SSBCI
Special Supplemental Benefits
for the Chronically Ill
for the Chronically Ill
Additional Flex Card Benefits for Eligible Members
Members enrolled in the MetroPlus Advantage Plan (HMO D-SNP) or MetroPlus UltraCare (HMO D-SNP) may qualify for additional Flex Card benefits through Special Supplemental Benefits for the Chronically Ill (SSBCI)
SSBCI is a Medicare program that offers additional Flex Card benefits to eligible members who have one or more complex chronic conditions, are at high risk for hospitalization or adverse health outcomes and require intensive care coordination. See complete list of conditions here.
The Centers for Medicare and Medicaid Services (CMS) has important rules for offering supplemental flex benefits for the chronically ill who qualify. MetroPlusHealth wants you to know that certain flex benefits, documentation requirements to access flex benefits, and any limitations are based upon CMS rules.
What is the Flex Card?
The Flex Card helps pay for approved products and services that support your patients’ health and well-being.
All members enrolled in the MetroPlus Advantage Plan (HMO D-SNP) and MetroPlus UltraCare (HMO D-SNP) receive a $780 Flex Card allowance each quarter.
Unused funds expire at the end of each quarter and do not roll over.
Qualifications & Benefits
What can your patients use their flex card for?
All MetroPlusAdvantage Plan (HMO D-SNP) and MetroPlus UltraCare (HMO D-SNP) members can use their Flex Card for approved:
- Over-the-counter (OTC) products
- Bathroom safety devices
- Personal Emergency Response System (PERS) services
- Chiropractic visits
Patients who qualify for SSBCI can also use their Flex Card for approved:
- Healthy food and groceries
- Utility bills
- Rent assistance
- Pet supplies
How do patients qualify for SSBCI?
To qualify for SSBCI benefits, they must:
- Have a qualifying chronic health condition.
- Be at high risk for hospitalization or other serious health problems.
- Require intensive care coordination.
Having a chronic condition alone does not automatically qualify a patient for SSBCI benefits.
Which chronic conditions qualify for SSBCI benefits?
Examples of qualifying chronic health conditions include:
- Diabetes
- Heart disease or chronic heart failure
- Chronic kidney disease
- Cancer
- Chronic lung disease
- Stroke
- Dementia
- HIV/AIDS
- Autoimmune disorders
- Certain chronic mental health conditions
Other chronic health conditions also qualify. This list includes examples of qualifying conditions and is not a complete list.
Important Eligibility Information
SSBCI benefits are available only to members who meet all Medicare and MetroPlusHealth eligibility requirements.
Having a chronic condition alone does not automatically qualify a member for SSBCI benefits.
Only members who qualify for SSBCI can use their Flex Card funds for healthy food and groceries, utility bills, rent assistance, and pet supplies.
How does the SSBCI eligibility process work?
If their coverage under the MetroPlus Advantage Plan (HMO D-SNP) or MetroPlus UltraCare (HMO D-SNP) begins on or after January 1, 2027, they will have the opportunity to complete an SSBCI survey during enrollment or can ask their provider to complete an SSBCI Provider Attestation form.
Complete the SSBCI survey during enrollment
- During enrollment, Enrollment Representative will ask if your patient would like to complete the SSBCI survey.
- The survey is submitted to MetroPlusHealth for review.
- MetroPlusHealth reviews the information provided.
- MetroPlusHealth determines whether your patient qualifies for SSBCI benefits.
- MetroPlusHealth will notify your patient of its eligibility determination.
If patient chooses not to complete the survey during enrollment
Patient may ask their primary care provider (PCP) to complete a Provider Attestation Form.
- PCP completes the Provider Attestation Form.
- The form is submitted to MetroPlusHealth for review.
- MetroPlusHealth reviews the information provided.
- MetroPlusHealth determines whether patient qualifies for SSBCI benefits.
- MetroPlusHealth will notify your patient of its eligibility determination.
What happens if patient does not complete the survey?
They will still receive their $780 quarterly Flex Card allowance.
Until MetroPlusHealth makes an SSBCI eligibility determination, their Flex Card can be used for approved:
- Over-the-counter (OTC) products
- Bathroom safety devices
- Personal Emergency Response System (PERS) services
- Chiropractic visits
If patient is later determined eligible for SSBCI, you can also use your Flex Card for approved:
- Healthy food and groceries
- Utility bills
- Rent assistance
- Pet supplies
Patients who are later determined eligible will receive additional correspondence from the MetroPlushealth about this benefit.
If patient is already a member, what do they need to do?
If they are currently enrolled in the MetroPlus Advantage Plan (HMO D-SNP) or MetroPlus UltraCare (HMO D-SNP), they do not need to take any action at this time.
MetroPlusHealth is developing a process to review existing members for SSBCI eligibility. Additional information, including timing and any next steps, will be shared in future member and/or provider communications.