AN ACT TO AMEND TITLE 16, TITLE 18, TITLE 29, AND TITLE 31 OF THE DELAWARE CODE, AND CHAPTER 237, VOLUME 83 OF THE LAWS OF DELAWARE, RELATING TO PRIMARY CARE SERVICES.
Sponsored By: Bryan Townsend (Democratic)
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Bill Overview
Analyzed Economic Effects
9 provisions identified: 7 benefits, 1 costs, 1 mixed.
Patients gain rules limiting health costs
By January 1, 2029, Delaware’s Office of Value-Based Health Care Delivery must adopt rules limiting covered patients’ financial responsibility. The limits apply to covered services subject to the law’s service-payment rate filing requirements. The law does not set dollar limits or state how much patients save.
State employees get health billing protections
Beginning in fiscal year 2029, Delaware’s state employee health plan caps service payments at 250% of comparable Medicare rates. Members owe only plan copayments, coinsurance, and deductibles, based on the insurer’s allowed payment. Providers cannot bill members above that allowed payment. When Medicare has no comparable rate, the State Employee Benefits Committee determines a rate based on similar Medicare services. The reimbursement rules exclude insurer-provider arrangements participating in an approved federal or state global budget model.
Delaware strengthens health care program oversight
The Office can collect data from insurers, providers, and groups contracting for Delaware-licensed clinicians with commercial insurers or government payers. It must set standard measures and assessment methods, and report compliance and annual quality, efficiency, and patient-experience results. The Health Care Commission works with the Primary Care Reform Collaborative to monitor providers’ use of and compliance with care models. Disclosing information does not waive an applicable legal privilege or confidentiality claim. The Insurance Commissioner can still use that information in official regulatory or legal actions.
Insurance penalties support primary care reforms
Penalties for specified primary care and payment-rule violations cannot exceed the monetary value tied to the violation. Those penalties go into a new Primary Care Fund. With annual legislative appropriations, the Statewide Benefits Office and Medicaid agency can use the money to support specified reforms. The fund can retain up to $5 million in uncommitted money at fiscal year-end. Any excess transfers to the state’s OPEB Fund for other post-employment benefits.
Insurers must fund more primary care
Beginning in 2026, commercial insurers must spend at least 11.5% of total medical costs on primary care, including 5% through advance care-management payments. The Office must set mandatory minimums for payment innovations and design care programs that increase provider accountability and access to investment. Insurers must offer required programs and cannot exclude contracted providers who accept standard program terms. The law removes the scheduled January 1, 2027 expiration of specified primary care requirements. The Department of Insurance must adopt implementing regulations within 18 months of enactment.
Medicaid plans invest in primary care
Covered Medicaid-related health plans must raise primary care spending by 1% in the third year from the higher of the prior two plan years. They must continue annual 1% increases until reaching 11.5% of total medical costs, then maintain at least 11.5%. Delaware’s Medicaid agency sets the compliance method, following the Office’s rules as far as feasible. These plans must also offer value-based care programs set by contract with the Medicaid agency. The law does not set an individual payment or savings amount.
State employee plans invest in primary care
In plan year 2029, Delaware’s state employee health plan must raise primary care spending by 1% from the higher of 2027 or 2028 levels. It must keep raising spending by 1% annually until reaching 11.5% of total medical costs, then maintain at least 11.5%. The plan’s insurer must also offer value-based care programs equivalent to those required for commercial insurers. Certain high-cost claims can be excluded from spending calculations only with State Employee Benefits Committee approval. Reports for plan years 2027 and 2028 are due July 1 following each year.
Larger insurers face care payment targets
The rules cover commercial insurers operating in Delaware for the last two years with more than 5,000 fully insured members. Their rate filings must tie at least 50% of total care costs to alternative payment contracts in Categories 3 or 4. At least 15% must use Category 3B contracts, which include risk of losses, or Category 4 contracts. Each target can fall to the highest percentage supported by actuarial credibility rules. Approved federal or state global budget arrangements are exempt, and the Department must publish approved models annually.
Health plans face new payment ceilings
Through 2027, covered rate filings cap aggregate nonprofessional service price growth at the greater of 2% or Core CPI plus 1 percentage point. The Commissioner sets Core CPI annually by March 31 using specified bimonthly measures. For filings in 2028 and later, service payments cannot exceed 250% of comparable Medicare rates. Without a comparable rate, filings must propose a rate based on similar Medicare services, under regulations. The Medicare-based ceiling excludes insurer-provider arrangements participating in an approved federal or state global budget model.
Sponsors & Cosponsors
Sponsor
Bryan Townsend
Democratic • Senate
Cosponsors
Nnamdi O. Chukwuocha
Democratic • House
S. Elizabeth Lockman
Democratic • Senate
Ray Seigfried
Democratic • Senate
David P. Sokola
Democratic • Senate
Madinah Wilson-Anton
Democratic • House
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
SS 2 for SB 1 - Signed by Governor
7/20/2026GovernorSS 2 for SB 1 - Passed By House. Votes: 41 YES
7/1/2026HouseSS 2 for SB 1 - Reported Out of Committee (Appropriations) in House with 6 On Its Merits
6/23/2026HouseSS 2 for SB 1 - Assigned to Appropriations Committee in House
6/18/2026HouseSS 2 for SB 1 - Reported Out of Committee (Administration) in House with 5 On Its Merits
6/17/2026HouseSS 2 for SB 1 - Assigned to Administration Committee in House
5/20/2026HouseSS 2 for SB 1 - Passed By Senate. Votes: 21 YES
5/19/2026SenateSubstituted in Senate by SS 2 for SB 1
5/18/2026SenateSubstituted in Senate by SS 1 for SB 1
5/14/2026SenateReported Out of Committee (Finance) in Senate with 3 On Its Merits, 1 Unfavorable
4/14/2026SenateAssigned to Finance Committee in Senate
3/18/2026SenateReported Out of Committee (Health & Social Services) in Senate with 2 Favorable, 5 On Its Merits
3/18/2026SenateIntroduced and Assigned to Health & Social Services Committee in Senate
3/5/2026Senate
Bill Text
Current
3/5/2026
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