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ODSP medical
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ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

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Facing a big
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I know ODSP law.
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Simon Shields, LLB
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ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

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(simonshields@isp.com)

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Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
advise - all
conveniently
online.

_____

Simon Shields, LLB
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Want to get on ODSP?

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legal help let's
put together the
best application
we can.

_____

Simon Shields, LLB
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ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

Talk to the Lawyer

(simonshields@isp.com)

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Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
advise - all
conveniently
online.

_____

Simon Shields, LLB
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Want to get on ODSP?

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legal help let's
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best application
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Simon Shields, LLB
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ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

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Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
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conveniently
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_____

Simon Shields, LLB
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Want to get on ODSP?

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legal help let's
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_____

Simon Shields, LLB
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ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

Talk to the Lawyer

(simonshields@isp.com)

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Background


Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
advise - all
conveniently
online.

_____

Simon Shields, LLB
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legal help let's
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_____

Simon Shields, LLB
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Background


ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

Talk to the Lawyer

(simonshields@isp.com)

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Background


Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
advise - all
conveniently
online.

_____

Simon Shields, LLB
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Want to get on ODSP?

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legal help let's
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we can.

_____

Simon Shields, LLB
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Background


ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

Talk to the Lawyer

(simonshields@isp.com)

Services
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Background


Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
advise - all
conveniently
online.

_____

Simon Shields, LLB
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(simonshields@isp.com)

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Background


Want to get on ODSP?

With my online
legal help let's
put together the
best application
we can.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

Talk to the Lawyer

(simonshields@isp.com)

Services
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Background


ODSP medical
eligibility appeal?

After over 900
SBT appeals I should
be able to help - all
conveniently online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

Talk to the Lawyer

(simonshields@isp.com)

Services
How It Works
Background


Facing a big
overpayment
assessment?

I know ODSP law.
Let me assess and
advise - all
conveniently
online.

_____

Simon Shields, LLB
Lawyer and Author of Isthatlegal.ca

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(simonshields@isp.com)

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Background


Want to get on ODSP?

With my online
legal help let's
put together the
best application
we can.

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Simon Shields, LLB
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Ontario Disability Support Program (ODSP) Law
(01 November 2012)

Chapter 4 - Benefits


  1. Important Explanatory Note
    (a) General
    (b) Benefits Included in Budgetary Requirements
    (c) Listed Benefits
    (d) Extended Health Benefits
    (e) Discretionary Benefits
    (f) "Employment Assistance"
  2. Listed Benefits
    (a) Overview
    (b) Health and Disability-Related Benefits
    . Drug Card
    . Dental, Vision and Hearing Items and Services
    . Eye Tests
    . Medical Supplies
    . Medical Transportation
    . Assistive Devices Contribution and Assessments
    . Mobile Device Batteries and Repairs
    . Necessary Home Repairs
    . Charitable Institution Resident Transportation
    . Second Residence Expenses During Employment Training
    . Chronic Care Institution Extra Services and Items
    (c) Winter Clothing for Children
    (d) Back to School
    (e) Community Start Up and Maintenance Allowance (CSUMA)
    (f) Guide Dogs
    (g) Employment-Related Benefits
    . Employment and Training Start-Up Expense Assistance
    . On-Going Employment Expenses Assistance
    . "Loss of Eligibility by Employment" Bonus
    . Upfront Child Care Expense Benefit
  3. Extended Health Benefits
    (a) Overview
    (b) Drug Card Extended Benefit Where Workfare Violation Ineligibility
    (c) General Extended Health Benefits Where Income Ineligibiity
    (d) "Re-Extended" Grand-Parented CPP-Eligible Recipients
    (e) One-Month Hep C Settlement Extended Health Benefit
  4. Discretionary Benefits
    (a) Welfare (Ontario Works) Discretionary Benefits
    (b) Low-Cost Energy Conservation Benefit
  5. Date of Benefit Entitlement
________________________________________


1. Important Explanatory Note

(a) General

In addition to basic financial "income support" for shelter and basic needs (which includes special diet, and the pregnancy and northern allowances: see Ch.3) - a range of additional "benefits" are available to ODSP recipients - particularly for medical and disability-related needs. These are explained in this chapter.

