1. ODSP: Know Your Benefits
ODSP Action Coalition
September 2013

2. Who We Are
ODSP Action Coalition has been around for more than 10 years
Advocate for changes to ODSP
Have a shared leadership model:
Made up of people on ODSP, and those who work in this field (at legal clinics, agencies and patient advocacy groups)
This workshop is part of our efforts to build knowledge and confidence in our members for personal and political advocacy

3. Overview Applying for ODSP Rates Income, Earnings, Assets & Changes
Benefits
Mandatory
Discretionary
Employment
Appeals
Tips & Strategies
For more information

4. Applying for ODSP Through Ontario Works (OW) Directly to ODSP
Everyone has the right to apply if they think they fit the definition of disability
You can apply for ODSP in 3 ways:
Through Ontario Works (OW)
Directly to ODSP
If you’re not on OW or don’t qualify for OW
Be “fast tracked” if you are:
Age 65+ and not receiving Old Age Security (OAS)
Receiving CPP-Disability or QPP-Disability
Resident in certain health facilities
CPP-D = Canada Pension Plan Disability
QPP-D = Quebec Pension Plan Disability

5. Applying for ODSP Two different types of eligibility requirements:
1. Financial
Financial eligibility is considered first, before the medical part of the application process
A single person cannot have an income over $1086/month or assets over $5000
Different income and asset limits apply where the benefit unit is larger than a single person
Don’t let a ‘no’ on the financial assessment stop you from applying. Get legal advice or file an appeal on the financials. 5

6. Applying for ODSP 2. Medical
If eligible financially, then given a Disability Determination Package (DDP)
Must meet the definition of a person with a disability as set out in the ODSP Act
Including, 1) that the impairment is continuous or recurrent and expected to last 1+ years; 2) that it results in substantial restriction in daily living; and, 3) has been verified by registered health practitioner in the Province Ontario
The Disability Determination Package includes a number of forms, most of which must be completed by a qualified medical professional. These forms are to prove that you meet the definition of “disabled” in the ODSP Act.
The DDP is submitted directly to the Disability Adjudication Unit (DAU), not your OW or ODSP office, within 90 calendar days
Make sure to keep a copy of the DDP and send it by “registered mail”
The DAU is responsible for determining if a person meets the legislative definition of a “person with a disability” under the ODSP Act.
The DAU may grant a 60 day extension of time to submit the DDP if requested before the 90 days has expired
The DDP (detailed medical info) stays at the DAU – it’s not in the client’s file at the local ODSP office

7. Rates—effective September 1, 2013
ODSP
Basic Needs
Max Shelter
Max OCB
Total
Single
$607
$479 $0
$1086
Couple
$893
$753
$1646
Single Parent +
1 Child
$750
$101
$1604
Couple + 1 Child
$816
$1810
This chart shows you the current rate calculations for some categories of people on ODSP.
Couple -One person in the couple has a disability, the other does not.
Child - under 13 years of age.
There are many rate calculations not shown here, including the double disabled rate:
Double disabled rate – there is a maximum amount that applies when an applicant/recipient and his/her spouse are both people with disabilities (receiving ODSP, CPP-D or were grandfathered from Family Benefits).
Some other living situations where people get different amounts than those listed here also include boarder/lodger rates, a Northern Allowance and supportive residences like long term care or supported group living for people with developmental disabilities.
These shelter rates apply if you are paying what we call ‘market value rent’. Your shelter benefits will be lower if you are in a rent-geared-to-income unit.
Rates change whenever the government decides to change them. This often happens during the provincial budget. Most recently an increase of 1% was applied to both ODSP and OW rates in December The Income Security Advocacy Centre keeps an updated list of rates on their website. 7

8. Income, Earnings, Assets & Changes
All income and earnings must be reported to ODSP by the 7th of the month
Income includes:
Earnings from work
Long term Disability
Foreign pensions
Canada Pension
Credit card cash advances
Old Age Security
Child support
WSIB payments
Boarder/lodger income
Employment Insurance
Loans
Child Tax Benefits
Honorariums
Assets or windfalls
When you’re on ODSP, any money or other assets that you earn or receive, is important in figuring out if you’re still eligible to receive benefits. So a lot of attention is paid to any money you get while receiving benefits.
You have to tell ODSP about any money you earn or receive – by the 7th of each month.
WSIB = Workplace Safety and Insurance Board
Assets or windfalls includes lottery winnings, inheritances, gifts of money
Note that you are able to have a credit card while on ODSP, but taking a cash advance is counted as income.
Honorariums may be exempt as income, but all income needs to be reported – regardless of how it may affect your benefits. 8

