Over-the-Counter (OTC) Plus Card Changes for 2026

Starting January 1, 2026, Healthfirst members enrolled in our Life Improvement Plan (HMO D-SNP) and Connection Plan (HMO D-SNP) will need to qualify for Special Supplemental Benefit for the Chronically Ill (SSBCI) to use their OTC Plus Card for healthy food and home utilities.

What is changing?

The Centers for Medicare and Medicaid Services (CMS) is ending the Value-Based Insurance Design (VBID) model which allowed health plans to provide non-medical benefits such as healthy food and home utilities.

However, many Healthfirst Life Improvement Plan and Connection Plan members will continue to qualify for food and utility benefits through the SSBCI program.

What is the Special Supplemental Benefit for the Chronically Ill (SSBCI)?

The SSBCI program under Medicare offers additional benefits for members who meet all of the following eligibility criteria:

• Have one or more comorbid/medically complex chronic condition that is life threatening or significantly limits overall health or function
• Have a high risk of hospitalization or other adverse health outcomes
• Requires intensive care coordination

Action Needed: How you can support patients’ access to healthy food and utilities

We expect many Healthfirst members to auto-qualify based on past claims data, without any action on your part.

However, for those who don’t, please complete this Provider Attestation as quickly as possible to confirm the members’ clinical eligibility. Be sure to also include your National Provider Identifier (NPI) and Tax ID number(s). Once complete, fax the form to 1-646-313-4603.

What health conditions allow for SSBCI qualification?

To be eligible for SSBCI, members must have a chronic condition such as cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, obesity, or another eligible condition not listed. All eligible conditions can be found in the Provider Attestation for OTC Plus Card Special Supplemental Benefits form.

Who can fill out the Healthfirst SSBCI form?

Any provider may attest to a member’s qualifying condition. Providers must include their NPI and Tax ID when filling out the form.

Where can I find the member’s ID number?

If you do not have access to your patient’s Healthfirst Member ID card, you may log in to Availity Essentials and use the Eligibility and Benefits Inquiry tool to find the Healthfirst Member ID number using the patient’s name and date of birth.

How will a member know if they qualify for the SSBCI benefit?

The member will receive a notification in the mail once the Provider Attestation has been successfully processed. This will take about two (2) weeks after you submit it. They can also check by:

• Logging in to myHFNY.org and going to the “OTC Plus” section. It will show whether you can use your benefit for healthy food and home utilities in addition to other eligible OTC Plus items
• Calling Healthfirst Member Services phone number on the back of their Member ID card

How often am I required to submit an attestation?

Existing members who do not qualify for SSBCI will receive a letter in November 2025. New members will only receive a letter if they qualify for SSBCI.

What if a member does not qualify for SSBCI?

Existing members who do not qualify for SSBCI will receive a letter in November 2025 notifying them of their adjusted status. They may still use their OTC Plus card for non-prescription drugs, health-related items, exercise equipment, and activity trackers.

Only members who meet SSBCI eligibility requirements may also use their OTC Plus Card to buy healthy foods at farmers' markets and other participating retailers, and pay for home utilities such as gas, oil, electric, water, and internet service.

Resources

• Provider Attestation for OTC Plus Special Supplemental Benefits
• OTC Plus Card Benefits

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.