When considering benefits however, it is important to know how the particular benefit item is categorized in ODSP law. The categorization can make a difference as to whether the benefit is subject to reduction by reason of chargeable income (see Ch.7 "Income Rules") or overpayment deductions (see Ch.11 "Director Decisions"). Further, only some (but most) types of benefit decisions may be appealed to the Social Benefits Tribunal (see Ch.12 "Appeals and Other Remedies") - others may face a much more cumbersome court process.

The specifics of these deduction and appealability issues are dealt with in the chapters referenced. Just note for the time that it is important when considering them for deductibility and appeal purposes to locate them within the four categories set out in this chapter:
  • Benefits Included in Budgetary Requirements

  • Listed Benefits

  • Extended Health Benefits

  • Discretionary Benefits
(b) Benefits Included in Budgetary Requirements

These are benefits for special diet, pregnancy and the northern supplement. They are discussed and explained in Ch.3 "Income Support".

These benefits are included in the amount known as "budgetary requirements" (BRs), which is the base "needs" figure in ODSP law uses to determine the amount of income support payable. Income support equals budgetary requirements minus chargeable income (see Ch.7 "Income Rules"). Being included in BRs means that these benefits (along with the other parts of budgetary requirements) can be reduced by "chargeable income" (such as earnings income) all the way down to zero (at zero ODSP eligibility is usually lost). Putting it another way, these benefits are reducible by chargeable income.

Further (as discussed in Ch.11, s.3: "Director Decisions: Overpayments") the amount of income support can be reduced by overpayment deductions (usually at 5 or 10%). As these benfits are included in income support by virtue of being included in budgetary requirements, they also are reducible by overpayment deductions.

The Director is given very little discretion in the granting and amount of these benefits, and generally the decision to grant and the amount is governed by clear rules. The decision to grant or refuse any of these supplements IS appealable to the Social Benefits Tribunal (see Ch.12: "Appeals and Other Remedies").
Note:
Changes to the "date of grant" rule [Reg s.17] (see Ch.10 "Applications and Procedures") regarding when ODSP eligibility as a "person with a disability" commences, may sometimes result in retroactive ODSP income support eligibility. Such retroactive eligibility DOES include retroactive eligibility for "benefits included in budgetary requirements" [Reg s.17(2)].
(c) Listed Benefits
Terminology Note:
ODSP law actually calls these items "benefits". I use the term "listed benefits" to distinguish them from the other "benefit-like" items discussed in this chapter.
"Listed benefits" are the items covered in section 2 of this chapter and included in the big list at s.44 of the ODSP General Regulation. They include: a variety of health and disability-related benefits (ie. drug card, dental, vision, hearing, medical supplies and transportation, etc), winter clothing allowance, back-to-school allowance, community start-up and maintenance (CSUMA allowance, guide dogs allowance, employment and training start-up assistance, up-front child care assistance and others [Reg s.44]).

Most of these are delivered to the recipient in the form of a financial addition to their cheque. Some however are provided otherwise, such as the "drug (entitlement) card" which vouches for payment of drug expenses to pharmacists (but not the "co-payment").

Unlike the benefits discussed immediately above, the value of these "listed benefits" is NOT included within the meaning of "budgetary requirements". This means that in determining the amount of income support, amounts for benefits are NOT REDUCIBLE by chargeable income (such as employment income). This means that if chargeable income reduces the financial amount of income support down close to zero (but not to or below zero), then the "benefit" will still be provided in full. (subject to any overpayment deductions - see below).

However, the value of these "listed benefits" IS included in the meaning of "income support" [Act s.2] and (like "benefits included within budgetary requirements") therefore they ARE REDUCIBLE by overpayment deductions.

Like "benefits included in budgetary requirements" (above), "listed benefits" are generally "non-discretionary". This does not mean that they MUST be provided simply if requested, but it does mean that generally there are defined eligibility criteria for their being granted and their amounts. If these criteria are met then the recipient has a mandatory entitlement to the benefit.

The decision to grant or refuse any listed benefit IS appealable to the Social Benefits Tribunal (see Ch.10: "Appeals and Other Remedies").
Note:
Changes to the "date of grant" rule [Reg s.17] (see Ch.10 "Applications and Procedures") regarding when ODSP eligibility as a "person with a disability" commences, may sometimes result in retroactive ODSP income support eligibility. While these "listed benefits" are included in the definition of "income support" [Act s.2 Definitions], they are specifically excluded from coming under this retroactivity [Reg s.44(1.0.0.0.1).
(d) Extended Health Benefits

When ODSP eligibility is lost by reason of excessive income (reducing income support to zero or below), sometimes health benefits (particularly the drug card and other medical items) can be continued. This is called the "extended health benefit".

