Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.7 - Eligibility and Special Rules on the Advanced Payments of the Premium Tax Credit and Cost Sharing Reductions

Current through June 14, 2024
A. Advanced
				 Payments of the Premium Tax Credit
1. In
				 General - §1401 of the ACA creates a new §36B of the Internal
				 Revenue Code (the Code, U.S.C. Title 26), which provides for a premium tax
				 credit for eligible individuals who enroll in a QHP through an Exchange. §1402 of the ACA establishes provisions aimed at reducing the cost-sharing
				 obligations of certain eligible individuals enrolled in a QHP offered through
				 an Exchange, including standards for determining Indians eligible for certain
				 categories of cost-sharing reductions. The ACA and its implementing
				 regulations, found in  45 C.F.R. §
												155.305, incorporated above at §
											1.3     of this Part, authorize the Exchange to determine qualified individuals'
				 eligibility for advance payments of the premium tax credits. In order to
				 qualify for advance payments of the premium tax credits, an applicant must meet
				 both the eligibility requirements to enroll in a Qualified Health Plan as
				 described at §
											1.5     of this Part and the eligibility requirements for the
				 advance payment of premium tax credits as described in this section and  45 C.F.R. §
												155.305, incorporated above at §
											1.3     of this Part. An
				 applicant determined eligible for a premium assistance amount may elect not to
				 take the full monthly premium assistance amount for which he or she is
				 determined eligible. The amount of the premium tax credit the applicant should
				 have received over the course of the Benefit Year will be reconciled when the
				 applicant files a tax return for that year.
2. Eligibility for Advance Payments of the
				 Premium Tax Credit - The Exchange shall find an applicant eligible for advance
				 payments of the premium tax credit if the Exchange determines that he or she
				 meets the criteria in  45 C.F.R. §
												155.305, incorporated above at §
											1.3     of this Part, including the following:
a.
				 He or she is expected to have a household income, as defined in the Internal
				 Revenue Code,  26 U.S.C. §
													36B(d)(2), of greater than or equal to one
				 hundred percent (100%) of the FPL and less than four hundred percent (400%) of
				 the FPL for the Benefit Year for which coverage is requested; and
b. He or she plans to file a Federal tax
				 return, and, if married, to file a joint return, for the Benefit
				 Year;
c. He or she may not be
				 claimed by another tax filer as a tax dependent under the Internal Revenue
				 Code,  26 U.S.C. §
													151.
3. Individuals for Whom a Premium Assistance
				 Amount Can be Provided - An applicant will be eligible for a premium assistance
				 amount only for a month that one (1) or more members of the tax filer's family
				 (the tax filer or the tax filer's spouse or tax dependent) meet the following
				 criteria:
a. Are enrolled in one (1) or more
				 QHPs; and
b. Are not eligible for
				 minimum essential coverage as defined in  26 C.F.R. §
													1.36B-2(c),
				 incorporated above at §
												1.3     of this Part, other than individual market
				 coverage described in the Internal Revenue Code,  26 U.S.C. §
													5000A(f)(1)(C).
4.
				 Special Rule for Non-Citizens Who are Lawfully Present Immigrants and Who Are
				 Ineligible for Medicaid by Reason of Immigration Status - In accordance with  45 C.F.R. §
												155.305(f)(2), incorporated above at §
											1.3     of this Part,
				 lawfully present immigrants who are ineligible for Medicaid based on
				 immigration status and whose household income is below one hundred percent
				 (100%) of the FPL shall be eligible for an APTC if they meet all other
				 eligibility requirements for advance payments of the premium tax
				 credit.
5. Calculation of Advance
				 Payments of the Premium Tax Credit - The Exchange shall calculate any
				 applicant's advance payment of the premium tax credit in accordance with the
				 requirements of  26 C.F.R. §
												1.36B-3, incorporated above at §
											1.3     of
				 this Part.
6. Appeals - An
				 applicant has the right to an appeal of an eligibility determination based on
				 this section and pursuant to the appeals process as described in §
											1.14     of
				 this Part and as set forth in 210-RICR- 10-05-2, Appeals Process and Procedures
				 for EOHHS Agencies and Programs, if applicable.