Right to Know PA Medicaid Payment Rates


DHS Fails to Comply with PA Supreme Court Order in Right-to-Know Case

In June 2016, the Commonwealth Court found the Pennsylvania Department of Human Services (DHS) in contempt for its failure to comply with the PA Supreme Court’s order to produce documents showing the rates the department pays to dental providers per our Right-to-Know request.

In 2011, we filed multiple Right-to-Know requests seeking to make public the rates DHS pays dental providers for treating children enrolled in Medicaid. DHS contracts with Managed Care Organizations (MCOs) to subcontract with dental providers who offer care. Sometimes DHS also contracts directly with providers. From our experience in other states, we know that low reimbursement rates can result in systemic lack of access to care.

Our requests were originally denied by DHS, which claimed the rates are “trade secrets,” and therefore protected under the Right-to-Know law. We appealed this denial all the way to the Pennsylvania Supreme Court, which in February 2016 ruled that the rates were in fact public records and ordered DHS to release the rates information within 60 days of the court ruling. DHS, however, only produced the rates that MCOs paid to subcontractors, not the rates they pay directly to providers.

In April 2016, we filed an application to hold DHS in contempt and responsible for civil penalties and legal fees. Following the PA Supreme Court’s June 28th ruling in our favor, DHS is now obligated to produce the rates within 60 days.