If your team spent the last two years building a Stars strategy around the Health Equity Index, that work isn't wasted. But the bonus it was chasing no longer exists. The 2027 Star Ratings arrive in early October, according to Healthcare Dive, and they'll be scored under the old reward rules.
This piece is the correction memo: what changed, what didn't, and where to put your effort instead.
What happened to the Health Equity Index?
CMS finalized its decision to not implement the Health Equity Index reward. The CMS fact sheet for the CY2027 final rule (April 2, 2026) says the agency will instead "continue the historical reward factor that encourages consistently high performance for all enrollees across all quality measures." The change applies starting with the 2027 Star Ratings.
Quick refresher on what was supposed to happen. The Health Equity Index, later rebranded EHO4All, would have rewarded plans for strong results among enrollees who are dual eligible, receive the low-income subsidy, or qualify through disability. It was slated to begin with the 2027 ratings and would have replaced the existing reward factor entirely, per RISE Health.
The historical reward factor works differently. It adds a bonus of 0.1 to 0.4 stars to contracts that score high and consistently across all their measures, according to Pelica. In plain terms, it rewards being good at everything, for everyone, rather than being good for one subgroup.
The rule went further than the reward. Healthcare Dive reports that plans are no longer required to address health disparities in quality improvement programs, include a health equity expert on utilization management committees, or publish annual health equity analyses.
Why this is a strategy problem, not just a policy footnote
Plenty of 2027 Stars plans were built with EHO4All as a line item: separate subgroup dashboards, targeted outreach budgets, modeled bonus scenarios. If that modeling is still feeding your forecasts, your forecasts are wrong.
That doesn't mean your dual-eligible and LIS members stop mattering. It means they matter the same way every other member does: through the measures themselves. A member who gets screened, followed up, and feels better moves your ratings whether or not CMS labels the result "equity."
Which 11 measures did CMS retire?
The CY2027 final rule removes 11 measures, most of them administrative. Three drop out of the 2028 Star Ratings (measurement year 2026) and eight drop out of the 2029 ratings (measurement year 2027), according to Wakely's final rule summary. None of the removals change the 2027 ratings.
| Measure | Type | Last counts in | Gone starting |
|---|---|---|---|
| Call Center: Foreign Language Interpreter and TTY Availability (Part C) | Administrative | 2027 Stars | 2028 Stars |
| Call Center: Foreign Language Interpreter and TTY Availability (Part D) | Administrative | 2027 Stars | 2028 Stars |
| Statin Therapy for Patients with Cardiovascular Disease | Process | 2027 Stars | 2028 Stars |
| Plan Makes Timely Decisions About Appeals | Administrative | 2028 Stars | 2029 Stars |
| Reviewing Appeals Decisions | Administrative | 2028 Stars | 2029 Stars |
| SNP Care Management | Process | 2028 Stars | 2029 Stars |
| Complaints About the Health/Drug Plan | Administrative | 2028 Stars | 2029 Stars |
| Medicare Plan Finder Price Accuracy | Administrative | 2028 Stars | 2029 Stars |
| Members Choosing to Leave the Plan | Administrative | 2028 Stars | 2029 Stars |
| Customer Service (CAHPS) | Patient experience | 2028 Stars | 2029 Stars |
| Rating of Health Care Quality (CAHPS) | Patient experience | 2028 Stars | 2029 Stars |
One proposed cut didn't survive. CMS kept the Diabetes Care Eye Exam measure after stakeholder pushback, "recognizing its importance in preventing serious complications," per RISE Health's analysis.
CMS framed the whole package as a pivot. Medicare Director Chris Klomp told Healthcare Dive the agency is "fundamentally shifting our approach to quality" toward "clinical outcomes and health of our beneficiaries" rather than "administrative box-checking."
Fewer measures means each one hits harder
Many of those retired measures were reliable points: plans tended to score similarly on call-center and appeals metrics, so they padded averages without much effort.
Take them out and the remaining clinical, survey, and outcome measures carry more of the load. RISE Health notes that shrinking the denominator increases the leverage of every measure left, and removes a performance floor along with it.
The market is already feeling the squeeze:
"There are very few tailwinds sitting in stars right now."
Melissa Newton Smith, Newton Smith Group, via Healthcare DiveWait, isn't this rule good news for plans?
