Over 4 Million MA Beneficiaries Have At-Home Care Access Through Supplemental Benefits


New data relating to Special Supplemental Benefits for the Chronically Ill (SSBCI) has been released. And while there are plenty of kinks to work through before these benefits become a significant revenue driver for home-based care agencies, their increasing popularity is undoubtedly encouraging.

The Centers for Medicare & Medicaid Services (CMS) unveiled a pathway for primarily health-related supplemental benefits to be offered through Medicare Advantage (MA) plans in 2018, then a year later, created the SSBCI pathway.

Uptick in usage for each pathway’s benefits has been slow and steady. Providers can’t reach a consensus on whether the benefits are something everyone in the home-based care space should be following, or if the opportunity that lies within these benefits is meager.

Regardless, certain benefits’ success – namely the in-home support services (IHSS) one – should be welcomed news to agencies across the country. That’s according to Elexa Rallos, a senior analyst at the research and advisory firm ATI Advisory.

“I think the key takeaway, in particular for [home-based care providers], is that in-home support services is really one of the most popular of these newer, non-medical supplemental benefits,” Rallos told Home Health Care News. “They were popular in 2020, but into the third or fourth year that these benefits have been available, they continue to grow fairly rapidly. They’re among the most popular benefits, and the most popular in the primarily health-related grouping.”

The Washington, D.C.-based ATI Advisory analyzed the growth in supplemental benefits in a report released Tuesday.

The IHSS benefit is unique in that it is technically a non-medical benefit, but can be offered through both the primarily health-related pathway as well as SSBCI.

The IHSS benefit’s growth is far outpacing other benefits in the latter pathway. In 2022, 14% of MA plans are offering IHSS, while other benefits are only utilized by 1% to 3% of plans, for instance. Take into account the plans offering IHSS through either pathway, and that number jumps to 18% of all plans, or 952 total plans.

Source: ATI Advisory

“We actually see that in-home support services has 952 plans offering it, which makes it the most common benefit offered, by plan count, of any of these benefits,” Tyler Cromer, principal at ATI Advisory, told HHCN. “And this benefit is still definitely growing, which is, again, great news for beneficiaries and home-based care providers.”

Meanwhile, other SSBCI benefits that home-based care agencies can tackle are also soaring. For instance, the food and produce benefit will be offered by 14% of MA plans this year, or 763 plans overall. Other notable increases include:

– Transportation for non-medical needs, which will be offered by 375 plans

– Meals (beyond a limited basis), which will be offered by 403 plans

– General supports for living, which will be offered by 328 plans, a number that’s grown by almost four times since 2020

The social needs benefit – which includes companionship services and a variety of other offerings – has also grown in popularity since 2020. While just 34 plans offered it then, 244 are offering it in 2022.

Overall, 24% of all MA plans are now offering one or more SSBCI, while 34% are offering at least one benefit through either pathway.

The IHSS benefit, on its own, is now available to more than 4 million MA beneficiaries.

“Over 3 million enrollees are enrolled in a plan offering in-home support services,” Rallos said. “But once you zoom out, and you look at all the available authorities, including Value-Based Insurance Design (VBID) and SSBCI, that number actually expands to over 4 million beneficiaries, which is fairly significant.”

Source: ATI Advisory

Supplemental benefit speed bumps

While the usage of these supplemental benefits is growing among MA plans, the data still paints a somewhat murky picture.

That’s because those plans are not currently reporting how much they – or the beneficiaries – are utilizing these benefits, even when they’re offered.

“We still don’t have any data available on the actual utilization, that data is not required from CMS. So there’s no way for us to access it,” Rallos said.

Dr. Meena Seshamani, deputy administrator at CMS and the director of the Center for Medicare, signaled last week at HHCN’s Capital+Strategy event that that could change soon.

“Some examples of what we proposed recently: We proposed a [requirement] for plans to report the dollars that are being spent on supplemental benefits, so that we can know what is actually being spent on these different supplemental benefits as a first step towards understanding how that is all working,” Seshamani said. “Is the money that’s being spent then leading to better care? Is it leading to better outcomes?”

Those reporting metrics would likely help all parties involved. If the benefits are being utilized – and working – that would likely put plans on notice that they should not only be offering these benefits, but also investing heavily in them.

Another issue with how these benefits are currently being offered is where they are being offered. Generally speaking, the benefits are more likely to be available in urban areas, leaving out rural populations.

To some extent, that could be due to MA plans’ geographies, but is still an area that should be identified for improvement, Rallos said.

Source: ATI Advisory

“These benefits, including in-home support services, are more commonly offered in the urban areas along the coasts, but really in regions and counties where there’s higher MA activity,” she said. “So conversely, a lot of rural regions are less likely to have these offerings available to them.”



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