CMS Releases Beneficiary-Level Risk Score Files to Support 2026 Part C Bids & ESRD Forecasting

As Medicare Advantage (MA) organizations prepare their bids for Calendar Year (CY) 2026, the Centers for Medicare & Medicaid Services (CMS) has issued comprehensive beneficiary-level files designed to support risk score analysis and bid accuracy. These files represent a critical step in aligning actuarial projections with upcoming policy changes under the finalized payment model. 

This web-ready blog offers a clear breakdown of what’s included, how health plans should use the data, and what it means for strategic forecasting in 2026. 

What's in the CMS Risk Score Files? 

CMS released two distinct files to Medicare Advantage and 1876 Cost Plans: 

  1. Part C Risk Score File 

  1. ESRD Risk Score File 

These files include: 

  • Contract-level, beneficiary-specific risk scores 

  • Medicaid status stratification (Non-dual, Partial Dual, Full Dual) 

  • Monthly segmentation by enrollment type (Institutional, Community, New Enrollee, C-SNP) 

  • Risk scores calculated using both CMS-HCC V24 and V28 for Part C 

  • Risk scores calculated using the 2023 ESRD model for ESRD enrollees 

Risk Adjustment Models Used 

  • Part C Scores: Based on 2023 data, using both 2020 CMS-HCC V24 and 2024 CMS-HCC V28 models. V28 will be used for 2026 payments. 

  • ESRD Scores: Based on the 2023 CMS ESRD model, which continues to apply for 2026. 

CMS provides raw scores; plans must apply normalization factors before using them for financial modeling. 

2026 Normalization Factors to Apply 

Model Type  Factor 

Part C (V28)  1.067 

ESRD Dialysis  1.062 

ESRD Functioning Graft  1.104 

Normalization ensures risk-adjusted payments are correctly scaled to reflect expected population-level costs. 

ESRD File Details 

  • Dialysis: LTI, non-LTI, dual status 

  • Post-Graft: 4–9 months and 10+ months post-transplant 

  • New Enrollee ESRD scores 

  • Additional indicators: transplant status, hospice enrollment, and dialysis months 

File Delivery and Access 

Files were delivered through CMS secure systems: 

  • GENTRAN or Connect:Direct 

Naming Conventions: 

  • Part C: P.Rxxxxx.PTC2026.Dyymmdd.Thhmmsst.pn 

  • ESRD: P.Rxxxxx.ESR2026.Dyymmdd.Thhmmsst.pn 

Strategic Recommendations for MA Plans 

  • Compare RAFs under V24 and V28 to evaluate revenue impact 

  • Stratify scores by Medicaid category for premium adjustments 

  • Integrate transplant, hospice, and dialysis indicators into bid capitation modeling 

  • Apply correct normalization before forecasting 

  • Educate actuarial and risk teams on CMS logic and assumptions 

Contact CMS for Support 

Final Thoughts 

These CMS files are essential for 2026 bid accuracy. They reflect evolving model logic, policy priorities, and the increased complexity of beneficiary stratification in Medicare Advantage. Proactively analyzing this data will help plans optimize bids, comply with CMS expectations, and maintain financial performance in the upcoming cycle.