Remember that "income support" equals "budgetary requirements" minus "chargeable income". The "extended health benefit" is achieved by adding the value of the health benefits required to the value of the budgetary requirements, in order to reduce the impact of chargeable income. When this is done it can (depending on the arithmetic) return "income support" to above zero, and thus "re-establish" the "extended health benefit" eligibility [note that it will NOT re-establish the main income support as the change is just done for extended health benefit calculation purposes: s.44(7)].

There are other situations of categorical ineligibility (see in s.3 below) where health benefits can be similarly extended.

While the value of needed "extended health benefits" may be added to the value of "budgetary requirements" solely for the purpose of determining extended health benefit eligibility, their value does not properly form a part of BRs for any other purposes. Therefore extended health benefits ARE NOT reducible by chargeable income. Thus even if chargeable income brings income support close to zero the full amount of the extended health benefit will continue.

Similarly, "extended health benefits" are expressly excluded from the definition of "benefits" contained in the Act [Act s.2], which means that they are also excluded from the definition of "income support" (which includes "benefits") [Act s.2]. This means that they ARE NOT REDUCIBLE by overpayment deductions.

Decisions regarding extended health benefits may be appealed to the Social Benefits Tribunal [Act s.21].
Note:
Changes to the "date of grant" rule [Reg s.17] (see Ch.10 "Applications and Procedures") regarding when ODSP eligibility as a "person with a disability" commences, may sometimes result in retroactive ODSP income support. Such retroactive eligibility does NOT include retroactive "extended health benefits" as they are not included in the definition of "benefits" - and therefore not included in the definition of "income support" [Act s.2 Definitions].
(e) Discretionary Benefits

"Discretionary benefits" are items which may - or may not - be provided by local welfare (Ontario Works) administrators as per local welfare policy. They are also available to ODSP recipients (see s.4 below).

These can include expenses associated with dental services, prosthetic appliances (for these see also the Ontario Assistive Devices Program), eyeglasses, vocational training, travel and transportation, moving, funeral and burial related expenses and others [OW General Reg s.59].

The value of discretionary benefits (being governed by welfare or Ontario Works law) is NOT included within "budgetary requirements" nor within "income support". As such they are NOT subject to reduction for either chargeable income or overpayment deduction.

Note however that the decision to grant or refuse a discretionary benefit IS NOT appealable to the Social Benefits Tribunal [OW Act s.26(2)] (see Ch.12 "Appeals and Other Remedies").

(f) Workfare and Employment Supports

There is another category (which the Ministry touts as a form of "benefit") - of employment-related programs (see Ch.13: "Workfare and Employment Supports").

For the most part (the "workfare" part) this comprises involuntary duties on non-disabled adult members of the benefit unit (ie. spouses and dependent adults) to seek employment (and more remunerative employment), and/or to participate in the local welfare (Ontario Works) "workfare" program.

Recipients and members of their benefit unit who are not required to engage in these "workfare" programs may (in some circumstances) elect into a similar voluntary ODSP program, called "employment supports".


2. Listed Benefits

(a) Overview

The following listed benefits (each of which is discussed in turn below) are available - upon qualification - to the members of a benefit unit, unless otherwise specified [Reg s.44]:
  • Health and Disability-Related Benefits (drug card; dental, vision and hearing items and services; eye tests; medical supplies; medical transportation, assistive devices expenses and assessment, mobility-device batteries);

  • Winter Clothing allowance;

  • Back-to-School allowance;

  • Community Start-up and Maintenance Allowance ("CSUMA");

  • Guide Dog expenses;

  • Employment-related Benefits;

  • Up-front Child Care expense;

  • Necessary Home Repairs;

  • Chronic Care Institution Extra Services and Items;

  • Second Residence Expenses During Employment Training;

  • Charitable Institution Resident Transportation.
While these benefits are available to all members of a benefit unit receiving welfare assistance, they can also be "extended" - in whole or part - to others in some circumstances. Such extensions apply to persons who have applied for (and still waiting determination of) ODSP eligibility, who are receiving payments under the Hepatitis C Settlement Agreement and those who have become temporarily ineligible by reason of excess income. These "extensions" are explained below.

