SSBCI home modifications benefit, ramps, grab bars, bathroom safety, what qualifies” (home safety intent)

Key points

• SSBCI is a Medicare Advantage benefit category that can include structural home modifications when they are expected to help maintain or improve your health or function.
• To qualify, you generally must meet your plan’s definition of “chronically ill,” and your plan must document that the benefit fits your needs.
• Home safety changes are most likely to be approved when they address a clear risk, like falls, limited mobility, or difficulty with daily activities such as bathing and toileting.
• Evidence suggests home assessment and targeted home modifications can reduce falls, especially for people at higher risk.

What SSBCI means for home safety

SSBCI stands for Special Supplemental Benefits for the Chronically Ill. It is a type of Medicare Advantage supplemental benefit that can include items and services that are not “primarily health related,” as long as they are expected to improve or maintain your health or overall function.

In plain language, SSBCI is one way some Medicare Advantage plans can help you make specific home changes that support safer movement and daily activities. If you are managing chronic conditions that affect balance, strength, endurance, breathing, or mobility, a safer home setup can help you stay independent and reduce avoidable injuries.

Who qualifies for SSBCI home modification benefits

SSBCI eligibility is determined by your Medicare Advantage plan, using a federal definition of “chronically ill.” Under CMS guidance, a chronically ill enrollee is someone who meets all three of these criteria:

• You have one or more medically complex chronic conditions that are life-threatening or significantly limit health or function
• You have a high risk of hospitalization or other serious health outcomes
• You need intensive care coordination

Plans have flexibility in how they identify eligible members, but they are expected to document the determination.

If you are not sure whether you qualify, it can help to gather recent information from your clinicians that describes how your condition affects daily function and safety at home.

If you want support organizing documentation or benefits questions, Understood Care’s care coordination services may help: https://understoodcare.com/care-types/care-coordination and https://understoodcare.com/healthcare-info/how-our-care-team-assists-you

What makes a home modification “qualify” under SSBCI

Even if you qualify as “chronically ill,” a specific home modification still needs to fit your plan’s SSBCI rules.

It must have a reasonable expectation of improving or maintaining function

CMS guidance allows Medicare Advantage plans to offer SSBCI when the item or service has a reasonable expectation of improving or maintaining your health or overall function.

For home modifications, this usually means the change should help you do something important more safely, such as:

• Getting in and out of your home
• Using the bathroom safely
• Moving between rooms with less fall risk
• Reducing hazards that could trigger injuries or worsen health

Plans can tailor SSBCI to your specific needs

SSBCI can be offered non-uniformly, meaning a plan can target benefits based on your medical condition and needs rather than offering the exact same package to every member.

Your plan may require care management or specific processes

Plans may require participation in a care management program or use of certain providers. Some benefits may be provided through reimbursement rather than direct installation.

Home modifications that may qualify under SSBCI

What is covered varies by plan, but CMS specifically names “structural home modifications” as permitted SSBCI when they support function, health, or mobility. CMS examples include widening hallways or doorways, permanent mobility ramps, and easy-use doorknobs and faucets.

Below are common home safety changes that often fit the intent of SSBCI for mobility and fall risk reduction.

Ramps and safer entryways

A ramp may be considered when steps create a fall risk or block access for a cane, walker, or wheelchair. Examples that may be considered include:

• Permanent mobility ramps
• Adding non-slip surfaces on outdoor steps
• Adding a steady hand support at points where you need balance, such as near the front door

Grab bars and bathroom safety changes

Bathrooms are a common place for slips and falls. Home safety guidance for older adults often emphasizes reducing slip hazards and adding supports.

