For much of the past year, plans followed the Clover Star Ratings case quietly from the sidelines. One court decision changed the mood. After a federal court ruled in Clover's favor and CMS recalculated part of the 2027 quality bonus payment ratings, other plans began raising the same questions about their own contracts. What started as a single case now includes several. The measures at the center run straight through your quality work.
How one case became several
Clover's win gave the industry a concrete reference point. Plans wondering about the measures behind their ratings now had a court decision to point to, and several moved from watching to filing:
- May 27, 2026 The U.S. District Court for the Southern District of Georgia ruled for Clover in Clover Insurance Company v. HHS. The court found CMS had drawn on data sources outside statutory authority for 10 measures and had adopted 10 others without notice-and-comment rulemaking.
- June 17, 2026 CMS issued a memo describing a voluntary recalculation of 2027 quality bonus payment ratings for certain contracts, using only data authorized by statute: HEDIS, CAHPS, and HOS. CMS included a hold-harmless provision, so no plan would see a lower rating.
- July 1, 2026 Elevance filed in the Southern District of Georgia, asking the court to apply the ruling's approach to Elevance's own contracts, with an estimated impact of about $115 million across five contracts.
- July 7, 2026 SCAN Health Plan filed in the U.S. District Court for the District of Columbia, seeking a rating of 4.5 stars rather than 4, and citing about $125 million.
- July 10, 2026 Alignment Healthcare filed a similar case in the same D.C. court, citing about $50 million.
Why more plans are speaking up
A few forces explain the move from quiet to vocal. The ruling gave plans a specific legal basis rather than a general sense of unfairness. Law firms and consultants followed with analyses, which helped plans read where their own contracts might stand. And the dollars are large enough to act on, with the filed cases citing figures from $50 million to $125 million. For plans narrowly missing a higher rating, the ruling turned a private concern into a shared question worth raising.
Where CMS stands
CMS acted promptly after the ruling. The June 17 recalculation applies the part of the decision about unauthorized data, rebuilds the affected ratings on statutorily authorized measures, and protects plans from any downgrade through the hold-harmless provision. CMS described the step as a way to align ratings with the data Congress authorized while limiting disruption for plans and members. The plans in court are asking whether the ruling reaches further, and the courts will decide.
The through-line for HEDIS®
One detail matters most for your work. The recalculated ratings now rest on HEDIS®, CAHPS, and HOS data alone. As more of the industry raises these questions, the measures your team owns carry more of the weight in each rating. Understanding your own position starts with clean, well-documented HEDIS® data, which supports an accurate rating no matter how the cases resolve.
The discussion Clover set off is now industry-wide, and quality leaders will continue the conversation in person at The 16th Annual HEDIS® and Quality Improvement Summit, November 3 to 5 in Baltimore. Comparing notes with peers on the measures at the center is exactly what the event is built for. Industry intelligence, not legal advice.
HEDIS® is a registered trademark of the National Committee of Quality Assurance (NCQA) and any reference thereto by RISE Health does not imply any endorsement by NCQA of RISE Health and its offerings.