(b) Health and Disability-Related Benefits

. Drug Card

ODSP recipients receive, on a monthly basis, a "drug card" which - when presented to drug-providers - vouches for payment of doctor-prescribed drugs listed by the Ministry of Health. It does not however cover the "co-payment" charged by most pharmacists.

The drugs covered by a 'drug card' are listed in the Ontario Drug Benefit Formulary.
Note:
Persons needing a "drug card" who have neither ODSP eligibility or ODSP 'extended health benefit' coverage [see s.3 below] may establish drug coverage eligibility if they receive "home care services" [Reg 201/96, s.2(1)1 under the Ontario Drug Benefit Act]. Application for home care services (typically assistance with the activities of daily living for disabled persons) may be made through your local CCAC Community Care Access Centre.
. Dental, Vision and Hearing Items and Services

For members of the benefit unit other than dependent adults (see Ch.2: "Claimants"), the cost of Minister-approved dental, vision and hearing services, and vision and hearing items. (excluding "periodic oculo-visual assessments" - otherwise covered).

MCSS Schedule of Dental Services and Fees (March 2003)

. Eye Tests

For all members of the benefit unit, "periodic oculo-visual assessments" at a rate of $39.15 each [Reg s.44(1)paras.(1.1), s.44(1.0.0.1)]. Such assessments are only available if the member of the benefit unit has not had such an assessment (or a major eye examination) within the past 24 months, and as long as such assessment is not OHIP-covered.

References to "major eye examinations" and "periodic oculo-visual assessments" include where they are performed by an optometrist or by a physician.

. Medical Supplies

The cost of diabetic and surgical supplies (including dressings), as long as such cost is not otherwise reimbursible to the member (for example under a private medical insurance policy).

. Medical Transportation

The cost of transportation required for medical treatment, as long as such cost is not otherwise reimbursible to the member and as long as the expense is $15 or more per month.

When very frequent medical appointments are required the Director may provide the member with transit tickets, tokens or a monthly pass.

In Director, ODSP v Billotte (Div Ct, 2009) the court held that voluntary attendence at a day program, although of benefit to the recipient, did not constitute "medical treatment" to justify a medical transportation allowance.

. Assistive Devices Contribution and Assessments

The province runs a program under the Ministry of Health and Long-Term Care called the "Assistive Devices Program" (ADP). It provides partial subsidization for a variety of illness or disability-related assistive devices such as motorized wheelchairs ("mobies"), artificial limbs, etc. ODSP will pay the "consumer contribution" toward such purchases if they are otherwise approved under the ADP for the member of the benefit unit.

Assistive Devices Program

Similarly, ODSP will pay the expense for an assessment - to a fixed amount - to determine if ADP eligibility is merited, as long as such cost is not otherwise covered.

. Mobile Device Batteries and Repairs

The cost of batteries and necessary repairs for mobile devices ("mobies"), as long as such cost is not otherwise reimbursible to the member.

. Necessary Home Repairs
Note:
This benefit is being phased out [Reg 44(5,5.1,5.2)]. Applications made on or before 30 June 2012, if they meet the eligibility requirements, will still be paid out to 31 December 2012. This deadline may be extended if the Director is satisfied that any of the following circumstances apply:
  1. Contractual disputes between the recipient and the contractor or the person doing the work prevent completion of the home repairs before December, 31, 2012;

  2. There are unforeseen circumstances, where an independent expert who is approved or contracted by the Director confirms that because of the circumstances the repair cannot be completed before December 31, 2012;

  3. The home repairs could not be completed before December 31, 2012 because of the condition of the recipient’s or a member of the benefit unit’s health.
The province has stated, in vague terms, that funding for this program will be consolidated into other future housing and homelessness support services: Ontario Integrating Housing and Homelessness Supports
The terms of this benefit, as they read before 30 June 2012, are set out below.

The Director, at their discretion, may grant a home-owner recipient an amount for home repairs "necessary in order to permit the home to continue to be used as a principal residence" [Reg 44(1)8]. If the recipient is the co-owner of the residence then only their proportionate share of the repair expense will be covered [Reg 44(5)].

