AN ACT RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL MARKET AFFORDABILITY ACT OF 2026 (Enacts the RI individual market affordability act of 2026 to establish a program to help reduce out-of-pocket costs for low- and moderate-income consumers enrolled in individual health insurance coverage through the RI health benefits exchange.)

S2255

2026 -- S 2255
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LC004164
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
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A N A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL
MARKET AFFORDABILITY ACT OF 2026

Introduced By:
Senators Lauria, Valverde, Kallman, Murray, Pearson, DiMario, Acosta,
Quezada, Mack, and Euer

Date Introduced:
January 23, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
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SECTION 1. Title 42 of the General Laws entitled "STATE AFFAIRS AND
2
GOVERNMENT" is hereby amended by adding thereto the following chapter:
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CHAPTER 157.2
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RHODE ISLAND INDIVIDUAL MARKET AFFORDABILITY ACT OF 2026
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42-157.2-1. Short title and purpose.
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(a) This chapter shall be known and may be cited as the "Rhode Island Individual Market
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Affordability Act of 2026."
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(b) The purpose of this chapter is to create a state affordability program to reduce out-of-
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pocket costs for low- and moderate-income consumers enrolled in health insurance coverage
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through the Rhode Island health benefits exchange.
11

42-157.2-2. Definitions.
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As used in this chapter:
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(1) "Affordability program" means a program to improve affordability for health care or
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health insurance coverage as set forth in § 42-157.2-5.
15

(2) "Board" means the exchange advisory board established by § 42-157-7.
16

(3) "Commissioner'' means the commissioner of the office of the health insurance
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commissioner.
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(4) "Cost-sharing reduction" means the program set forth in 42 U.S.C. § 18071 by which

1
certain individuals eligible to purchase health insurance coverage through the exchange are entitled
2
to purchase a plan with an adjusted actuarial value to lower out-of-pocket expenses.
3

(5) "Director" means the director of the Rhode Island health benefits exchange.
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(6) "Exchange" means the Rhode Island health benefits exchange established within the
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department of administration by § 42-157-1.
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(7) "Federal poverty line" has the same meaning as "poverty line" as set forth in 42 U.S.C.
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§ 9902(2).
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(8) "Health insurance carrier" or "carrier'' has the same meaning as set forth in § 27-18.5-
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2.
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(9) "Health insurance coverage" has the same meaning as set forth in § 27-18.5-2.
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(10) "Household income" has the same meaning as set forth in 26 U.S.C. § 36B(d)(2) in
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effect as of January 1, 2026.
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(11) "Individual market" has the same meaning as set forth in § 27-18.5-2.
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(12) "Office of the health insurance commissioner" means the entity established by § 42-
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14.5-1 within the department of business regulation.
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(13) "Original ACA premium assistance amount" means the collective amount of premium
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assistance provided by the federal premium tax credits utilizing the applicable percentages of
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household income established in the version of 26 U.S.C. § 36B(b)(3)(A)(i) in effect on July 3,
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2025.
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(14) "Premium assistance credit amount" has the same meaning as set forth in 26 U.S.C. §
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36(B)(b)(1), effective January 1, 2026.
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(15) "Premium tax credit" means the refundable tax credit available, pursuant to federal
23
law, to assist certain individuals in purchasing health insurance coverage through the exchange.
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(16) "Program" means the individual market affordability program established by § 42-
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157.2-3.
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(17) "Program fund" or "fund" means the fund established by § 42-157.2-4.
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(18) "State" means the State of Rhode Island.
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42-157.2-3. Establishment of the Rhode Island individual market affordability
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program.
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(a) The director is authorized to establish a state-based affordability program, to be known
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as the "Rhode Island individual market affordability program":
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(1) To provide for improved affordability for individuals who purchase health insurance
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coverage through the exchange; and
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(2) That is consistent with state and federal law.

