In the News - Federal court orders CMS to recalculate Clover Health's Star Rating, potentially reshaping how all MA plans are scored

On May 27, a Georgia federal court ruled in favor of Clover Health's challenge to 20 measures in CMS's Star Ratings methodology, finding them improperly included—10 because they drew on data sources outside CMS's statutory authority, and 10 added without proper rulemaking—and ordered CMS to recalculate Clover Health's 3.5-star PPO rating.

Unlike prior Star Ratings challenges, Clover argued CMS lacked the authority to use certain metrics at all, turning a scoring dispute into a challenge to the methodology itself. Only 5 of the 20 struck measures overlap with the 11 CMS already planned to cut in its 2027 rule; the rest, including three medication-adherence measures, are ones CMS intends to keep scoring.

An appeal is likely, and CMS has signaled a recalculation may not lift Clover to 4 stars—suggesting the insurer is pursuing the precedent more than the refund. If the statutory-authority reasoning survives, it could force CMS to drop measures across all MA contracts. Partners selling quality measurement, performance analytics, or Star Ratings optimization solutions to provider-sponsored MA plans should model which measures are most likely to survive and align their roadmaps accordingly—the scored set could shrink, and the direction is clearly away from administrative and process measures toward clinical performance.