Booker, Marshall Urge CMS to Issue Clear Guidance on Allowable and Non-Allowable Foods for Medicare Advantage Nutrition Benefits

WASHINGTON, D.C. - U.S. Senators Cory Booker (D-NJ) and Roger Marshall (R-KS), members of the Senate Committee on Agriculture, Nutrition, and Forestry, sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz urging CMS to provide clearer guidance defining allowable and non-allowable foods under the Special Supplemental Benefits for the Chronically Ill (SSBCI) in Medicare Advantage (MA). Grocery cards in these health care plans are supposed to help patients purchase healthy foods, which are known to help treat chronic conditions. Instead, insurance companies have used the lack of specificity in CMS guidance to market generic grocery cards that do not improve patient health.

"Medicare Advantage plans are spending billions on 'food is medicine' grocery benefits, yet too often that money is buying soda, candy, and other junk food, driving the very illnesses they are supposed to cure. Taxpayer dollars should support health, not marketing gimmicks. It's time to close this loophole and ensure these benefits provide truly nourishing food," said Dr. Dariush Mozaffarian, Cardiologist and Director of the Food Is Medicine Institute, Tufts University.

"We write to encourage the Centers for Medicare & Medicaid Services (CMS) to provide further specific guidance defining allowable and non-allowable foods for purposes of Special Supplemental Benefits for the Chronically Ill (SSBCI) in Medicare Advantage (MA)," the Senators wrote.

"While some MA plans have restricted SSBCI benefits to healthy foods that prevent and reduce chronic illness, other MA plans have used SSBCI to provide generic grocery cards without any nutritional criteria, creating a patchwork of benefits that undermines evidence-based care," the Senators continued.

The senators note that the current policy does not specify clear parameters for what constitutes non-healthy food, leaving determinations to each individual MA plan, and suggest that benefits be limited to foods that meet established federal standards, including the Food and Drug Administration's "healthy" labeling criteria or the Women, Infants, and Children (WIC) program purchasing guidelines.

"We encourage CMS to build on its April 2025 action by issuing specific guidance on allowable and non-allowable foods for SSBCI," the Senators concluded.

To read the full text of the letter, click here.

The Honorable Mehmet Oz, M.D.
Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Administrator Oz,

We write to encourage the Centers for Medicare & Medicaid Services (CMS) to provide further specific guidance defining allowable and non-allowable foods for purposes of Special Supplemental Benefits for the Chronically Ill (SSBCI) in Medicare Advantage (MA).

Poor nutrition is a leading cause of preventable complications and healthcare utilization. Billions of dollars are spent annually on SSBCI which, if appropriately administered, could improve health and provide cost-efficient care in MA.

While some MA plans have restricted SSBI benefits to healthy foods that prevent and reduce chronic illness, other MA plans have used SSBCI to provide generic grocery cards without any nutritional criteria. One evaluation by an MA plan found that soda and junk food represented significant portions of items purchased using SSBCI, and that individuals with such purchasing had higher levels of illness and total costs of care.

The variance SSCBI implementation in MA creates a patchwork of benefits for patients and undermines evidence-based care, creating a need for oversight. To begin to address the lack of nutritional guidance for SSBCI, in April 2025, CMS appropriately clarified that non-healthy food--which is food that does not assist in meeting the nutritional needs of a chronically ill enrollee-- does not meet the statutory standard for SSBCI. We commend CMS for this critical first step to ensure that nutrition-related supplemental benefits are aligned with health improvement rather than plan enrollment and marketing incentives.

However, as CMS has acknowledged, the current policy does not specify parameters for what constitutes non-healthy food, leaving determinations at the whim of each MA plan. Some MA plans have used this lack of specificity as a loophole to not update their benefits at all, continuing to allow benefits to be used to purchase any grocery items. This goes against the April 2025 rule clarification and the intent of the policy.

Beneficiaries and plans require clearer, evidence-based guidance that ensures that SSBCI nutrition benefits meaningfully support the health of chronically ill enrollees. Importantly, such guidance is also needed to establish a level playing field among plans, so that plans with health-promoting nutritional criteria are not penalized in the market.

The most straightforward approaches to defining allowable foods in SSBCI would leverage existing federal standards. Plan benefits should be used to support purchases of food that meet one of these criteria:

· The Food and Drug Administration's definition for use of a "healthy" food labeling claim, as finalized in Docket No. FDA-2016-D-2335.

· The purchasing standards for the WIC program.

These established standards emphasize minimally processed foods that improve health- fruits, vegetables, whole grains, legumes, nuts, seeds, fish and shellfish, plant oils, dairy, and lean proteins-while excluding categories linked to health harms, including sugar-sweetened beverages, candy, ultra-processed foods, and processed meats.

We encourage CMS to build on its April 2025 action by issuing specific guidance on allowable and non-allowable foods for SSBCI.

Thank you for your consideration. I welcome continued dialogue on how CMS can advance evidence-based nutrition policy and accountability within Medicare Advantage.