Modifications that may align with SSBCI’s purpose include:

• Grab bars near the toilet and in the shower or tub area
• Non-slip strips or mats on surfaces that get wet
• Improved lighting for nighttime bathroom trips
• Adjustments that make bathing or toileting safer and easier when strength or balance is limited

Doorways, hallways, and “easy-use” hardware

If tight spaces make walking aids harder to use, or if arthritis and weakness make gripping difficult, the following may support daily function:

• Widening hallways or doorways
• Replacing knobs with easier-to-use handles
• Easier-to-use faucets and controls

Whole-home fall hazard reduction

Some of the most effective approaches focus on identifying hazards and fixing the highest-risk areas. Evidence supports home assessment and modification programs, particularly in higher-risk groups.

Practical changes often include:

• Improving lighting and access to switches
• Removing clutter and tripping hazards (cords, loose rugs)
• Adding non-slip surfaces where floors may get wet

Home modifications that usually do not qualify

Plans vary, but SSBCI is intended for health and function, not general home improvement. Requests are more likely to be denied when they are primarily for convenience, aesthetics, or general property upgrades.

Examples that are commonly harder to justify as SSBCI include:

• Major kitchen remodels that do not clearly affect safety or daily function
• Purely cosmetic renovations
• General home repairs that do not connect to a health or functional need

If you are not sure, ask your plan what documentation they need to connect the modification to a functional limitation or safety risk.

Step-by-step: How to request SSBCI home modifications

If you are trying to get ramps, grab bars, or bathroom safety changes approved, a clear process can help.

1) Confirm that your plan offers SSBCI and includes home modifications

Start with your plan’s Evidence of Coverage or supplemental benefits summary. Ask specifically about SSBCI and whether structural home modifications are included.

2) Ask what the plan considers “qualifying” home modifications

Use plain, specific wording:

• “Does your SSBCI include structural home modifications such as permanent mobility ramps?”
• “Does it include bathroom safety supports like grab bars or other fall-prevention changes?”

3) Connect the request to a health and function goal

Plans typically need a clear reason the change matters for you, such as:

• Reducing fall risk if you have balance problems
• Making bathing safer if weakness or dizziness affects transfers
• Improving safe mobility if stairs are a barrier

A fall history, gait issues, muscle weakness, vision changes, and multiple medications can all increase fall risk.

4) Gather supporting documentation

Helpful documentation may include:

• A clinician note describing the condition and how it limits function
• A short statement of what task is unsafe (for example, stepping into the tub)
• A home safety checklist or brief hazard list

The National Institute on Aging provides a room-by-room checklist approach that can help you identify risks and needed changes.

5) Ask whether a home assessment is recommended or required

Some plans approve more readily when an occupational therapist (OT), physical therapist, or nurse evaluates your home risks and recommends modifications. NIA notes that clinicians may suggest an OT or other provider visit your home to assess safety and advise on changes to lower fall risk.

Research also supports OT-led home hazard assessment and modification as an approach that can reduce falls in some populations.

6) Clarify how the benefit is delivered

Ask:

• Is installation arranged by the plan, or do you pay and get reimbursed?
• Is there a spending cap for the SSBCI package?
• Do you need to use specific vendors?

CMS notes plans may deliver benefits through retroactive reimbursement in some cases.

If you would like help organizing your questions and paperwork, Understood Care’s financial help and benefits support resources may be useful: https://understoodcare.com/healthcare-info/financial-help‍

Safety basics for ramps, grab bars, and bathrooms

SSBCI is about coverage, but safety also depends on choosing the right fix and installing it correctly.

Ramps: focus on stability and traction

A ramp should feel steady underfoot and support the way you actually move, including with a walker or wheelchair if needed.

Practical safety priorities include:

• Non-slip surfaces, especially in rain or cold weather
• Adequate lighting at entry points
• Hand support if balance is an issue

Grab bars: prioritize the locations where you transfer weight

Grab bars are most helpful at the moments you are most likely to lose balance, such as:

• Getting on and off the toilet
• Stepping in and out of the shower or tub
• Standing up from a low seated position

A home safety checklist approach can help identify the highest-risk spots before you install anything.

