Healthfirst Health Plan, a New York Medicare Advantage plan, filed a case against HHS and CMS in the U.S. District Court for the Southern District of New York on Monday, October 19, adding a new voice to the discussion of how Star Ratings calculations apply after the Clover ruling. Bloomberg Law reported on October 20 Healthfirst's position. CMS recalculated Clover Insurance's performance score after a court decision, and Healthfirst asks the court to review why its own rating was not adjusted in the same way, given the bonus payments tied to Star Ratings.
What Healthfirst filed and why
The Georgetown Health Care Litigation Tracker lists the case as Healthfirst Health Plan Inc. v. Department of Health and Human Services, docket 1:26-cv-09158, assigned to Judge Edgardo Ramos, and summarizes the complaint as an Administrative Procedure Act case about the 2027 Star Ratings for Healthfirst's Medicare Advantage plans. According to the tracker, Healthfirst points to the Clover decision and asks the court to consider whether five measures in the 2027 calculation required notice-and-comment rulemaking, and the plan seeks a ruling on the agency's approach.
Bloomberg Law describes the same case in terms of bonus payments, so the filing connects a methodology question to a payment outcome. For a plan with a large share of membership in one contract, a Star Rating decides quality bonus payments and rebate dollars in a later year, which gives a methodology dispute direct weight in benefit design and budgeting. No CMS response to the filing has appeared in the coverage reviewed for this article, and the questions raised are now with the court.
How the case connects to the Clover ruling
In Clover Insurance Company v. HHS, the Southern District of Georgia addressed how CMS used certain measures when calculating Clover's rating, and CMS recalculated Clover's 2026 rating on June 9. According to Healthcare Dive, CMS then applied the same approach to other plans only where removing the measures improved a plan's score. CMS has appealed the Clover decision to the Eleventh Circuit, where briefing is ongoing.
Healthfirst's filing follows from this sequence. The plan notes CMS adjusted another insurer's score after a court decision and asks the court to consider how the ruling applies to its own rating. If you run a plan with a contract near a star threshold, the answer shapes whether a recalculation is available to you and how far the Clover reasoning travels beyond Clover itself.
Where the case sits among the other cases
Alignment Healthcare filed its second case on October 9 in the District of Columbia, raising questions about the 2027 ratings and the role of technical notes in the methodology, which we cover in our look at the Alignment filing. Alignment's earlier case on its 2026 ratings, SCAN's case in the District of Columbia and Elevance's case in the Southern District of Georgia each bring related questions to the courts, and our litigation rundown traces how those cases developed.
Healthfirst's filing adds a New York federal court to the courts in Georgia, the District of Columbia and the Eleventh Circuit already weighing related questions. The cases approach the topic from different angles, with some focused on how measures are adopted and others on how a recalculation applies once a court has ordered one, and together they give the industry a fuller picture of how the program will work going forward.
What the 2027 ratings set for 2028
The 2027 Star Ratings fix the 2028 quality bonus year, so plans built 2027 benefits on their 2026 ratings and now budget 2028 on 2027 results. A court ruling changing how a measure counts, or how a recalculation applies, would reach those budgets through bonus payments and rebates, and plans with one dominant contract feel this most directly. Because outcomes so far have varied by plan and by court, your own contract-level results and the measures behind them matter alongside the headline rule.
Timing and runway
Plans have time to follow these cases as they develop, and each ruling adds clarity for everyone. The Eleventh Circuit appeal in Clover, the pending District of Columbia and Georgia cases, and the second CY2028 rule CMS has said is still to come give you several decision points before 2028 payments are set, and each one will help clarify how technical notes and rulemaking fit together in the Star Ratings program.
The RISE Star Ratings Master Class brings these questions into one room. The program runs December 14 to 16 at the Fairmont Scottsdale Princess in Scottsdale, Arizona, and includes State of Play: Where the Star Ratings Litigation Stands Today on December 15 and The CY2028 Proposed Rule: What It Means for Your Stars Strategy on December 16. Learn more about the Star Ratings Master Class.