However such assistance is prohibited in the following circumstances:
  • other sources of funding are available;

  • a repair loan is received under the federal Residential Rehabilitation Assistance Program (RRAP);

  • the cost is for digging a well;

  • for internal renovation or remodelling except for privacy purposes;

  • the cost is for new foundations;

  • for a new furnace, unless the existing one is unsafe;

  • for insulation, unless minimum thermal insulation Building Code Act standards [Reg 403/97, s.9.25] are met AND the expected heating efficiency savings render the expenditure reasonable;

  • the market value of the premises "does not warrant incurring the cost of the repairs."
Otherwise, whether to grant the benefit and its amount is at the discretion of the Director, which must be exercised reasonably and fairly. Appeal of any decisions may be made to the Social Benefits Tribunal (see Ch.12 "Appeals and Other Remedies").

. Charitable Institution Resident Transportation

Recipients resident in facilities operated by charitable institutions so designated under the Charitable Institutions Act may be granted an amount up to $30 per month "in order to travel in the community" [Reg 44(1)9].

. Second Residence Expenses During Employment Training

Recipients required to temporarily change residence in order to participate in an employment training program, and who were granted eligibility as being either (1) a "person with a disability" (PWD), (2) grand-parented into ODSP from FBA as a disabled or PUE person, or (3) due to being in receipt of a CPP-disability pension may be granted an additional benefit up to $455 per month for "costs of maintaining the normal place of residence during the training" [Reg 44(1)10]. This benefit is not available to the extent that such expenses are otherwise covered.

. Chronic Care Institution Extra Services and Items

The Director may, at their discretion exercised reasonably and fairly, grant recipients resident in chronic care facilities a benefit "for dental services, dentures, prosthetic devices including eye glasses, clothing, wheelchairs and wheelchair accessories" [Reg 44(1)1(iv)].

Coverage here is similar to that provided under the "discretionary benefits" category (see s.4, below), though they are provided through the ODSP Director.

(c) Winter Clothing for Children

When the applicant and their dependent minor/s (under 18 years old) are eligible for assistance in October or any subsequent month of the year (ie. to 31 December), the amount of $111 per dependent minor. However there is no eligibility if a winter clothing allowance has already been paid out that year for the dependent minor under any other OW or ODSP entitlement.

This benefit terminates July 2008, the province merging it into the monthly "Ontario Child Benefit" [see Ch.7, s.6(d)].

(d) Back to School

When the applicant and their dependent minor/s are eligible for assistance in either July or a subsequent month of the year, and where the dependent minor is or will be attending school, an amount once a year as follows:
- $73 for each dependent child who is four years of age or more and less than 13 years of age, and

- $134 for each dependent child who is 13 years of age or older.
For purposes of the back-to-school allowance ONLY, ages are assessed at 31 December of the year under consideration.

However there is no eligibility if a back-to-school allowance has been already paid out that year for the dependent minor under any other OW or ODSP entitlement.

This benefit terminates July 2008, the province merging it into the monthly "Ontario Child Benefit" [see Ch.7, s.6(d)].

(e) Community Start Up and Maintenance Allowance (CSUMA)
Note:
This benefit will be terminated, with the last applications being taken on 31 December 2012. The province intends to replace it with a new program, delivered in conjunction with the Ministry of Housing, to provide a range of housing expense-related assistance (first and last month's rent, arrears, etc) at that time. While ill-defined at present, here is what the province posted on the new program at September 2012:

Consolidating Housing and Homeless Programs
The terms of the CSUMB, up to and including 31 December 2012, are as follows.

An amount, paid no more frequently than every 24 months and if the recipient requires it, to establish a new residence (the law is silent as to whether this includes new residence outside of Ontario, thus leaving it to the Director's discretion) or remain in his existing residence, if ANY of the following conditions are met [Reg 44(1)4,(1.1)]:
  • the recipient is being discharged from "an institution which provided for his or her basic needs and shelter" (eg. hospital, homeless shelter, residential substance abuse recovery facility, women's shelter, jail or penetentiary, nursing home); (see Ch.3 "Income Support: Institutional Residents");

  • it would be "harmful to (the recipient's) health or welfare to remain in his or her current place of residence";

  • the recipient has been evicted from his or her current residence;

  • the recipient "has received a notice of termination or a notice to quit with respect to his or her tenancy or a final demand for payment under a mortgage and has satisfied the administrator that, if a payment is made, he or she will not be evicted from his or her current residence"; or

  • has had any energy source (ie. heat, light, cooking, etc), water and sewage, or rental of a furnace or hot water heater discontinued, or where notice of impending discontinuance has been given, and where the payment of arrears will result in the resumption or prevention of discontinuance, as the case may be.
The amount of the CSUMA shall not exceed $799 for a single recipient or $1500 for a recipient with dependent minors, subject a discretionary increase in that same amount by the Director if "exceptional circumstances" exist. Interpretating what constitutes "exceptional circumstances" is left to the discretion of the Director, which must be exercised reasonably and fairly.

