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Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date:

Prior Approval Date: 09/28/2007 - 50 - Section 12. Applicant and enrollee protections (Sections 2101(a)) □ Check here if the State elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan. Eligibility and Enrollment Matters 12.1 Please describe the review process for eligibility and enrollment matters that complies with 42 CFR part 457.1120. Response: Missouri maintains an independent State fair hearing process as required by federal law and regulation, as amended for MO HealthNet, SCHIP 1, and SCHIP 2. The State fair hearing process shall provide recipients an opportunity for a State fair hearing before an impartial hearing officer. The parties to the State fair hearing include recipients, his or her representative, or the representative of a deceased recipient's estate, and the MCOs if applicable. The State agency and/or MCO shall comply with decisions reached as a result of the State fair hearing process. MO HealthNet, SCHIP 1, and SCHIP 2 recipients have the right to request information regarding: • The right to request a State fair hearing. • The procedures for exercising the rights to appeal or request a State fair hearing. • Representing themselves or use legal counsel, a relative, a friend, or other spokesperson. • The specific regulations that support or the change in federal or state law that requires the action. • The individual’s right to request a State fair hearing, or in cases of an action based on change in law, the circumstances under which a hearing will be granted. • A State fair hearing within 90 calendar days from the MCOs notice of action. The State must reach its decisions within the specified timeframes: • Standard resolution: • Within 90 calendar days of the date the member filed the appeal with the MCO if the member filed initially with the MCO (excluding the days the enrollee took to subsequently file for a State fair hearing) or the date the member filed for direct access to a State fair hearing. • Expedited resolution (if the appeal was heard first through the MCO appeal process): within three working days from the state agency’s receipt of a hearing request for a denial of a service that: