10/16/2026
Effective January 1, 2027, Medicare members must meet all CMS eligibility criteria to qualify for SSBCI benefits. Eligibility will not be based solely on a chronic condition diagnosis, and enrollment in a C-SNP plan does not automatically qualify a member for SSBCI benefits.
As outlined by CMS under Section 1852(a)(3)(D)(ii), an eligible member must meet all the following criteria:
Have one or more medically complex chronic conditions that are life-threatening or significantly limit overall health or functional status;
Be at high risk for hospitalization or other adverse health outcomes; and
Require intensive care coordination.
All eligibility requirements must be met for a member to qualify for SSBCI benefits. Members who do not satisfy all CMS criteria will not be eligible