Blue Cross and Blue Shield of Louisiana has lost its legal challenge against CMS over how its 2025 Medicare Advantage star ratings were calculated.
On July 9, the U.S. District Court for the District of Columbia ruled that CMS acted within its authority when it assigned the health plan a 3.5-star rating after the company consolidated two MA contracts in 2024.
At the center of the dispute was how CMS evaluates special needs plan care management. CMS initially did not include data from the discontinued contract in the 2025 rating but later reversed course after BCBS argued the data should be used, expecting it would boost the plan’s overall score. Instead, the plan received a lower-than-expected score on the SNP measure, and its overall star rating stayed at 3.5 stars.
The insurer then sued CMS, claiming the agency violated its own rules by including that data. The court found that CMS followed its regulations, which require using data from both contracts during the first two years after a merger. The judge also said CMS adequately explained its actions and largely acted based on the insurer’s own request, thereby denying BCBS’s request to have its rating recalculated.
CMS has been sued over star ratings by several insurers this year after some successfully challenged their 2024 ratings, leading the agency to recalculate star ratings for every MA contract. Alignment Healthcare won its challenge in June, Florida Blue lost in May, and CMS revised ratings for UnitedHealthcare and Centene after courts ruled in their favor earlier this year.
