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210-RICR-30-05-3 TITLE 210 – EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES CHAPTER 30 – MEDICAID FOR CHILDREN, FAMILIES, AND AFFORDABLE CARE ACT (ACA) ADULTS SUBCHAPTER 05 – SERVICE DELIVERY OPTIONS PART 3 – RIte Share Premium Assistance Program 3.1 Overview / Legal Authority A. This Part is promulgated pursuant to Federal authorities as follows: 1. Federal Law: § 701(f)(3) of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1181(f)(3); § 1115 of the Social Security Act, 42 U.S.C. § 1315; Title XIX of the Social Security Act, 42 U.S.C §§ 1396a-1396w-8; Title XXI of the Social Security Act, 42 U.S.C. §§ 1397aa- 1397mm; 42 U.S.C. § 1396k 2. The Medicaid State Plan and the Section 1115 Demonstration Wavier granted pursuant to § 1115 of the Social Security Act, 42 U.S.C. § 1315 B. Applicable State authority is derived from R.I. Gen. Laws Chapters 40-6, 42-7.2, 40-8, 40-8.4, 40-8.12, and 42-12.3. 3.2 Scope and Purpose A. This Part applies to individuals determined to be Medicaid-eligible under Chapter 30 of this Title. If these individuals have access to employer sponsored insurance (ESI) and the employed person works thirty (30) or more hours per week, EOHHS must conduct a review of the coverage to determine if the benefits are comparable to Medicaid benefits and if the cost of the ESI is less expensive than Medicaid managed care (in the aggregate). When ESI is found to be cost- effective, the State will pay the employee’s premium for that coverage as well as wrap-around costs such as deductibles, co-insurance, etc. B. The purpose of this rule is to set forth the provisions governing participation in the RIte Share Program, the Buy-in requirement, and the process for determining whether an ESI plan meets the cost-effectiveness criteria established by EOHHS, the Medicaid agency. The rule also identifies the respective roles and responsibilities of Medicaid-eligible individuals and the Medicaid agency.