LC004164 - Page 2 of 7
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(b) The program is intended to mitigate the impact of high and rising healthcare costs for
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low- and middle-income Rhode Islanders who purchase health insurance coverage through the
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exchange by reducing out-of-pocket costs through expanded affordability programs.
4

(c) The director is authorized, based on recommendations advanced by the board, to
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implement affordability programs and direct payment to carriers to reduce the cost of health
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insurance coverage purchased through the exchange, and to improve the actuarial value of health
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insurance coverage, for individuals determined eligible for state-based subsidies.
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(d) In addition to the funding contribution established by § 42-157.2-4, the director, in
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consultation with the commissioner, the secretary of the executive office of health and human
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services, and the Medicaid director, shall collaborate to identify any federal or other external
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sources of funding for the program, including funding available through the state's existing section
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1115 Medicaid demonstration waiver, the state's existing section 1332 state innovation waiver, or
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new funding available under those authorities or any other authority.
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(1) The director is authorized to apply for and obtain any available identified funding for
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the program.
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(2) The secretary of the executive office of health and human services is authorized to apply
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for, submit, and negotiate any necessary changes to the Medicaid state plan, the state section 1115
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Medicaid demonstration waiver, or any other necessary authorities in order to facilitate the
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obtaining of identified funding for the program.
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42-157.2-4. Establishment of program fund.
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(a) There is created a state general fund appropriation to be known as the "health insurance
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individual market affordability appropriation."
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(b) In establishing the size of the health insurance individual market affordability
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appropriation:
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(1) As long as federal premium tax credits remain in place that are no less generous than
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the original ACA premium assistance amount defined at § 42-157.2-2(14), the general assembly,
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based on any estimates provided by the director in coordination with the work of the board, shall
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appropriate sufficient general revenue to create, in combination with any other sources of funding
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identified to support the program, a total funding amount equal to the amount necessary to provide
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state premium assistance payments on behalf of enrollees which shall provide a total monthly
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premium assistance payments on behalf of enrollees which shall provide a total monthly premium
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assistance amount for each enrollee, including both federal premium tax credits and state premium
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assistance payments, which achieves an applicable percentage utilizing the following income tier
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table in lieu of the income table established in 26 U.S.C. § 36B(b)(3)(A)(i):

LC004164 - Page 3 of 7
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In the case of household income

The initial premium

The final premium
2
(expressed as a percent of the

percentage is:

percentage is:
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Federal Poverty Line) within
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the following income tier:
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Up to 150.0 percent

0.0

0.0
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150.0 percent up to 200.0 percent

0.0

2.0
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200.0 percent up to 250.0 percent

2.0

4.0
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250.0 percent up to 300.0 percent

4.0

6.0
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300.0 percent up to 400.0 percent

6.0

8.5
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400.0 percent and higher

8.5

8.5
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(2) If the federal premium tax credits in place are less generous than would have existed
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under the original ACA premium assistance amount defined at § 42-157.2-2(14), the general
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assembly shall appropriate sufficient general revenue to create, in combination with any other
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sources of funding identified to support the program, a total funding amount no lower than fifty-
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nine million three hundred thousand dollars ($59,300,000).
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(3) The general assembly shall provide a further appropriation, as needed, to support the
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total administrative costs of the program as provided by § 42-157.2-5(a)(4).
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(c) The funds appropriated under this section may be utilized by the exchange pursuant to
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the process established by § 42-157.2-5.
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(d) The exchange shall submit to the general assembly an annual report on the program and
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costs related to the program, on or before February 1 of each year.
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42-157.2-5. Utilization of program fund -- Affordability programs.
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(a) The director shall allocate the program fund, pursuant to regulations adopted under this
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chapter for any of the following state affordability programs, individually or in combination:
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(1) To provide payments on behalf of individual enrollees to carriers in the form of
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supplemental state premium assistance payments, to increase the affordability of health insurance
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on the individual market by reducing out-of-pocket premium expenses, for individuals who receive
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federal premium tax credits;
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(2) To provide payments on behalf of individual enrollees to carriers in the form of state
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premium assistance payments, to increase the affordability of health insurance on the individual
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market by reducing out-of-pocket premium expenses, for individuals who are over the household
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income limit, as established by federal law, for federal premium tax credits;
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(3) To provide subsidies to reduce cost sharing for individuals enrolled in health insurance
34
coverage through the exchange who are determined eligible for state subsidies; and

