CMS appealed the Clover ruling and Clover still gets paid either way
CMS filed its notice of appeal on 7/21. Three things:
It’ll take a while. Eleventh Circuit appeals run roughly 10–15 months, so a decision lands late 2027 at the earliest.
No stay. CMS didn’t ask to pause the ruling, so it already recalculated. Clover’s PPO went 3.5 > 4.5 stars, HMO 4 > 4.5, for 2027. Bonus payments flow monthly through the year, and plans have already set 2027 benefits around the new ratings. Even a CMS win can’t unwind benefits members have already received.
So why appeal? Not for the $120m. The ruling says CMS can’t use measures outside its statutory authority and has to do notice-and-comment first, which constrains the whole rating methodology from 2028 on. Humana and CareFirst are already citing it.
CMS is defending the system from further attack from other plans, rather than trying to fight clover.