Bathroom safety: reduce slip risk and make nighttime trips safer

Common fall-reduction steps include:

• Non-slip mats or strips on wet surfaces
• Good lighting, including a night light path to the bathroom
• Keeping frequently used items within easy reach
• Addressing clutter and cords that create trip hazards

When an occupational therapist home assessment can help

If you have had a fall, feel unsteady, or need help deciding what changes matter most, an OT home visit can be especially valuable.

Evidence suggests that home assessment and modification programs can reduce falls, with stronger effects in higher-risk groups.

An OT can help you match the environment to your abilities, so you are not just adding equipment, but making daily tasks realistically safer.

If SSBCI is not available, you still have options

Not every Medicare Advantage plan offers SSBCI home modifications, and even when it does, the covered items may be limited.

If you are stuck, consider these practical next steps:

• Ask your clinician about a referral for fall risk evaluation or therapy, especially if balance, strength, or gait issues are present
• Use a room-by-room fall prevention guide and checklist to identify the highest-impact changes first
• Ask local aging or public health resources whether there are home modification or fall prevention programs in your area

If you want help coordinating next steps, Understood Care’s care coordination overview explains how a care team can help you organize services and benefits: https://understoodcare.com/healthcare-info/how-our-care-team-assists-you‍

FAQ

• What are SSBCI home modifications in Medicare Advantage?
  SSBCI home modifications are plan-specific benefits that may cover certain home changes when they are expected to maintain or improve health or function.
• Do SSBCI benefits cover ramps for seniors or people with disabilities?
  Some plans may cover permanent mobility ramps as a structural home modification when it supports safe mobility and daily function.
• Do SSBCI benefits cover grab bars and bathroom safety equipment?
  Coverage varies by plan, but bathroom safety changes are often requested because they can reduce fall risk during transfers in wet, slippery spaces.
• What qualifies as a bathroom safety home modification under SSBCI?
  A modification is more likely to qualify if it addresses a documented safety risk and helps you bathe, toilet, or move safely despite chronic condition limitations.
• How do I prove I qualify for SSBCI home modification benefits?
  Plans commonly look for documentation that you meet their “chronically ill” criteria and that the requested change reasonably supports health or function.
• Can SSBCI home modification benefits reimburse me if I pay first?
  Some plans may use reimbursement processes for SSBCI benefits, but you should confirm the rules before purchasing or installing anything.
• Is an occupational therapist home safety assessment required for SSBCI?
  Not always, but an OT or clinician home safety evaluation can help document risk and support a targeted, medically relevant request.

References

• CMS. Implementing Supplemental Benefits for Chronically Ill Enrollees (SSBCI), HPMS Memo (Apr 24, 2019). https://www.cms.gov/medicare/health-plans/healthplansgeninfo/downloads/supplemental_benefits_chronically_ill_hpms_042419.pdf
• eCFR. 42 CFR § 422.102 Supplemental benefits. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-C/section-422.102
• National Institute on Aging. Preventing Falls at Home: Room by Room. https://www.nia.nih.gov/health/falls-and-falls-prevention/preventing-falls-home-room-room
• National Institute on Aging. Worksheet: Home Safety Checklist (PDF). https://www.nia.nih.gov/sites/default/files/2023-04/worksheet-home-safety-checklist_1.pdf
• CDC. Falls Compendium (Older Adult Fall Prevention). https://www.cdc.gov/falls/interventions/falls-compendium.html
• Cleveland Clinic. Fall Prevention Program. https://my.clevelandclinic.org/departments/rehabilitation/services/falls-prevention
• PubMed. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. https://pubmed.ncbi.nlm.nih.gov/10591231/
• PubMed. Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials. https://pubmed.ncbi.nlm.nih.gov/18815408/
• PubMed. Effect of Home Modification Interventions on the Participation of Community-Dwelling Adults With Health Conditions: A Systematic Review. https://pubmed.ncbi.nlm.nih.gov/28218595/

This information is for general education and does not replace medical advice from your own clinicians or care team. If you are considering PACE or have questions about PACE program food benefits, talk directly with your local PACE organization or a trusted advocate.