9. Income, Earnings, Assets & Changes
Allowable Asset Levels
$5000 for Recipient
$2500 for Spouse
$500 for dependent (other than a spouse)
Sometimes more assets could be exempted if they will be used to purchase disability-related items or the health of a benefit unit member (Director’s permission needed)
People are only allowed to have $5000 in savings (if they are single) or $7500 for a couple, and another $500 for each child.  But some forms of savings or assets are “exempt”, meaning you are allowed to have more.  Some examples of exempt assets include RESP’s (Registered Educations Savings Plans), RDSPs (Registered Disability Savings Plans), trust funds from an inheritance or insurance policy, pain and suffering awards. In order to be an exempt asset that type of savings must be listed in the ODSP regulation.

10. Income, Earnings, Assets & Changes
Other exempt assets:
Principle residence
One motor vehicle
Pain & suffering awards: $100,000
Car Accident, criminal injuries compensation, Bill 165, Ontario Child Benefit equivalent payments for children in care, disaster relief
Awards: WSIB Non-Economic Loss, Family Law, First Nation, Hep C, Walkerton, Grandview, Helpline, Veteran Affairs
Inheritances: $100,000 (in trust)
Gifts: $6000 or less in 12 month period
Lottery winnings: $5000 or less in 12 month period
Registered Education Savings Plans & Registered Disability Savings Plans
Disability related education, items or services
Student loans, bursaries, grants – tuition and educational costs
Business or self employment loan or assets - $20,000 (tools & vehicle)
You are “allowed” to have a mortgage while on ODSP, IF you can cover the payments out of your ODSP income.
If you notice, the limit for gifts is $6000, but the asset limit is $5000 – this means you can receive up to $6000 per year in gifts of cash, but you must spend $1000 of it in order to keep to the $5000 asset limit.

11. Income, Earnings, Assets & Changes
Changes to report
Changes in address
Changes in people living or moving away from home
Children turning 18
Adults turning 65
Changes in amount of rent you pay
Changes in assets or income
It is important that you notify ODSP of any changes in your situation that might affect whether you are eligible or how much income you receive from ODSP. This means not just changes to do with money.

12. Benefits: Two main types
Mandatory
Available across Ontario
If ODSP says ‘no’ to your request, you can appeal all the way to the Social Benefits Tribunal
Funding for mandatory benefits is based on needs
Discretionary
Available through municipalities
Different benefits are available in different places
You can ask for a review if you are denied, but there is no higher level appeal
Funding is limited/capped
Funding for mandatory benefits: It’s flexible - So if more people need a benefit one year, the province will pay more so all who qualify for the benefits receive them
Funding for discretionary benefits: It’s not flexible, at least not from the province - So if a municipality has more requests for a benefit one year, they run out of provincial money and might decide to pay from municipal funds or to limit how many people can receive the benefit.
Municipalities may list, on their website for example, the types of benefits they will not cover under discretionary benefits.

13. Benefits: Mandatory Special Diet Allowance
Recipient must ask his/her worker for the Application for Special Diet Allowance
Doctor, nurse practitioner or dietician must complete the application
Amount depends on applicable medical condition(s)
Maximum is $250/month
If a person is pregnant or nursing she should also ask for the Pregnancy/ Breastfeeding Nutritional Allowance
Changes were made to Special Diet on April 1, After a fight to save the benefit from elimination, the government changed the schedule of conditions eligible for the benefit, and some of the benefit amounts for various conditions.
Pregnancy/breastfeeding allowance is not part of special diet maximum – $50/month for non-dairy, $40/month for milk-based.
If breastfeeding not possible, infant is eligible for formula under SDA for $145/month until 1 year old 13

14. Benefits: Mandatory Drug Benefit
A monthly drug card is provided to all members of the “benefit unit”
Covers cost of prescription medications listed in Ministry of Health’s Ontario Drug Benefit (ODB) Formulary (co-pay could be required up to $2)
If medication not listed in ODB Formulary, ask doctor about Ministry of Health and Long Term Care’s “Exceptional Access Plan”
Exceptional Access Program: If a drug is not on the Formulary, doctor can fill out an application for coverage
“Benefit Unit” means a person and all of his or her dependents on behalf of whom the person receives or applies for income support. 14

15. Benefits: Mandatory Dental Benefit A dental card is provided to:
All recipients, their spouses and dependent children from 0 to 17 years old
If not covered (for example, dependent child 18 or over) can apply for OW discretionary dental coverage
An emergency dental card can be issued in exceptional circumstances
Talk to dentist about services that are available and what you may require.

