Wellcare 2027 SSBCI and D-SNP: What Changed
New pathways for D-SNP members to qualify for SSBCI, Wellcare's 2027 D-SNP resources, and where to check D-SNP eligibility now
Your D-SNP clients want to know if they'll get Wellcare's SSBCI benefits, and for 2027 more of them may qualify. But the one thing you still can't do is promise it.
Wellcare has expanded the objective criteria it uses to determine SSBCI eligibility for 2027, released new D-SNP resources, and changed how D-SNP eligibility shows in Ascend.
What's Changing for SSBCI
LIS status can meet the high-risk requirement. For D-SNP members, Low-Income Subsidy status, together with clinical criteria, can now show the member is at high risk of hospitalization or other adverse health outcomes.
D-SNP enrollment can meet the intensive care coordination requirement. D-SNPs operate under a Model of Care that provides a care management and coordination framework.
What Isn't Changing
Members must still meet all three SSBCI requirements: one or more qualifying chronic conditions, a high risk of hospitalization or other adverse health outcomes, and a need for intensive care coordination. LIS status and D-SNP enrollment don't replace the qualifying chronic condition.
What This Means for Your Clients
Wellcare identifies most qualifying members automatically, continuously reviewing claims data, medical records, clinical assessments, and other information.
Wellcare estimates about 97% of members on a plan offering SSBCI will qualify and have access to those benefits.
Provider attestation may still be used for new members without enough claims or clinical information, but submitting one doesn't guarantee eligibility.
Current members will be notified by mail starting mid-October if they're eligible for SSBCI in 2027.
SSBCI eligibility must be revalidated every plan year.
Questions about the updated SSBCI eligibility guidelines can go to your Wellcare regional sales manager.
2027 D-SNP Resources
Wellcare's 2027 D-SNP Enrollment Options Summary covers its 2027 D-SNP footprint, new enrollment alignment requirements affecting certain markets, and additional D-SNP education, FAQs, and election period resources, along with state-specific plan grids.
