qualified health 
plan'' has the meaning given such term in section 1301(a) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 
18021(a)).
(6) Secretary.--The term ``Secretary'' means the Secretary 
of Health and Human Services.
(7) Small employer.--The term ``small employer'' has the 
meaning given such term in section 1304(b)(2) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18024(b)(2)).
(8) Health-related social needs.--The term ``health-related 
social needs'' has the meaning given such term by the Director 
of the Centers for Disease Control and Prevention.
(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
(1) $4,800,000 for fiscal year 2026;
(2) $7,200,000 for fiscal year 2027; and
(3) $12,000,000 for each of fiscal years 2028 and 2029.
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