There is no eligibility for a CSUMA if it has been already paid out in the 24-month period under any other OW or ODSP CSUMA entitlement, except that where the maximums have not yet been exceeded additional payments may be made to the maximums (or to such maximum as may be extended by the administrator in "exceptional circumstances", above).

(f) Guide Dogs

If a member of the benefit unit has a guide dog, an amount not exceeding $74 (increasing to $75 on 01 November 2012) for the care of the guide dog.

There are no forms of ODSP available to assist with the care and keeping of pet animals.

(g) Employment-Related Benefits

. Employment and Training Start-Up Expense Assistance

If a recipient, spouse, dependent adult (who is not attending secondary school full-time), or a dependent child (who has received an Ontario Secondary School Diploma or its equivalent) of the benefit unit [Reg 44(1)6]:
  • begins or changes employment,

  • begins an "employment assistance activity" (see Ch.13 "Workfare"),

  • begins "any other activity intended to assist the person to become and stay employed that is approved by the Director"
the Director may grant an amount "for expenses approved by the Director and reasonably necessary" for the change or commencement, up to a maximum in any twelve-month period for any member of $500.

If assistance has already been paid under this category under the similar welfare (Ontario Works) provision (see that program, Ch.4 "Benefits"), the maximum allowance provided for here shall not be exceeded by any further allowances paid under this ODSP provision [Reg 44(2)].

. On-Going Employment Expenses Assistance

The Director may provide members of the benefit unit who receive income from employment or an employment assistance activity, or net income from a business, an amount up to $100 per month for work-related expenses [Reg 44(1)6.2], as follows:
  • if they are a recipient or spouse in the benefit unit, they are NOT in attendence at a post-secondary institution at the following levels or higher:

    - where the member is disabled (ie. a "person with a disability" under s.4 of the ODSP Act, or of equivalent status: See Ch.9: "Person With a Disability"), 40% of a full course load;

    or

    - where the member is a not-ODSP-disabled, 60% of a full course load.

  • if they are a dependent adult in the benefit unit, they are NOT in attendence at secondary school full-time or at a post-secondary institution with a 60% course load or higher.
This benefit is apparently being implemented by the Director as a flat rate monthly entitlement of $100 - NOT as an 'expense-compensation' scheme where receipts would have to be shown, and only those compensated for.

. "Loss of Eligibility by Employment" Bonus

Further, where a benefit unit is about to lose ODSP income support eligibility by reason of excess income, and where part of the benefit unit's income is from employment, a training program or a business, then the Director may grant an amount up to $500 per member. This is only available once every year, and is paid in the month before eligibility ends [Reg 44(1)6.1].

Unlike the start-up expense assistance there is no legal requirement that this payment be related to expenses, and thus appears to be a "bonus".

. Upfront Child Care Expense Benefit

Assistance is available for a recipient, spouse, dependent adult or dependent minor member of the benefit unit who requires up-front child care fee assistance for a dependent child in order to begin, change or maintain employment, a welfare employment assistance activity, or any other Director-approved "activity intended to assist the person to become and stay employed" [Reg 44(1)7].

The maximum amount payable for this annually is the same amount as the monthly child-care income deduction set out in s.38(1)(iv) [see Ch.7, s.3(d): "Income Rules: Earnings Income Treatment: Child Care Expense Exemption"]. These deduction maximums are (provided that such amounts are not otherwise reimbursible to the member):
  • the actual amount paid if it is paid to a person licensed under the Day Nurseries Act; or

  • otherwise $600.
No up-front child care benefit is payable for child-care provided by a member of the benefit unit.

Similar up-front child care assistance is available under the welfare (Ontario Works) OWA program, but the total amount from both programs shall not exceed the maximums set out above [Reg s.44(3)].

The effect is to provide the assistance for a month's pre-payment, but only once annually.