16. Benefits: Mandatory Vision Benefit
ODSP covers cost of an eye exam every 24 months
Recipients and members of benefit unit (except dependent adults) receive coverage for purchase (every 3 years) and repair of lenses and frames
Replacement lenses if any change in prescription for kids, only for adults if “significant” change
Replacement for loss or damage for kids but NOT for adults except if no fault loss/damage

17. Benefits: Mandatory Hearing Benefit Cost of hearing evaluation
ODSP covers 25% of cost of hearing aid or appliance; Assistive Devices program covers 75%
Replacement batteries and appropriate repairs
Hearing aids can be replaced every 3 years as long as its no longer working and cannot be repaired at a reasonable cost
Cost of Visual Smoke Alert System and installation for each room (must be hardwired)
People are often required to get more than one estimate for the cost of hearing aids and possibly repairs or batteries.

18. Benefits: Mandatory Mandatory Special Necessities (MSN)
Health professional must fill out the Mandatory Special Necessities Form to access these benefits
Diabetic Supplies
Covers needles, swabs, lancets, blood glucose monitors
Surgical Supplies and Dressings
Prescribed by physician as a result of surgical, radiological or medical procedure or disease.
For diabetic supplies – a recipient must access other sources of funding first, as some supplies may be fully or partially covered by the Canadian Diabetes Association, the Assistive Devices Program, the drug card (test strips, insulin), or another program.
Also true for surgical supplies and dressings that they will be covered if not covered by another source such as Community Care Access Centre, Easter Seals, ADP, drug card, etc.
ODSP doesn’t cover short-term emergency supplies like braces or casts – but you can try to access these through OW discretionary benefits.
You should also keep any medical receipts and submit any not covered by ODSP (or OW) with your income tax. 18

19. Benefits: Mandatory Mandatory Special Necessities
Medical Transportation
If costs are more than $15/month, ODSP may cover:
Transport to doctor’s appointments
AA or NA support groups (prescribed, local)
counselor or psychiatrist sessions
mental health therapy
Emergency costs (ambulance, family member driving) may be covered with receipts & details
Mental health therapy or counseling must be prescribed and supervised by doctor, psychologist or psychiatrist
If you need it, make sure to mention to your doctor your need for an escort (for example, someone to drive you to appointments). 19

20. Benefits: Mandatory Medical travel continued
If doctor indicates recipient must take taxi, ODSP may pay for the taxi (with receipts)
If overnight travel is necessary to get medical treatment, ODSP may pay for travel, accommodation and meals if specified by approved health professional
Northern Travel Amount - $100 for accommodation if live more than 200km away, plus $.41/km less 100km
If Doctor doesn’t specify taxi, ODSP will only pay for cheapest possible mode of transport.
If need to travel for medical treatment, costs for someone to accompany you might be paid, if specified by approved health professional. 20

21. Benefits: Mandatory
Guide Dog Benefit
If you have a guide dog you may receive up to $75 a month to help with care and feeding costs
Veterinary bills are not included in this amount. Look for an animal foundation or a sympathetic vet!

22. Benefits: Mandatory Extended Health Benefit
If you have too much income to remain on ODSP
AND your monthly health related cost are greater than your monthly entitlement, you can get coverage for:
Prescription drugs
Dental & vision (incl. eye exam every 24 months)
Diabetic & surgical supplies
Batteries and repairs to mobility devices
Medical transportation costs (more than $15/month)
Co-payments for Assistive Devices Program

23. Benefits: Discretionary
Health-related
Prosthetic appliances (e.g., back braces, surgical stockings, artificial limbs, etc)
Cost of completing other medical forms
Air conditioners for people with severe asthma
Funeral and burial costs (unless you receive CPP death benefits)
Remember – discretionary benefits are granted with the approval of the municipal Administrator (Ontario Works). They are not mandatory, so your right to them is much different than for mandatory benefits. They may be harder to get than ODSP mandatory benefits.
The Ontario government has now cut back the amount they give to municipalities for “discretionary” needs to cover things that are not otherwise covered by OW and ODSP benefits.  This can include health-related things like oxygen tanks, dentures, air conditioners for people with breathing problems; or non health related things like employment expenses or transportation for volunteering.  This may mean that municipalities will cut things that they used to give.  And it may increase the problem of people who live in different towns or cities having unequal access to benefits.

