Lilac Software Medicare Advantage Star Roadmap – Star Year 2026 & Beyond
Star measures for Medicare Advantage (MA) plans get updated every year. The types of changes include major structural changes, changes to the weights of existing measures, new measure specifications, retirement of measures, and introduction of new measures. Lilac’s experts closely monitor all of CMS’ many communication channels to track all confirmed and possible changes.
Our current assessment of upcoming changes is reflected in the table below. We include Star Year (SY) 2026 and Star Year (SY) 2027 for historical and reference purposes. The forward-looking changes reflect the finalization of the 2026 Medicare Advantage Rule in April 2025, the finalization of the 2026 Final Announcement regarding rates and policies in April of 2025, the proposed 2027 Medicare Advantage Rule released in November 2025 (items noted as pending), and the just released 2027 Advance Notice regarding rates and policies in January 2026 (items are noted as possible or non-substantive).
Star Year 2026 |
Star Year 2027 |
Star Year 2028 |
Star Year 2029 |
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| Star Program Structural Changes: | NA | The Health Equity Index has been renamed the “Excellent Health Outcomes for All (EHO4all). No other changes were announced. EHO4all replaces the Reward Factor (Measure Years 2024 and 2025 blended).
Note: Retention of the Reward Factor and elimination of EHO4all has been proposed in MA and Part D 2027 rule (pending). |
NA | NA |
| Change in Measure Specification, Scope or Calculation: | (1) Colorectal Cancer Screening becomes ECDS.
(2) Medication Adherence measures and SUPD measure – Continuous enrollment and other calculation changes to be consistent with PQA. |
(1) Colorectal cancer screening age range expanded. Treated as a significant change in this MY.
(2) Statin tolerance exclusion for SUPD. (3) Diabetes Care — Eye Exam – removal of chart review option. |
(1) Three medication adherence measures – Risk-adjustment methodology and removal of IP/SNF adjustments.
(2) SUPD — PQA-recommended denominator exclusion to recognize alternative treatment for Statin Intolerance (2027 Advance Notice — non-substantive change for MY 2026). (3) POLY-ACH — PQA-recommended non-substantive changes (2027 Advance Notice — non-substantive change for MY 2026). |
(1) Substantive changes/expanded age group for Breast Cancer Screening. |
| Measure Weight Changes: | (1) Patient Experience and Complaints (drop from 4x to 2x weight).
(2) Access measures (drop from 4x to 2x weight). |
(1) Improving/Maintaining Physical Health (move to 3x weight).
(2) Improving/Maintaining Mental Health (move to 3x weight). |
(1) Three medication adherence measures (drop to 1x weights for 1 year). | NA |
| Returning Measures: | (1) Improving/Maintaining Physical Health (1x weight) .
(2) Improving/Maintaining Mental Health (1x weight). |
(1) Updated COA—Functional Status Assessment (1x weight). | (1) MTM CMR returns to an active Stars measure from Display (1x weight). | |
| New Measures Added: | (1) Kidney Health Evaluation for Persons with Diabetes (1x weight). | (1) Concurrent Use of Opioids and Benzodiazepines (COB) (1x weight).
(2) Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) (1x weight). Note: COB also excludes cancer pain treatment for COB (non-material change). |
(1) Depression Screening and Followup (1x weight).
Note: Above is pending finalization of proposed MA and Part D 2027 rule. |
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| Measures Removed: | NA | (1) Medication Reconciliation Post-Discharge
(2) COA Pain Assessment (3) MTM CMR (note: MTM CMR is slated to return to Stars for SY 2029) |
(1) Removal of two Call Center measures and Statin Therapy for CVD.
Note: Above are pending finalization of proposed MA and Part D 2027 rule. (2) Removal of Statin Therapy for CVD (female age exclusions changed and conversion to ECDS). Moves to display page for two years unless removed entirely in SY 2028 by proposed MA and Part D 2027 rule. |
(1) Complaints (2 measures)
(2) Leave (2 measures) (3) MPF (4) SNP-CM (5) EED (6) Customer Services (7) Rating of Health Care Quality (8) Appeals (2 measures) Note: Above are pending finalization of proposed MA and Part D 2027 rule. |
Other Changes Mentioned
Note: Monitoring ECDS conversion. NCQA has a goal of converting all hybrid measures to ECDS by MY 2029 and non-hybrid in MY 2030.
- BCS, COL – DONE
- CBP – MY 2028
- GSD, TRC, COAs – MY 2029
Changes to All Cause Readmissions, including denied claims inclusion and re-estimation of risk adjustment (2027 Advance Notice — possible in MY 2028 and would require rule-making and updated measure on display).
Changes to Transitions of Care, including ECDS conversion in MY 2028 and Hybrid measure changes for MY 2028, including reducing Patient Engagement and Medication Reconciliation submeasures from 30 days to 14 days (2027 Advance Notice — possible in MY 2028 and would require rule-making and updated measure on display).
Diabetes Care — Blood Sugar Control will convert to ECDS upon successful testing in MY 2029 (2027 Advance Notice — possible in MY 2029 with two-year testing transition).
Additional Universal Foundation measure adoption TBD:
- Adult Immunization at 1x weights (possible SY 2029 or beyond)
- Physical Functioning Activities of Daily Living (possible SY 2029 or beyond)
Polypharmacy: Use of Multiple Central Nervous System Medications in Older Adults (possible – year TBD)
Initiation and Engagement of Substance Use Disorder Treatment (1x) (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again.)
Initial Opioid Prescribing for Long Duration (1x) (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again.)
Measure specification changes – COA-Functional Status and COA-Medication Review (possible SY 2031 or beyond)
Adjust HEDIS-HOS measures (possible SY 2031 or beyond)
Substantive changes to Plan Makes Timely Decisions about Appeals (Part C) and the Reviewing Appeals Decisions (Part C) (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again. But proposed to sunset both in MA and Part D 2027 rule (pending))
Removal of following beyond what was proposed in the MA and Part D 2027 rule (pending) (possible – year TBD):
- COA measures (3)
- MTM CMR (currently slated to return to Stars in SY 2029)
Remove guardrails for non-CAHPS measures when calculating cut points (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again.)
Monitoring provision not finalized in 2024 draft rule: Remove “with and without improvement” for 4 and 4.5 Star plans, effectively requiring improvement in calculations for all plans other than 5 Star plans
Possible use of percentile distribution cutoffs to assign measure Stars vs. clustering (2027 Advance Notice — possible — TBD)
Add Geography toEHO4all – urban/rural indicator (possible – TBD, but proposed to sunset EHO4all in MA and Part D 2027 rule (pending))
Monitoring others provisions not finalized from draft CY 2026 rule :
- Clarifying how the EH04all reward factor will be calculated when a contract consolidation applies, when there are data discrepancies, or when data are missing.
- Clarifying how the EH04all reward factor will be calculated when Dual Eligible Special Needs Plan (D-SNPs) offerings migrate from master contracts to free-standing ones.
- Clarifying how the EH04all reward factor will be calculated for Institutional Special Needs Plan (I-SNP)-only contracts.
- Clarifying how the hold harmless provision for highly rated plans is calculated in terms of the addition of EHO4all.
- But, proposed to sunset EHO4all in MA and Part D 2027 rule (pending)
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Lilac’s Stars Management platform helps plans navigate these types of major changes to Stars. We have the data models and analytics to easily understand the strategic implications of Stars program changes and agentic AI tools to make a plan’s member engagement in support of Stars more efficient and impactful.
Reach out here to start a conversation with the Lilac team about how we can help your plan.