The "Rhode Island Individual Market Affordability Act of 2025" aims to create a state affordability program to reduce out-of-pocket costs for low- and moderate-income individuals enrolled in health insurance coverage through the Rhode Island health benefits exchange. The bill establishes a new chapter, CHAPTER 157.2, within Title 42 of the General Laws, which includes definitions, the structure of the program, and the creation of a dedicated program fund.

The act authorizes the director of the Rhode Island health benefits exchange to establish the Rhode Island individual market affordability program, which is intended to improve affordability for individuals purchasing health insurance through the exchange. The program will mitigate the impact of high healthcare costs by reducing out-of-pocket expenses through expanded affordability programs. The director, based on recommendations from the newly created Individual Market Affordability Board, will implement these programs and direct payments to health insurance carriers to enhance the affordability of coverage.

The Individual Market Affordability Board will consist of various members, including representatives from health insurance carriers, healthcare providers, and consumers, and will be responsible for issuing recommendations regarding the program's implementation and funding allocation.

The act also establishes a restricted receipt account known as the health insurance individual market affordability account, which will be funded through various sources, including a portion of the healthcare services funding contribution. The funds in this account will be used exclusively for the purposes of the affordability program.

Additionally, the bill amends existing laws regarding indirect cost recoveries on restricted receipt accounts, specifying that the health insurance individual market affordability account shall be exempt from indirect cost recovery provisions. The act emphasizes collaboration with federal programs and other funding sources while ensuring that the state is not obligated to make general revenue appropriations to support the program. The act is set to take effect upon passage.

Statutes affected:
5996: 35-4-27