LC004164 - Page 4 of 7
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(4) To pay for the actual administrative costs for implementing and administering the
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program established under this chapter. These actual administrative costs include the following:
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(i) The costs of the board related to their activities under § 42-157.2-6;
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(ii) The actual costs related to implementing and maintaining the assessment established
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by § 42-157.2-4;
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(iii) The costs for conducting analyses necessary to determine the payments to be made to
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carriers for the purposes described in subsections (a)(1), (a)(2), and (a)(3) of this section; and
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(iv) Any other costs which accrue to the state traceable to the operation of this program.
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(v) The program fund shall be allocated as the director, pursuant to recommendations
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established by the board, determines is in the best interest of advancing consumer affordability.
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42-157.2-6. Board recommendations for program design.
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(a) The board is authorized to recommend, for approval and establishment by the director
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by rule or regulation:
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(1) The appropriate allocation of program funds toward premium assistance payments
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under §§ 42-157.2-5(a)(1) and (a)(2) and for cost-sharing subsidies under § 42-157.2-5(a)(3) in a
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manner that best improves affordability for individual marketplace enrollees; and
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(2) The parameters, including income limits, for implementing the program and for
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identifying subsidized populations, including the appropriate balance between affordability
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programs and the most effective method to improve the availability and comprehensiveness of
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coverage to serve the goal of improved consumer access to care across all populations.
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(b) In formulating its initial recommendations, the board shall consider the
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recommendations advanced by the Marketplace Coverage Affordability Work Group and
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summarized in the report delivered to the general assembly entitled “Coverage at Risk: State
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Actions to Keep Rhode Islanders Covered.”
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42-157.2-7. Rules and regulations.
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(a) The director may promulgate rules and regulations as necessary to implement the
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purposes of this chapter.
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(b) In establishing regulations relating to the parameters of the program, the director shall
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consider the recommendations of the board and shall explain in writing the reasons for any
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deviation from the recommendations of the board.
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SECTION 4. Section 42-157-7 of the General Laws in Chapter 42-157 entitled "Rhode
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Island Health Benefit Exchange" is hereby amended to read as follows:
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42-157-7. Exchange advisory board.
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(a)
The exchange shall maintain an advisory board
which shall be appointed by the director
.

LC004164 - Page 5 of 7
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(b)
The
director shall consider the expertise of the members of the board and make
2
appointments so that the board’s composition reflects a range and diversity of skills, backgrounds,
3
and stakeholder perspectives

board shall consist of the following fourteen (14) voting members:
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(1) The director of the exchange or designee;
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(2) The commissioner of the office of the health insurance commissioner or designee;
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(3) The secretary of the executive office of health and human services or designee;
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(4) Eleven (11) additional members appointed by the director of the exchange as follows:
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(i) Two (2) members employed by health insurance carriers that offer plans on the
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exchange;
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(ii) Three (3) members representing healthcare providers who do not represent a health
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insurance carrier, including at least one member representing a primary care healthcare provider
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and one member representing a pediatric healthcare provider;
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(iii) Two (2) members who represent healthcare advocacy organizations;
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(iv) One member who is a representative of a business that purchases or otherwise provides
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health insurance coverage for its employees;
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(v) One member who represents a hospital; and
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(vi) Two (2) members who are consumers of health care who are not representatives or
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employees of a hospital, health insurance carrier, or other healthcare industry entity.
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(c) To the extent possible the director shall ensure that the consumer members of the board
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are individuals who lack affordable offers of coverage from their employers and who otherwise
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struggle to afford to purchase health insurance or who struggle to afford to pay for their health care
.
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SECTION 5. This act shall take effect upon passage.
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LC004164
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LC004164 - Page 6 of 7
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL
MARKET AFFORDABILITY ACT OF 2026
***
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This act would enact the Rhode Island individual market affordability act of 2026 to
2
establish a program to help reduce out-of-pocket costs for low- and moderate-income consumers
3
enrolled in individual health insurance coverage through the Rhode Island health benefits exchange.
4
This act would take effect upon passage.
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LC004164
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LC004164 - Page 7 of 7