3. Extended Health Benefits

(a) Overview

ODSP law recognizes the disruption that can be caused by abrupt termination of some health care benefits - particularly drug coverage - when a person is doing their best to become self-sufficient. Therefore, in the following circumstances, some or all health benefits are "extended" (EHBs) despite the benefit unit's (or a member's) (usually temporary) ineligibility for assistance [Act s.49.1].
Note:
Properly the legal criteria for such extension is: "(i)n order to provide an incentive to recipients of income support to become self-sufficient and to support persons who were recipients in remaining self-sufficient: [Act 49.1]. However it is (quite reasonably) extended in hardship cases unrelated to self-sufficiency efforts.
(b) Drug Card Extended Benefit Where Workfare Violation Ineligibility

Drug card coverage is extended to a dependent adult or spouse in the benefit unit where that member's inclusion in the benefit unit for income support purposes is temporarily suspended by reason of their workfare violation [see Ch.13, s.2(c): "Workfare and Employment Supports: Workfare for Non-Disabled Adults: Non-Compliance], and where the member "requires the drugs referred to in that subparagraph for a serious illness or serious health condition" [Reg s.24, 44(6)].

(c) General Extended Health Benefits Where Income Ineligibility

Recall the basic social assistance principle that "income support" equals "budgetary requirements" minus "chargeable income" (see Ch.3: "Income Support: Budgetary Requirements").

Where eligibility for income support is lost by reason of excess income AND a member requires any of the below-listed health benefits, the value of those health benefits is "added" to the "budgetary requirements" in the above calculation - BUT ONLY for the below-listed health benefit eligibility purposes: it does NOT reinstate the main income support. The effect of this is to reduce the impact of the income, and - if sufficient in value - to re-establish the below-listed health benefits eligibility.

This provision applies to the following health benefits ONLY (discussed in s.2, above) [Reg s.45(1)]:
  • drug card;

  • dental services, and hearing and vision services and items;

  • diabetic and surgical medical supplies;

  • medical transportation;

  • the consumer contribution required in the Assistive Devices Program (ADP); and

  • eye tests.
Important Note:
This provision [Reg 45(1)] was extensively amended by Reg 121/09, s.8, effective 27 March 2009 [creating the new Reg 45(1)-(1.3)]. I have reviewed these amendments and am presently uncertain as to their intended legal effect, and have been unable to locate any Ministry publications explaining them. What follows is my 'best guess' as to their legal effect.

Briefly, it appears that persons receiving the Extended Health Benefits (EHBs) based on eligibility established prior to 27 March 2009 (ie. by reason of excess income as described above) will continue to have eligibility for them as long as they meet the original eligibility criteria (ie. medical eligibility for the specific benefit, and income less than the combined value of the budgetary requirements and the required health benefit) are still met. This is an obvious form of 'grand-parenting'.

However, for new applicants (after 26 March 2009)- or for those whose EHB 'grand-parenting' as described here - is 'broken' by lack of EHB eligibility for even one month, new rules apply.

These new rules are almost identical to the old rules, except that they seem to require that this general 'income ineligibility' form of EHB eligibility may now
only be established when the applicant was in receipt of 'regular' income support (ie. shelter and basic needs) in the month before they seek EHBs
(technically, an EHB is not "income support" under ODSP legislation). The effect seems to be that, while - before the amendment - a person who was NOT receiving ODSP before they asked for EHB could get it if they had medical need and met the income requirement, AFTER the amendment EHB is only available to someone who was receiving 'regular' ODSP income support in the month immediately preceding their request for EHB.

It may be that these amendments are just to tidy some perceived 'loopholes' in the previous Reg s.45(1) wording, as I can't imagine there were many people seeking EHBs who were not already on ODSP. In any event, I welcome anyone's thoughtful input into the interpretation of these new Reg provisions: s.45(1)-(1.3).
(d) "Re-Extended" Grand-Parented CPP-Eligible Recipients

Chapter 2 explains the concept of "grand-parenting", where rights established by recipients under the old Family Benefits Act (FBA) provisions are preserved in the new ODSP program - often despite ineligibility under ODSP. This concept is most relevant to establishing "grand-parented" ODSP eligibility for persons formerly medically-eligible under the former Family Benefits Act (FBA) at June of 1998.

