Does your agency have to file with Rhode Island?
Rhode Island requires entities that provide minimum essential coverage to Rhode Island residents to report it to the Rhode Island Division of Taxation. In practice that means:
| Your situation | Who files | What gets filed |
|---|---|---|
| Fully insured group plan | The carrier | You file nothing with Rhode Island; keep the carrier's confirmation |
| Self-insured or level-funded plan | You, the employer | Coverage statements to RI-resident employees by March 2; the same 1095-B/C data uploaded to the Division of Taxation by March 31 |
| Out-of-state agency with RI-resident caregivers on a self-insured plan | You, the employer | Rhode Island applies the requirement to all employers, in-state or out-of-state, that provide coverage to RI residents |
| No plan offered | No one | Nothing to file with Rhode Island (but see the employer mandate below) |
The federal forms satisfy Rhode Island; there is no separate state form. The Division provides an upload portal for the files.
Rhode Island deadlines and penalties
| Date | Obligation | Applies to | Penalty |
|---|---|---|---|
| March 2 | Furnish 1095-B/C statements to covered RI residents | Self-insured employers; carriers | No fixed penalty; failures reviewed case by case by the Division of Taxation |
| March 31 | File coverage returns with the RI Division of Taxation | Self-insured employers; carriers | No fixed penalty; failures reviewed case by case |
Rhode Island's reporting FAQ says penalties for failure to furnish or file are reviewed on a case-by-case basis rather than assessed at a published rate, so the exposure is enforcement and audit risk rather than a dollar amount you can budget for. The furnish date matches the federal 1095-C date, so one statement run covers both obligations.
Is your agency an Applicable Large Employer?
Count full-time employees (30+ hours a week or 130+ a month) and add full-time equivalents from everyone else: total part-time hours in the month ÷ 120. Average the monthly totals over the prior calendar year.
Worked example. A Rhode Island agency has 42 caregivers and office staff at 130+ hours a month, plus 20 part-time caregivers averaging 54 hours a month.
- Full-time employees: 42
- Part-time FTEs: 20 × 54 = 1,080 hours ÷ 120 = 9
- Total: 51 → the agency is an ALE.
Two home care specifics. Entities under common ownership are combined under the controlled-group rules, so multiple agency LLCs or franchise territories with the same owners count as one employer. And caregivers with variable hours can be classified using the IRS look-back measurement method (a 3–12 month measurement period followed by a stability period), which is how most agencies decide who must be offered coverage without re-running the math every month.
What an ALE owes if it doesn't comply (2026 amounts)
- 4980H(a), no offer: if you don't offer minimum essential coverage to at least 95% of full-time employees and any one of them gets a subsidy on HealthSource RI, you owe $3,340 per full-time employee minus the first 30. In the example above: (42 − 30) × $3,340 = $40,080 a year, triggered by a single subsidized caregiver.
- 4980H(b), unaffordable offer: if you offer coverage that's unaffordable or below minimum value, you owe $5,010 for each full-time employee who enrolls in a subsidized marketplace plan.
Which Rhode Island caregivers can actually trigger a penalty
Penalties are only triggered when a full-time employee actually receives a premium tax credit on the marketplace. Who can get one depends on income:
| Caregiver household income | Can they get a marketplace subsidy? | Can they trigger a penalty for you? |
|---|---|---|
| Below 138% FPL | No. Rhode Island expanded Medicaid, so adults to 138% FPL qualify for Medicaid and cannot receive a marketplace credit | No |
| 138%–400% FPL | Yes | Yes — each one is a potential $5,010 (b) trigger, or the single trigger for the (a) penalty |
| Above 400% FPL | Generally no in 2026, now that the enhanced credits have expired | No |
Rhode Island expanded Medicaid; adults to 138% FPL qualify. kff.org ↗
Rhode Island runs its own exchange, HealthSource RI. healthsourceri.com ↗
What counts as "affordable" for a Rhode Island caregiver in 2026
Coverage is affordable if the caregiver's self-only contribution is no more than 9.96% of household income. Since you can't know household income, the IRS provides three safe harbors:
| Safe harbor | How it's calculated | 2026 monthly ceiling for a Rhode Island caregiver |
|---|---|---|
| Federal poverty line | FPL × 9.96% ÷ 12 | $129.89 regardless of wage |
| Rate of pay | Lowest hourly rate × 130 hours × 9.96% | $207.17 at the $16.00 minimum |
| W-2 wages | 9.96% of Box 1 wages | Varies; known only after year-end |
The Rhode Island-specific point: because the state minimum wage is $16.00, the rate-of-pay safe harbor gives Rhode Island agencies far more room than the $129.89 FPL figure most national guides quote. An agency paying $16.00 can charge up to $207.17 a month for self-only coverage and still be safe from the (b) penalty. Use each caregiver's actual lowest hourly rate; where local minimums are higher, the ceiling is higher still.
