Administrative Appeals

Appeal procedures involving MCHCP administrative issues (eligibility, effective date of coverage, etc.) and judicial reviews are available to all plans.

MCHCP Administrative Appeals:

If a subscriber wants to appeal issues regarding eligibility, effective dates, and change of plan request at a time other than Open Enrollment, the subscriber appeals directly to MCHCP’s Board of Trustees. (If the Open Enrollment period is over, and you need to make a plan change, your request must be submitted prior to January 31st. After that date, no appeals for plan changes can be made.) The Board of Trustees or their designee decides on these issues. The Board of Trustees generally meets on a monthly basis.

To ensure the appeal is handled in an expeditious and efficient manner, be sure to include the subscriber’s name, address, MCHCPid or SSN, member’s name for whom the appeal is being submitted and the “specific” circumstances for the appeal. (For example, the subscriber states why he/she is requesting coverage for a specific dependent.)

MCHCP Administrative Appeals are sent to:

Attn: Appeal - Administrative
Board of Trustees
MO Consolidated Health Care Plan
PO Box 104355
Jefferson City, MO 65110-4355

If an appeal is submitted that requests a change in your level of coverage or health plan selection, an Enroll/Cancel/Waive/Change form must be submitted with the appeal. Changes cannot be made without the form, and the effective date of the change may be determined by the date the form is received at MCHCP.

Judicial Reviews:

If you or the plan representative are still not satisfied with the outcome of the appeal procedure, a judicial review may be sought in the appropriate circuit court within 30 days of receipt of the decision (as provided in Chapter 536, RSMo.)