After nearly seven years, the region was re-established on June 11, 2024, this time with the inclusion of Siquijor, an island province located southeast of Negros that was formerly part of Central Visayas.

This argued that the two provinces "nestle in one common island; have common fowls and beasts in the forest; share the same soil in our plains and mountains; benefit and suffer together from the rivers that snake through our land; and our ancestors roamed the same length and breadth without complications of political, social, economic, religious and lingual obstacles."

[5] At the same time, opposition was voiced by some officials from Negros Oriental who feared that the province would be dominated economically by its larger neighbor and Bacolod.

[8] They also claimed that a one-island region would also result in better coordination between both provinces in tourism, peace and order, environment, development planning, disaster management, and road infrastructure.

Edward Du, president of the Negros Oriental Chamber of Commerce and Industry, also proposed to convert existing offices of national agencies in the provincial capitals of Bacolod and Dumaguete to sub-regional offices during an interim period if the proposal was approved to defray the costs of establishing a new regional center.

Various public officials and representatives from academic, religious, media, and other private sectors aired support for the proposal.

[9][10] Notably, Negros Oriental Governor Roel Degamo was tagged as being initially opposed to the talks, claiming he was not convinced with a one-island region setup and that his constituents were allegedly not in favor of its creation.

[11] He eventually clarified that his original stand as regards the region was being "open" to it and that there were some concerns, such as revenue sharing between the two provinces, that had to be thrashed out first.

[12] President Benigno Aquino III directed the Department of the Interior and Local Government (DILG) to study the establishment of a new region.

[28] The measure was also opposed by the Roman Catholic Diocese of Dumaguete, with Bishop Julito Cortes and eight other senior clergy calling it an "insult" to the people of Negros Oriental and adding that residents of the province as well as Siquijor were not consulted on the matter.

[34] In August 2024, a civil society group from Dumaguete and Siquijor, Negros Oriental led by Reverend Father Hendrix Alar challenged the legality of Republic Act 12000, allegedly based on its lack of public consultations.

It filed with the High Tribunal the petitions for declaratory relief, prohibition, and a temporary restraining order against the creation of the Negros Island Region.

Kanlaon, one of the most active volcanones in the Philippines, is the highest point of Negros Island, with its peak situated at 2,465 meters (8,087 ft) above sea level.

Marine terraces can be found in San Juan, as well as fossils of the giant clam tridacna in the island's plowed inland fields.