A CHOICE (formerly known as ICHRA) counts as an offer of coverage. It's affordable if the caregiver's cost for the lowest-cost self-only silver plan on HealthSource RI for their rating area, minus your monthly allowance, stays within the 9.96% test.
IRS Rev. Proc. 2025-25 ↗ · IRS HRAs ↗ · minimum wage → see the Rhode Island wage & hour page
2026 compliance calendar: Rhode Island and federal together
| Date | Obligation | Who | Authority |
|---|---|---|---|
| Ongoing | Track caregiver hours under your measurement/stability periods | ALEs | IRS |
| Mar 2, 2026 | Furnish Form 1095-C to full-time employees, or post a website notice and furnish within 30 days on request | ALEs | IRS |
| Mar 31, 2026 | E-file Forms 1094-C/1095-C with the IRS (e-filing required at 10+ returns) | ALEs | IRS |
| Mar 2, 2026 | Furnish RI coverage statements | Self-insured employers; carriers | RI Division of Taxation |
| Mar 31, 2026 | File coverage returns with RI Division of Taxation | Self-insured employers; carriers | RI Division of Taxation |
The Rhode Island rows apply to self-insured/level-funded sponsors (and to every employer for any item marked as such above); the IRS rows apply to ALEs. If you also employ caregivers who live in other reporting states under a self-insured plan, see the state-by-state ACA hub.
Other Rhode Island benefit mandates that touch home care agencies
These aren't ACA rules, but they land on the same desk.
- TDI + Temporary Caregiver Insurance. Rhode Island TDI (the nation's oldest, employee-funded at 1.1% of wages in 2026 - down from 1.3% in 2025 - up to a $100,000 taxable wage base) includes Temporary Caregiver Insurance, which expanded to 8 weeks of paid family leave beginning 2026. dlt.ri.gov ↗
- RISavers auto-IRA. RI Secure Choice (RISavers) opened October 21, 2025 in partnership with Connecticut's program; employers with 100+ employees must register by October 21, 2026, phasing down to 5+ employees by October 2028. treasury.ri.gov ↗
Frequently asked questions
Our plan is fully insured. Do we file with Rhode Island?
No. The carrier files for insured plans. Keep the carrier's confirmation.
Does Rhode Island reporting apply to agencies based in Massachusetts or Connecticut with RI caregivers?
Yes, if you provide coverage to Rhode Island residents. The Division of Taxation applies the requirement to out-of-state employers as well as in-state ones.
Is there a Rhode Island penalty for missing the deadline?
Not a fixed one. The Division of Taxation's FAQ says failures to furnish or file are reviewed case by case.
We have 48 full-time caregivers and a handful of part-timers. Are we under the threshold?
Probably not. Add the part-timers' monthly hours and divide by 120. Two part-timers at 120 hours a month between them add one FTE, which puts you at 49; a third pushes you to 50 and ALE status the following year.
Can a caregiver on Medicaid trigger a penalty against us?
No. Penalties are triggered only by full-time employees who receive a marketplace premium tax credit. Rhode Island caregivers below 138% FPL qualify for Medicaid instead, so they can't trigger 4980H. Caregivers between 138% and 400% FPL can.
We pay the Rhode Island minimum of $16.00. What's the most we can charge for self-only coverage?
Under the rate-of-pay safe harbor, $16.00 × 130 hours × 9.96% = $207.17 a month in 2026. That's well above the $129.89 FPL figure, so rate of pay is the better harbor for Rhode Island agencies.
Not legal advice. Confirm details with the cited official sources or counsel. Full disclaimer
- https://dlt.ri.gov/individuals/temporary-disability-caregiver-insurance
- https://healthsourceri.com
- https://tax.ri.gov/guidance/health-coverage-mandate
- https://tax.ri.gov/guidance/health-insurance-mandate
- https://tax.ri.gov/sites/g/files/xkgbur541/files/healthcoveragemandate/IndividualMandate_ReportingRequirements_FAQ.pdf
- https://treasury.ri.gov/risavers/employers-faqs
- https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees
- https://www.irs.gov/affordable-care-act/employers/information-reporting-by-applicable-large-employers
- https://www.irs.gov/newsroom/health-reimbursement-arrangements-hras
- https://www.irs.gov/pub/irs-drop/rp-25-25.pdf
- https://www.irs.gov/pub/irs-drop/rp-25-26.pdf
- https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/