For 2027, CMS has clarified how to interpret the Special Supplemental Benefits for the Chronically Ill (SSBCI) program requirements. SSBCI allows health plans to offer non-medical and non-primarily health-related benefits (like food and utilities benefits) to members who have a qualifying chronic health condition, who are at high risk for hospitalization or adverse health outcomes, and who require intensive care coordination.

The clarification indicates that health plans cannot apply an overarching policy that members who have a chronic condition are inherently at high risk of hospitalization and need care coordination. Other plan verification tools must be used to confirm the member meets these other two components.

For more information, see the “2027 Agent Quick Reference Guide: Special Supplemental Benefits for the Chronically Ill (SSBCI)” on Jarvis.