Right to Know PA Medicaid Payment Rates | The Public Interest Law Center

In Philadelphia and its surrounding counties, children enrolled in Medicaid receive insurance coverage through managed-care organizations (MCOs), which receive money from the state for each patient they enroll based on unpublished formulas.

The MCOs negotiate payment arrangements with dental subcontractors, which in turn contract directly with dentists; the MCOs also negotiate some payment arrangements directly with dentists. The terms of those agreements are also unpublished. However, most low-income children get no dental care at all. The Pew Center on the States rated access to dental care in Pennsylvania an “F” in 2010 and a “D” in 2011, and the federal government has expressed concern about the low percentage of Medicaid children in Pennsylvania who see a dentist in the course of a year. Still, the state refuses to share vital information needed to assess the state’s Medicaid program with the public.

Beginning in 2011, the Law Center filed two requests under Pennsylvania’s new Right to Know Law for financial information about how much money the Pennsylvania Department of Public Welfare (DPW) pays for each child enrolled in Medicaid for dental services in the Philadelphia area — a number that has a direct effect on whether or not children have access to the care they need.