Financially, yes, in aggregate. CMS estimates the rule's Star Ratings changes will add about $18.56 billion in Medicare Trust Fund spending from 2027 through 2036, roughly 0.21% of MA payments, according to RISE Health.
But averages hide a lot. About 63% of contracts see no change in their overall rating from these policies, per RISE Health. The upside flows mostly to plans that already perform consistently across the board, because that's exactly what the historical reward factor pays for.
So the bonus isn't a gift you can bank. It's a reward for having no weak spots. That shifts the question from "how do we win the equity subgroup?" to "where are we inconsistent, and which of those gaps are highest-weight?"
The measure worth your attention: Depression Screening and Follow-Up
CMS is adding a Part C Depression Screening and Follow-Up measure. It's display-only (shown but not scored) in the 2027 and 2028 ratings, based on earlier years of HEDIS data, then counts toward the 2029 Star Ratings at a weight of 1, using 2027 data, per the CMS fact sheet and Wakely.
A weight-1 measure sounds minor. Two reasons it isn't.
First, no ceiling in year one. The five-point guardrail that limits how far cut points can move doesn't apply to new measures in their first scored year, so the Depression Screening and Follow-Up cut points enter 2029 Stars unconstrained, per RISE Health. If peers invest early and you don't, the bar could land well above where you are.
Second, it feeds a weight-3 outcome. Improving or Maintaining Mental Health, a Health Outcomes Survey (HOS) measure, carries a weight of 3 in the 2027 measure list. Members whose depression gets caught and treated are the same members answering that survey. The screening measure is worth 1; the downstream outcome is worth 3.
How the measure works
The measure is built on the HEDIS Depression Screening and Follow-Up (DSF-E) specification. Based on the Johns Hopkins DSF-E guide, it has two parts:
- Screening: Members are screened with a standardized tool such as the PHQ-2, PHQ-9, or Geriatric Depression Scale between January 1 and December 1.
- Follow-up: Members who screen positive get follow-up care within 30 days.
Qualifying follow-up is broader than many teams assume. It includes an outpatient, telephone, or virtual visit with a behavioral health diagnosis; a depression case management encounter; a behavioral health encounter such as assessment or collaborative care; a dispensed antidepressant; or an encounter for exercise counseling.
The real gap is follow-up, not screening
Depression is common in your membership and routinely missed. According to CMS minority health data, 18.4% of Medicare fee-for-service beneficiaries had a depression diagnosis in 2018. Only about 6% used the fully covered annual depression screening benefit.
Notice who carries the heaviest burden: dual-eligible members, the same group the Health Equity Index was designed to reward. The equity bonus is gone, but the clinical need moved straight into a scored measure.
Screening is a workflow problem you can solve with EHR prompts and member outreach. The 30-day follow-up window is harder. It needs someone to reach the member, keep them engaged, and connect them to care before the clock runs out.
That's also where the evidence is strongest. In the landmark IMPACT trial of 1,801 older adults with depression, 45% of patients in a care-manager-supported collaborative care model saw their symptoms drop by half or more at 12 months, versus 19% in usual care, as reported in JAMA. On the provider side, Medicare now pays for this kind of coordinated care through its new APCM behavioral health codes.
Where to refocus your Stars strategy now
Stop running a separate equity program. Focus on being consistent everywhere. The historical reward factor pays for high, even performance across every measure, so your biggest wins come from shoring up your weakest high-weight measures rather than building separate subgroup programs.
Here's a practical sequence for quality and Stars leaders:
Where health coaching fits
Coaching won't replace clinical care for depression, and it shouldn't. But the hardest part of this measure isn't the diagnosis. It's the 30 days after, when a member who just scored a 12 on the PHQ-9 needs a human to follow up, help them take the next step, and keep them from dropping off.
That's the job a coaching team is built for: picking up the warm handoff, supporting behavior change between clinical visits, logging each touchpoint cleanly, and routing members to behavioral health when they need more. It's the kind of scaled, documented follow-up Avidon Health's coaching platform for health plans was designed to support. If you're weighing options, see how the top health coaching platforms compare.
The bottom line
The Health Equity Index was a two-year planning assumption for a lot of plans. It's gone. The measure set is smaller, cut points are tougher, and the bonus now pays for being consistently good across the board.
The smartest move is to redirect equity-era effort into the measures that are actually scored, starting with a depression follow-up workflow you can test before 2027 data starts counting. Talk with Avidon Health about building coach-supported follow-up that scales with your membership.
