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HB 5996

AN ACT RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL MARKET AFFORDABILITY ACT OF 2025

2025 Regular Session Introduced by Edith Ajello and 7 co-sponsors

Creates a state-based program to reduce out-of-pocket costs and improve plan value for RI individual market enrollees through carrier payments funded by a dedicated account and pot

05/20/2025 Committee recommended measure be held for further study
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Bill Summary · HB 5996

Summary — HB 5996: Rhode Island Individual Market Affordability Act of 2025

Status: Introduced in 2025; referred to House Finance. Scheduled hearing 05/16/2025; committee recommended measure be held for further study (05/20/2025).

Note: The bill text supplied included unrelated material from another state's school-code bill before the Rhode Island language. This summary covers the Rhode Island "Rhode Island Individual Market Affordability Act of 2025" (LC001839).

Main purpose

Create a state-administered affordability program to reduce out-of-pocket costs and improve plan actuarial value for low- and moderate‑income individuals who purchase health insurance through the Rhode Island Health Benefits Exchange.

Key provisions and structure

  • Establishes a statutory chapter (Chapter 157.2) titled the "Rhode Island Individual Market Affordability Act of 2025."
  • Definitions: sets terms used in the chapter (e.g., “affordability program,” “board,” “director,” “premium tax credit,” “household income,” etc.), generally aligned to federal and existing state definitions as of Jan 1, 2025.
  • Program authority:
    • Authorizes the Exchange Director to establish and operate a state-based individual market affordability program consistent with state and federal law.
    • Director may implement affordability programs, make payments to carriers to reduce consumer cost‑sharing, and improve actuarial value for eligible individuals, based on recommendations from a health insurance affordability board (referenced in § 42-157.2-6).
  • Funding and fund mechanics:
    • Creates a restricted receipt account within the General Fund called the "health insurance individual market affordability account" to be used solely to operate the program.
    • Beginning July 1, 2025, a portion of amounts collected under § 42-7.4-3 (as identified in the bill) shall be deposited into this account up to the actual (or projected) amount expended for the program, net of any prior-year excess.
    • The Exchange must provide an annual report to the General Assembly by February 1 each year on program activity and costs; excess collections reduce subsequent year funding requirements.
    • The account is exempt from the state’s indirect cost recovery statute.
    • The chapter explicitly states it does not obligate the state to make general revenue appropriations for the program.
  • Federal funding and coordination:
    • Director, in consultation with the Commissioner of the Office of the Health Insurance Commissioner, the Executive Office of Health and Human Services, and the Medicaid director, may identify and pursue federal or other external funding sources, including through the state’s Section 1115 Medicaid waiver, Section 1332 innovation waiver, or other authorities.
    • The Secretary of EOHHS is authorized to negotiate and submit necessary changes to Medicaid or waiver authorities to obtain identified funding.
  • Program administration:
    • Director to allocate program funds pursuant to regulations (text specifying allocation rules and eligibility is partly truncated in supplied excerpt).
    • Exchange must make program cost details available to any entity making a contribution under § 42-7.4-3 upon request.

Who is affected

  • Primary beneficiaries: low‑ and moderate‑income individuals and families who purchase individual market coverage through the Rhode Island Exchange and who are eligible for federal premium tax credits and/or cost‑sharing reductions.
  • Health insurance carriers: would receive state payments (supplemental payments or adjustments) to reduce enrollees’ cost‑sharing or improve plan actuarial value.
  • State agencies involved: Rhode Island Health Benefits Exchange, Office of the Health Insurance Commissioner, EOHHS and Medicaid administration, and the General Treasurer (for account management).
  • Entities that contribute under § 42-7.4-3 (source of deposits) — required reporting and potential financial obligation per existing statute referenced.

Procedural / timeline aspects

  • Text sets start for fund deposits: July 1, 2025.
  • Annual reporting requirement: Exchange to report by February 1 each year.
  • The bill was referred to House Finance and had a scheduled hearing 05/16/2025; committee recommended holding the measure for further study on 05/20/2025.

Missing / unresolved details (excerpts truncated)

The supplied excerpt truncates portions describing:
- Specific eligibility criteria, benefit adjustments, formulas for carrier payments, and precise allocation/regulatory mechanics.
- Composition, authorities, and appointment process for the referenced affordability "board" (§ 42-157.2-6).
- Exact meaning and source of amounts collected under § 42-7.4-3 referenced as the primary funding mechanism.

For a full assessment of fiscal impact, eligibility rules, and operational implementation, review the complete bill text (including sections omitted in the excerpt) and any fiscal notes or regulatory guidance issued by the Exchange or House Finance Committee.

Compiled from official sources — confirm details with the bill’s official record.

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