What does this research mean for the field?

The Categorical Adjustment Index (CAI) significantly increases the probability of Medicare Advantage contracts achieving bonus eligibility, but contracts serving the highest proportion of socially at-risk beneficiaries remain less likely to achieve bonus eligibility even after adjustment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate how Categorical Adjustment Index (CAI) adjustments influence bonus eligibility in Medicare Advantage star ratings.

March 29, 2026JAMA Health ForumOpen Access

Social Risk Adjustment and Bonus Eligibility in Medicare Advantage Star Ratings

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This study aims to evaluate how Categorical Adjustment Index (CAI) adjustments influence bonus eligibility in Medicare Advantage star ratings.
Retrospective cohort panel study design
Analysis of MA contracts with star ratings data from 2014 to 2025
Used publicly available CMS files for data merging
Assessed annual CAI value based on dual eligibility and disability status
Applied fixed-effects linear regression models for analysis
156 (46.0%) of 339 contracts became bonus eligible at least once due to CAI adjustments
Each 0.10-point increase in CAI value increased bonus eligibility probability by 0.16 points
Contracts with highest CAI values were less likely to achieve bonus eligibility even after adjustments

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Implication

A retrospective cohort panel study assesses CAI's impact on bonus eligibility in Medicare Advantage plans, suggesting implications for performance evaluation.

Cite This Study

Anderson et al. (2026) studied this question.

synapsesocial.com/papers/69c8c0b0de0f0f753b39b7eb https://doi.org/10.1001/jamahealthforum.2026.0326

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Implication

A retrospective cohort panel study assesses CAI's impact on bonus eligibility in Medicare Advantage plans, suggesting implications for performance evaluation.

Social Risk Adjustment and Bonus Eligibility in Medicare Advantage Star Ratings

Key Points

Discussion

Implication

Cite This Study

Social Risk Adjustment and Bonus Eligibility in Medicare Advantage Star Ratings

Key Points

Discussion

Implication

Cite This Study

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