Community Multi-Share Coverage Program Act of 2026

Purpose and overall aim

• HR 8585, the Community Multi-Share Coverage Program Act of 2026, would require the Secretary of Health and Human Services to award grants to establish and support Community Multi-Share Coverage Programs.
  
• The targeted goal is to provide affordable health coverage and integrated health-related social needs services to qualifying individuals and workers at small businesses, with the aim of improving health, promoting long-term economic self-sufficiency, and supporting employment and retention.

Key provisions and requirements

• Grants and timeline

  • Within 180 days of enactment, the Secretary must award at least 3 and up to 5 grants to establish Community Multi-Share Coverage programs.
  • Each grant funded under this section would run for 4 years.
  • The Secretary would determine the maximum grant amount and ensure at least one grant goes to a program already operating when the bill becomes law.

• Program design and services (Community Multi-Share Coverage Program)

  • Physical presence: Programs must maintain a local presence near enrollees to facilitate face-to-face interactions.
  • Health coverage details:
  • Coverage must include a broad suite of services (physician, hospital, behavioral health including substance use treatment, preventive, labs/x-rays, prescription drugs, emergency services, population health improvement, etc.).
  • No deductibles on in-network services; copays for in-network services limited to levels that do not create barriers.
  • Network providers must be established within the community.
  • Community collaboration: The program must work with or align with an existing community-based intermediary/entity that has experience coordinating safety-net health, human services, and workforce services; this entity assists with identifying community needs and coordinating among health providers, community organizations, employers, and other partners.
  • Integrated continuous health improvement: The program must provide ongoing health improvement services, including:
  • Regular assessments of community factors impacting health (physical, emotional, economic).
  • A community-based planning process to address identified negative influences, with partnerships across employers, educational/training providers, health initiatives, investors, government agencies, and relevant 501(c)(3) organizations.
  • Individualized enrollee assessments to identify barriers and health risks, including a health domain score.
  • Individualized plans with milestones and engagement strategies; health coaching and linkage to community resources (e.g., classes, training, mentorships).
  • Funding structure and sustainability: Costs are to be shared among public sector, local providers, enrollees, and enrollees’ employers or trade organizations. The plan must pursue a multi-year transition toward stable funding from multiple sources (federal, state/local government, hospital community benefit resources) and demonstrate measurable progress toward a mature financing structure.

• Eligibility and enrollment (Qualifying Individuals)

  • Eligibility criteria include:
  • Residing or working in the program’s catchment area.
  • Household income above Medicaid eligibility but not more than 400% of the federal poverty line (with potential program-specific modifications).
  • Not enrolled in a qualified health plan in the prior 180 days, unless coverage was terminated due to a special event.
  • Ineligible for Federal health care programs (e.g., IHS, VA).
  • Employed by a small employer not offering a qualified health plan with an otherwise affordable total cost of coverage (premium plus deductible) relative to household income.
  • Additional requirements may be determined by the Secretary.
  • If demand exceeds capacity, the program must have a publicly available enrollment policy.

• Enrollment management and performance

  • Programs may rescind enrollment for sustained failure to meet minimum engagement and personal growth thresholds, with non-health-contingent, participatory processes and reasonable alternatives in the individual’s plan.
  • Programs must evaluate impact on employment, health, income, and economic self-sufficiency.

• Administration and reporting

  • Applicants for grants must be non-profit entities with commitments from local partner hospitals and small employers, and must certify compliance with program requirements (e.g., no preexisting condition exclusions, adequate provider resources, ALICE-income targeting, administrative/financial management, and annual progress reports).

• Definitions and statutory references

  • Defines terms such as “qualifying individual,” “small employer,” “health-related social needs,” “health coach,” “federal health care program,” and other key concepts to implement and monitor the program.

Who would be affected

• Small employers in participating communities (through potential changes in coverage options and workplace health initiatives).
• Qualifying individuals within designated catchment areas who gain access to affordable, integrated health coverage and associated health-related social services.
• Local hospitals and health care providers entering network agreements and collaborating with community intermediaries.
• Community-based organizations, intermediaries, and other partners coordinating health, social services, and workforce development.

Procedural and timeline aspects

• Enactment would authorize appropriations starting with:
  • $4.8 million for FY 2026
  • $7.2 million for FY 2027
  • $12.0 million for each of FYs 2028 and 2029
• The Secretary would award grants within 180 days of enactment and set grant sizes and number (minimum 3, maximum 5).
• Programs must include reporting to the Secretary on annual progress and results.

Summary takeaway

HR 8585 proposes a federally supported, community-centered approach to expanding affordable health coverage for low- to moderate-income workers at small businesses, integrated with health-related social needs services and workforce development. It emphasizes local presence, networked providers, cross-sector collaboration, individualized enrollment plans, and a shared funding model intended to achieve long-term sustainability beyond federal funding.