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SB 2255

AN ACT RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL MARKET AFFORDABILITY ACT OF 2026

2026 Regular Session Introduced by Jonathon Acosta and 9 co-sponsors

Rhode Island would create a state-funded affordability program to supplement federal subsidies and reduce out-of-pocket costs for individual-market plans.

05/05/2026 Committee recommended measure be held for further study
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Bill Summary · SB 2255

Summary of Bill SB 2255 (Rhode Island) – Rhode Island Individual Market Affordability Act of 2026

Jurisdiction: Rhode Island | Session: 2026 | Introduced: Jan 23, 2026 | Referred to: Senate Health & Human Services

purpose: Create a state affordability program to reduce out-of-pocket costs for low- and moderate-income individuals purchasing health insurance through the Rhode Island Health Benefits Exchange (the exchange).

1) Main purpose and intent

  • Establish a state-based affordability program to lower the cost of health insurance on the individual market for Rhode Island residents enrolled through the exchange.
  • Supplement or replace portions of federal premium tax credits with state funding mechanisms to improve affordability and actuarial value of plans.

2) Key provisions and changes

Establishment and scope

  • Creates Chapter 42-157.2: Rhode Island Individual Market Affordability Act of 2026.
  • Authorized program name: “Rhode Island individual market affordability program.”
  • Director of the Rhode Island Health Benefits Exchange (the director) is responsible for establishing and administering the program, consistent with federal law.

Definitions (for clarity)

  • Defines terms such as affordability program, board, commissioner, exchange, premium credits, premium assistance, cost-sharing subsidies, household income, and program fund.
  • Incorporates federal concepts (e.g., premium tax credits under 26 U.S.C. § 36B) and aligns with state administration.

Program design and funding (42-157.2-3 to 42-157.2-5)

  • The director, with board recommendations, may implement affordability programs and make direct payments to carriers to reduce costs and improve actuarial value for eligible state subsidies.
  • The director must seek and collaborate on external/federal funding sources (e.g., Medicaid waivers: 1115, 1332, or other authorities) to support the program.
  • The program may work in tandem with federal premium tax credits to reduce costs for eligible enrollees.

Program fund and financial framework (42-157.2-4)

  • Creates a dedicated appropriation in the state General Fund: “health insurance individual market affordability appropriation.”
  • Funding rules:
    • If federal premium tax credits remain at or above the original ACA levels, the General Assembly must appropriate sufficient funds so that total monthly premium assistance (state + federal credits) achieves specified affordability targets by income tier.
    • If federal credits are less generous than ACA's original amount, the General Assembly must provide at least $59,300,000 in total funding.
    • An additional appropriation may be provided for ongoing administrative costs.
  • Annual reporting: The exchange must provide an annual program and cost report by Feb 1 each year.

Use of funds and programs (42-157.2-5)

  • Potential uses of the program fund include: 1) State supplemental premium assistance to reduce enrollees’ out-of-pocket premium costs (for those receiving federal credits). 2) State premium assistance for enrollees who are above the federal income limit for federal credits. 3) Cost-sharing subsidies to reduce out-of-pocket costs for eligible individuals. 4) Coverage of actual administrative costs necessary to implement and operate the program (board costs, assessment administration, analyses, and other related costs).
  • The director, guided by board recommendations, determines the allocation of funds to optimize affordability.

Governance and oversight (42-157.2-6 to 42-157.2-7)

  • A broad Exchange Advisory Board (14 voting members) provides guidance:
    • Ex officio: Director, Commissioner of the Office of the Health Insurance Commissioner, and Secretary of the Executive Office of Health and Human Services (or designees).
    • Additional appointments (11) include carriers, healthcare providers (including a primary care and a pediatric representative), healthcare advocacy organizations, a business representative, a hospital representative, and two consumer health care users not affiliated with providers or insurers.
  • The board can recommend program design and parameters, including income limits, funding allocation between premium assistance and cost-sharing subsidies, and methods to improve coverage availability and comprehensiveness.
  • The board’s initial recommendations should consider prior state work (e.g., the “Coverage at Risk” report).
  • The director may promulgate rules and regulations, with reasons for deviations from board recommendations documented in writing.

Administrative and regulatory alignment

  • The existing Rhode Island Health Benefit Exchange framework is amended to incorporate the new affordability program and its governance.
  • The act emphasizes coordination with federal law and state authorities to maximize funding opportunities.

Effective date

  • The act takes effect upon passage.

3) Who and what is affected

  • Rhode Island residents enrolled in health insurance through the Rhode Island Health Benefits Exchange (the individual market) are the primary beneficiaries.
  • Carriers offering plans on the exchange may receive state supplemental premium payments to reduce enrollees’ costs.
  • Consumers, healthcare providers, and advocacy groups may participate indirectly via the Exchange Advisory Board.
  • State agencies (Executive Office of Health and Human Services, Medicaid program, Department of Administration, Office of the Health Insurance Commissioner) are involved in implementation and potential waivers/funding arrangements (1115 waivers, 1332 waivers, etc.).

4) Procedural and timeline aspects

  • Referred to Senate Health & Human Services upon introduction (Jan 23, 2026).
  • Scheduled hearing and/or consideration noted (May 5, 2026).
  • Annual reporting due by February 1 each year.
  • Effective date: upon passage.

This bill aims to bolster health insurance affordability on Rhode Island’s individual market by creating a state-funded program that supplements federal credits, allows for cost-sharing subsidies, and integrates with existing exchange governance and potential federal waivers or external funding sources.

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

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