Documented chronic condition required by CMS for Medicare SNP benefits

Effective Jan. 1, 2026, new or existing members of UnitedHealthcare Special Needs Plans (SNPs), including C-SNP, D-SNP and IE-SNP,¹ will need a qualifying chronic condition to access benefits that cover healthy food and/or utilities.

The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage plans to validate and document that each eligible SNP member meets several criteria, including having an eligible chronic condition.

The Special Supplemental Benefits for the Chronically Ill (SSBCI) Healthy Food and/or Utility Benefit is designed for individuals with at least one of following chronic conditions²:

Autoimmune disorders
Cancer
Cardiovascular disorders³
Chronic alcohol use disorder and other substance use disorders (SUDs)
Chronic and disabling mental health conditions
Chronic gastrointestinal disease
Chronic heart failure³
Chronic hyperlipidemia
Chronic hypertension
Chronic kidney disease (CKD)
Chronic lung disorders

Conditions associated with cognitive impairment: Alzheimer’s disease, intellectual disability and developmental disabilities, traumatic brain injuries, disabling mental illness associated with cognitive impairment, and mild cognitive impairment
Conditions with functional challenges that require similar services, including the following: spinal cord injuries, paralysis, limb loss, stroke and arthritis
Dementia
Diabetes mellitus³

HIV/AIDS
Immunodeficiency and immunosuppressive disorders
Myasthenia gravis/Myoneural disorders and Guillain-Barre syndrome/Inflammatory and toxic neuropathy
Neurologic disorders
Overweight, obesity and metabolic syndrome
Post-organ transplantation care
Severe hematologic disorders
Stroke

¹Chronic Special Needs Plans (C-SNP), Dual-Eligible Special Needs Plan (D-SNP), Institutional Equivalent Special Needs Plan (IE-SNP).
²All conditions qualify D-SNP members to enroll in SSBCI and receive food and utilities benefits, and for IE-SNP members to enroll in SSBCI and receive food benefits only. List can be found at CMS.gov.
³These conditions qualify C-SNP members to enroll in SSBCI and receive food benefits only.

Requirements

C-SNP

We’ll assess each C-SNP application for SSBCI eligibility upon receipt of the chronic condition verification form, which will be used to document eligibility for both C-SNP plan enrollment and SSBCI. You will not be asked to provide 2 separate verifications.

D-SNP

We’ll assess each D-SNP application for SSBCI eligibility upon receipt of the SSBCI verification form. Documentation of the qualifying condition must include an eligible diagnosis code or provider attestation of the member’s diagnosis.

We’ll review existing documentation to determine if the member qualifies for the program. If we’re unable to confirm eligibility from those materials, we’ll ask you to provide verification of a qualifying diagnosis. This validation can come from the member’s treating provider or their office staff, either verbally or in writing.

IE-SNP

We’ll assess each IE-SNP application for SSBCI eligibility upon receipt of the IE-SNP verification form. The form will be used to document eligibility for both IE-SNP plan enrollment and SSBCI. You will not be asked to provide 2 separate verifications.

If verification is not received within 60 days, the SSBCI benefits will be removed from the member’s plan and we’ll notify them of the benefit status change. We may make continued attempts to document the diagnosis of an eligible condition as SSBCI benefits can be granted at any time.

About SNPs

SNPs offer targeted care to those who are institutionalized individualized, dual-eligible individuals; and/or individuals with specific or disabling chronic conditions.