There is however a further (obscure) extended health benefits provision that applies to (some) persons who were recipients of FBA at January 1987. These are recipients who at that date received token FBA assistance ($2.50 per month) because their eligibility was otherwise eliminated by CPP (or QPP) pension income. The token amount paid under the law at that time was the "old" way in which "extended health benefits" where achieved (because such benefits were only available to FBA assistance "recipients").

These (few) current recipients, who were grand-parented in June of 1998 have had health benefit coverage "re-extended" for any month in which they are otherwise ineligible due to such [CPP or QPP] income [Reg 45(2)]:
  • drug card;

  • dental, hearing and vision services and items;

  • medical supplies;

  • medical transportation;

  • ADP assistance (but not for assessments); and

  • eye tests.
(e) One-Month Hep C Settlement Extended Health Benefit

Persons who received social assistance (welfare or ODSP) at April 1, 1999 and who at any time receive payments for "loss of income or a loss of support" under the 1986-1990 Hepatitis C Settlement Agreement (NOT the Hepatitis C Plan: see Ch.8 "Asset Rules") have extended health benefits (listed below) for that month only, if receipt of such monies would otherwise render them ineligible for excess income [Reg 45(3)].

Note that such payments are treated as assets in the months following receipt, and as such (if large enough) typically disentitle the recipient from ongoing ODSP eligibility (see Ch.8 "Asset Rules: Overview"). This is why the extension is characterized as "one-month".

This provision applies to the following health benefits (see s.2):
  • drug card;

  • dental, hearing and vision services and items;

  • medical supplies;

  • medical transportation;

  • ADP assistance (including eligibility assessments);

  • eye tests;

  • extra institutional services and items;

  • mobility device batteries and repairs;

  • eye tests.

4. Discretionary Benefits

(a) Welfare (Ontario Works) Discretionary Benefits

Municipalities (and other local welfare or Ontario Works providers such as Indian bands) may provide a (variable) range of other benefits under their welfare programs (see that program, Ch.4, s.4 "Benefits: Discretionary Benefits"). These "discretionary benefits" are ALSO available to ODSP recipients including those receiving Assistance for Children with Severe Handicaps (ACSD: see Ch.5) [OW Act, s.8].

Such "discretionary benefits" may include [OW Reg s.59]:
  • the cost of dental services;

  • the cost of one or more prosthetic appliances, including eye-glasses;

  • the cost of vocational training and retraining;

  • the cost of travel and transportation;

  • the cost of moving;

  • the cost of a funeral and burial and the extraordinary costs of transporting a deceased person;

  • any other special service, item or payment authorized by the Director (of Ontario Works).
"Discretionary benefits" under welfare have limited "extended coverage" provisions (similar to extended health benefits coverage: see s.3, above) where social assistance (welfare or ODSP) ineligibility is due to employment income.

Inquiries and applications should be directed to your local Ontario Works office.

(b) Low-Cost Energy Conservation Benefit

The Director, at their discretion exercised in advance of any expenditure, may provide a benefit to assist in "paying for low-cost energy-conservation measures to the recipient"s principal residence" [Reg 45.2].


5. Date of Benefit Entitlement

I have often ranted (off-line) about the formalistic focus of OW/ODSP administration on the 'date of application' as the initiating (and limiting) act in any social assistance entitlement claim - be it for main ODSP income support or for separate "benefits". After all, if a person was eligible two years before they applied - and can prove it - why should the fact that they applied 'late' be held against them? If the purposes of the programs are to assist impoverished and otherwise eligible recipients, why apply the unrealistic (and very middle-class) premise that they only 'want' the income support or benefit when they first apply.

This issue, referred to as "date of grant" when considering primary ODSP eligibility, is discussed at length in Ch.10, s.4(b): "Applications and Procedures: Date of Grant". In that section I have included a case note on the recent Smith v ODSP (Div Ct, 2008) case. That case - while relevant to establishing a main eligibility "date of grant" PRIOR to the date that the application was completed (ie. before the DDP forms where filed), was in fact a case about retroactive special diet allowance (based on special diet rules as they were before the restrictions imposed in November of 2005). Smith provides some guidance to discretionary factors that the Director may apply in granting benefits retroactively (that is, IF the 'entitlement date' for the particular benefit is not determined plainly by statute or regulation, as it now is with the new special diet regime).

Anyone considering seeking retroactive benefits (ie. before the date that they applied for them), should review that case carefully.
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