CMS Proposes Medicare Advantage Star Ratings Changes for 2027, Emphasizes Integrated Care for Duals
The Centers for Medicare and Medicaid Services (CMS) has released its Contract Year (CY) 2027 Proposed Rule, which signals key changes and continuities in the Medicare Advantage (MA) Star Ratings and integration efforts for dual-eligible members.
CMS has proposed delaying the implementation of the Excellent Health Outcomes for All (EHO4All) reward, maintaining the current reward system instead of transitioning to the Health Equity Index (HEI). This decision emphasizes achieving uniformly high performance across all members without awarding extra points for serving high-risk populations.
The proposed rule aims to streamline the Star Ratings by eliminating about twelve measures, mostly administrative or low-variance metrics, to focus more on critical clinical outcomes and patient experience. This reflects CMS's strategic focus on core quality indicators and member experience rather than equity-specific rewards. Despite some advances in 2026 Star Ratings, plans are under persistent pressure due to performance guardrails and an industry-wide demand for consistent improvement, especially for members with complex needs such as dual-eligible individuals.
EHO4All was designed to weight existing clinical quality measures more heavily for members with social risk factors, particularly for indicators like diabetes control and medication adherence. Although CMS pauses this initiative, the focus on these clinical and experience measures remains critical due to the proposed removal of process measures, which increases the significance of remaining metrics in determining overall Star Ratings.
Quality outcomes for dual-eligible beneficiaries, who often face higher multimorbidity and functional challenges, are closely linked to the performance of Long-Term Services and Supports (LTSS) providers. The proposed rule underscores this connection by highlighting integrated care for dual-eligible populations and the need for better coordination between Medicare Advantage and Medicaid services, including Home and Community-Based Services (HCBS).
CMS also continues to push for stronger integration of Dual Special Needs Plans (D-SNPs) through policy expectations such as HIDE/FIDE requirements and unified enrollment approaches. There is a focus on reducing enrollments in less integrated plans like Chronic Condition Special Needs Plans (C-SNPs) if they do not meet Medicaid coordination standards. States are aligning with this federal direction by incorporating LTSS outcomes into their quality frameworks.
To succeed, plans should adopt integrated governance models linking Stars, LTSS, behavioral health, and Medicaid operations, supported by robust data integration for risk stratification and intervention targeting. Value-based arrangements incentivizing providers and LTSS agencies to effectively manage care transitions and reduce readmissions are essential strategies. These efforts prepare plans for future equity-focused incentives and improve performance under current Star frameworks.
Overall, the CY 2027 proposed rule reinforces that high performance in Medicare Advantage depends on excelling in core clinical and member experience measures, particularly for dual-eligible and complex-need populations. Treating LTSS coordination as a fundamental care strategy rather than a Medicaid administrative task will position plans for success in the evolving Star Ratings landscape.