The Clover Ruling: What Changes for Star Ratings and Why Medication Management Is Still Critical for Reducing Total Cost of Care and Improving Quality

In May 2026, a Georgia federal judge sided with Clover Health in its challenge against the Centers for Medicare and Medicaid Services (CMS) over its own 2026 Medicare Advantage Star Ratings.

In this article, we’ll look at what changed, what stays for now, and why medication management still matters as an important lever to drive savings and improve outcomes in Medicare Advantage.

What the Clover Ruling Changed in the Star Ratings Measure Set

Clover filed this lawsuit after its PPO plan dropped from 4 to 3.5 stars, a shift the company alleged cost it roughly $120 million in bonus payments. The Clover ruling found that CMS had improperly included 20 measures in the calculation and ordered the agency to recalculate Clover’s rating.

While the ruling only applied to Clover, CMS voluntarily chose to apply the revised methodology to all Medicare Advantage (MA) plans. However, CMS has clarified that this is not a definitive policy shift for 2027 Star Ratings, so some uncertainty remains. The federal government has also asked the court to reconsider the ruling, so the legal picture may continue to shift.

For the recalculation, CMS used only measures drawn from HEDIS, CAHPS, and HOS data. That excluded all Part D measures, including the three medication adherence measures, along with Part C measures such as call center availability, health plan complaints, members choosing to leave the plan, timely appeals decisions, appeals decision reviews, and SNP care management.

Importantly, the court removed these measures on legal and procedural grounds, not clinical ones. The ruling turned on what data CMS has the authority to collect and how it adopts measures, not on whether the measures reflect quality of care. Their removal from a bonus calculation does not change what determines the health of a member.
For plans whose ratings improved as a result, CMS provided a limited window to resubmit their 2027 bids. The agency also structured the adjustment so that no plan would see its rating decrease. Clover’s own rating was recalculated to 4.5 stars, half a star above the 4 stars it originally sought.

For Clarest, none of these change the day-to-day work. Good medication management was never built around chasing a specific measure set; it’s built around identifying risk early, closing gaps, and keeping people safe on their medications. When that work is done well, Star Ratings and HEDIS performance follow as a byproduct, not the target. While the legal and regulatory picture around Star Ratings continues to shift, the case for effective medication management doesn’t.

What Remains in Place for Health Plans

Operationally, the mandate has not changed: the Part D Comprehensive Medication Review (CMR) completion rate measure is returning for the 2029 Star Ratings, making 2027 an active measurement year. Plans that are not already building toward it are behind.

Clinically, nothing about the ruling changes what these measures were built to capture. Medication adherence, Concurrent Use of Opioids and Benzodiazepines (COB), and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) remain in the Star Ratings program, and a court decision about bonus payment math does not change what non-adherence and unsafe medication use do to hospitalizations, ER visits, and overall member health.

This distinction matters for health plans. The measures tied to patient outcomes must continue to be effectively managed across every touchpoint or plans risk driving up total cost of care through preventable hospitalizations, emergency visits, and adverse health events that could have been caught earlier. That’s hardest to do when medication management is fragmented across point solutions, and far easier when one team, working from one unified platform, follows the member through every setting and every transition instead of resetting the relationship each time care changes hands.

Why the Measures That Affect TCOC Matter More Than Check-the-Box Star Measures

As CMS priorities keep shifting, whether through formal rulemaking or informal guidance, plans need a medication management partner that holds up regardless of which measures are in or out in a given year. That means one platform handling the full continuum, from patient risk identification and stratification to medication delivery for the most medically complex members, rather than a stack of point solutions reassembled for every measurement cycle. Because underneath the measure-set churn, the clinical drivers don’t change. Adherence, polypharmacy, and concurrent high-risk medication use are what’s actually tied to hospitalizations, ER visits, and downstream costs. CMR completion rates and adherence fills are just the starting point.

Medication management addresses the root causes and drives down TCOC. It does so by going beyond the prescription: identifying why a member is not adhering, resolving unsafe interactions, and deprescribing when appropriate, so the treatment plan is working for that individual.

Does your medication management strategy go beyond completion rates? Connect with our team to explore how Clarest Path can help.