GOSHEN — After the hiring of a full-time dentist allowed the county health department’s juvenile clinic to see more patients, health officials decided to update fees for the first time in years.

The Elkhart County Health Department hired Dr. Jason Maxwell to work full-time in the Healthy Beginnings pediatric dental clinic in January. Health Officer Lydia Mertz told the Elkhart County Commissioners on Monday that the clinic fees hadn’t been touched since the last time they had a full-time dentist 14 years ago.

“They are way behind what they should be. We were charging people $5 for a sealant, for example, and that wouldn’t even pay for the sealant,” she said. “So what we’re trying to do is update them to at least pay for themselves, or a little more even, so that the dental clinic can pay for itself.”

The new fees range from about $35 for X-rays to $359 for a resin-based composite crown. Sealant in the new fee schedule is $62 per tooth.

The fees represent what they would charge private insurance companies and are based on local customary fees and recommendations from dental associations, Mertz said. But it doesn’t represent what the clinic actually charges most of its clients.

Medicaid covers many of their clients, she said, and the department has no control over what Medicaid will pay for. Many of the families who come to the clinic are also “cash paying” customers, whose income is too far above the federal poverty level to receive Medicaid but too low to afford full price for the health care they need.

“We hardly ever see private insurance. On occasion we will, but hardly ever,” Mertz told the commissioners. “Most of what we see are Medicaid. We also see some people who kind of fall through the cracks. They don’t qualify for Medicaid for one reason or another, but they’re certainly living in poverty. So that’s when we use the sliding fee scale.”

On the income-based scale, those families are charged 50 percent or less of the private insurance rates. So for the same X-rays, they would be charged closer to $4, $8 or $15; for the crown, about $45 to $180; and for the sealants, a range of $7.75 to $31.

Mertz said the proposed fees, which were recommended by the county Health Board, are the first in a series of planned updates. She said they didn’t want to impose all of the increases on their clients all at once.

She also said the clinic has experienced a shortage of dentists who are willing to work for less than they can earn in private practice, which hurt their ability to see patients. Maxwell worked in the clinic as a volunteer for several years before agreeing to come on full-time.

“For years we’ve had wonderful dentist volunteers taking care of our patients, but really couldn’t grow the dental clinic without a full-time commitment,” Mertz said. “He has instituted a number of changes for the better, and we can now see more patients and take better care of them. We were really happy he made the decision to work with us.”

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