Bill
HB 7823
Creates a state-run universal health system (RICare) with public financing, a dedicated fund and 16-member board to provide comprehensive benefits with no out-of-pocket costs.
Purpose and intent
- Establish a universal, publicly financed and publicly administered healthcare system for Rhode Island residents, called RICare.
- Replace or consolidate existing multi-payer coverage with a single, unified payment and administration system to improve access, contain costs, and simplify administration.
- Frame healthcare as a fundamental right and aim to reduce uninsured/underinsured status, medical debt, and inefficiencies in the current system.
Key provisions and changes
- Creation of RICare and the RICare Fund:
- Establishes a dedicated RICare Fund in the state treasury to finance the program.
- The fund may receive general fund transfers, federal funds (via waivers), grants, donations, taxes, and administrative fines.
- Funds are to be spent on administration, delivery, and payment for RICare-covered services.
- RICare governance and administration:
- Creation of the RICare Board (16 Rhode Island residents) within the Department of Health.
- Board duties include overseeing payment and delivery system reforms, cost containment, and quality assurance; designing a unified payment methodology; and approving the RICare benefit package.
- The Director of Health coordinates reform efforts, ensures coordinated implementation, and provides testimony to committees as requested.
- Department shall administer RICare with no private claims-processing contracts; preference for staff displaced from health carriers/provider administration.
- Eligibility and enrollment:
- All Rhode Island residents are eligible for RICare, with a single, public payer to cover biomedical and administrative costs.
- RICare acts as a secondary payer to Medicare, RIChild, and other private plans if federal waivers are not in place; otherwise, it integrates with those programs via waivers.
- Rules for residency verification, eligibility, and penalties for false information, including potential False Claims Act implications when Medicaid/RIChild funds are involved.
- Enrollment procedures to be established; simplified enrollment processes contemplated, with ongoing public enrollment support.
- Coverage and benefits:
- RICare includes a broad set of medically necessary benefits: primary and preventive care, chronic and acute care, hospital services, behavioral health, prescription drugs, medical devices, dental, vision, hearing, substance use disorder treatment, reproductive/obstetrical care, long-term/home care, laboratory services, gender-affirming care, organ donation/transplant, autism treatment, ambulance, hospice, and telehealth.
- Benefits package must meet or exceed essential federal ACA benefits; no premiums, deductibles, copays, or caps under RICare; no out-of-pocket costs for covered services.
- RICare benefits for Medicaid/RIChild participants include federal-law-mandated benefits plus additional optional benefits; Medicaid/RIChild coverage may be adjusted over time within federal constraints.
- Payment rates and delivery system:
- Board to set base payment rates for healthcare professionals, manufacturers, suppliers, and non-licensed service providers.
- Payment methodologies may include bundled payments, risk-adjusted capitation, and other reform approaches to encourage efficiency, outcomes, and primary care access.
- Rates aimed at recruiting/retaining healthcare professionals and ensuring access statewide, with geographic and service-type adjustments as appropriate.
- Annual evaluation of system performance, including access, outcomes, cost containment, and provider staffing conditions.
- Implementation timeline and milestones:
- Initial feasibility and planning steps, including waivers, financing, benefit package approval, and appropriation.
- Implementation targeted 90 days after the last of specified conditions are met (waiver approval, financing law, benefit package, appropriations, and performance prerequisites).
- Notable studies: feasibility studies on replacing motor vehicle accident coverage and workers’ compensation coverage with RICare (due by 2027-2028), as well as a long-term care inclusion study (due by 2027-11-01).
- Annual reporting requirements starting January 15, 2027, on board activities and program developments.
- Federal and intergovernmental considerations:
- The act anticipates waivers under the federal ACA (1332 waiver) to support direct federal funding to RICare and reduce reliance on the health insurance exchange.
- If waivers are not secured, RICare would still function with a secondary-payer arrangement and alternative funding mechanisms as feasible under federal law.
- Public input and transparency:
- The board must solicit public input on benefit packages and report regularly to the General Assembly.
- Reports and performance evaluations must be publicly accessible.
- Non-duplication and compatibility:
- The act does not require private insurance terminations, allows for supplemental coverage, and contemplates coordination with existing programs and federal funds where possible.
- The act affirms that collective bargaining rights are not diminished.
Who would be affected
- Rhode Island residents would transition to a universal coverage model (RICare), with RICare as the primary or secondary payer depending on federal waivers.
- Healthcare professionals, hospitals, insurers, and medical suppliers would participate in new payment methodologies and rate-setting under the RICare framework.
- State agencies (Department of Health, EOHH, OHIC, Medicaid program administrators) would coordinate reform, enrollment, data sharing, and financing under the new system.
- Employers, local governments, and state employees would be affected indirectly through shifts in financing and potential changes to health benefits administration.
Timeline and procedural notes
- The act establishes a multi-step implementation process, with planning, waiver acquisition, and budgetary approvals required before RICare can commence.
- Initial board and plan development due dates: work plan submission by January 1, 2027; ongoing annual reporting starting January 15, 2027.
- Full implementation targeted 90 days after all specified prerequisites are met (waiver, financing, benefit package, appropriation, and performance prerequisites).
- The act provides for several quasi-experimental feasibility studies (motor vehicle accident coverage, workers’ compensation coverage, and long-term care) with milestones through 2027-2028.
- The act includes severability, liberal construction language, and public-input provisions to guide ongoing governance and adjustments.
In sum, HB 7823 would create a state-run universal health system (RICare) with a dedicated fund, a new 16-member RICare Board, and a comprehensive benefits package financed through public means, aiming to stabilize costs, improve access, and streamline healthcare financing and delivery in Rhode Island.
Compiled from official sources — confirm details with the bill’s official record.
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