24. Benefits: Discretionary
Non Health-related expenses
Vocational training/retraining
Used after employment assistance expense funds used up and include transportation costs
Must be job specific and connected to a job available in local labour market
Moving expenses (may include storage)
Non health-related travel/transportation
To return home outside Ontario
To attend court to seek spousal support
To visit next of kin in hospital or for funeral

25. Benefits: Discretionary
Other special items and services if no other source available to pay:
New Born Allowance ($360 for stroller, crib, etc)
Blood test – for child support application
One time $50 energy conservation benefit
Caulking, weather stripping, insulating water pipes
Cost of preparing a will (where not covered by another service)
And “any other service” – it can’t hurt to ask!
Other Discretionary Benefits – normally if needed towards work related project or an emergency/disaster.

26. Assistive Devices Program
Ministry of Health provides assistance to people with longer term physical disabilities
Assistive devices include walkers, wheelchairs, visual, hearing or speech aids, etc.
Ministry of Health covers 75% of cost and ODSP pays remaining 25%
If assessment needed for any device, ODSP will pay for assessment
ODSP covers cost of batteries and repairs—this is a mandatory benefit 26 26

27. Earnings
The amount of income from a job or self-employment that you can keep changed in September, 2013
The 1st $ of net earnings is “exempt”—it will not be subtracted from ODSP cheque
Net earnings: “take home” pay after deductions like taxes, EI, CPP, union dues
50% of remaining net earnings is deducted
$100 is added to ODSP cheque whenever anyone has net earnings (Work Related Benefit)
Disability related expenses (if not paid by the employer or another program) can include things like specialized transit services, attendant care, specialized equipment, sign language interpretation, etc.
Example: If you earn $1000/month, ODSP will give you $400 less in income support 27 27

28. Self Employment
Net Earnings for self-employed people means the gross earnings of the business minus approved expenses
Expenses are deemed to be at least $100 per month; no proof is required for expenses less than $100.00
Casual work or odd jobs, earning less than $ per month, are usually considered self-employment.

29. Employment Benefits When starting a new job
Up front child care costs (such as a deposit for daycare). Up to $600 for informal care or the actual child care cost at a formal (licensed) daycare
Employment and training start up benefits. This includes things like tools and equipment, work wear, and the cost of a pardon
There are some benefits that ODSP provides to make it more affordable for you to work.

30. Employment Benefits Transitional Health Benefit (THB)
Exit ODSP due to excess earnings. No coverage with employer. Don’t qualify for Extended Health Benefit.
Rapid Reinstatement
If you’ve exited ODSP and want to reapply, AND you’re financially eligible, this allows you to skip the full reapplication process IF:
Exited for employment and were previously on family benefits
Exited for any reason and didn’t have a medical review date
Had a medical review date and exited before date passed, but no review by Director has taken place yet.
There are several other benefits that you might be able to access if starting work, training for work, leaving ODSP because of work, or needing to come back to ODSP after a period away (often for work).
The transitional health benefit is for those whose health-related expenses are not high enough to qualify for the extended health benefit (covered under mandatory benefits) but don’t get coverage from employer. Includes drugs, dental and vision. Provides coverage until covered by employer health plan, but must re-establish eligibility annually.
Rapid reinstatement can be crucial for someone, for example, who earns $2000 or more per month, and has to exit ODSP because their earnings are too high. If that person becomes too ill to work, they can get back onto ODSP without going through the full application process, and once they’ve used up any Employment Insurance or sickness benefits they are entitled to.

31. Employment Benefits Employment Supports Employment transition benefit
Up to $500 once every 12 months
If going off ODSP for full time or part time employment or training
Salary is greater than ODSP entitlement
Employment Supports
Help provided through non-profit agencies to prepare for, find or maintain employment
Employment transition benefit –If you find a full or part-time job and are earning too much to stay on ODSP, ODSP will pay you $500, in addition to training, self employment supports and so on.
In terms of self-employment supports, you need to be job ready and show what accommodations you will need in the workplace. A caseworker works with you and a job broker to assist you in finding employment. There is no appeal process to the social benefits tribunal if there is an issue with the job broker or the employment supports process more generally. 31 31

32. Appeals The process for appealing is the same first step:
Submit an Internal Review request (in writing)
Within 30 days of a decision (if miss deadline, request an ‘extension of time’)
If denied or cut off ODSP
Mandatory benefits
Discretionary benefits
Suspensions, changes or reductions in benefits
ODSP office has 30 days to answer
It is not unusual that a person applying for ODSP or on the program may be told ‘no’ when requesting a certain type of benefit or support.
Knowing your rights of appeal is very important. It can be tiring challenging decisions made by ODSP, but it is your right and it can lead to positive decisions that make a difference in your income and your life.
Make sure to ask for any decision you receive in writing – so for example, if you request a health-related benefit, make sure you request it in writing, AND ask for a response in writing if your caseworker answers you verbally. 32 32

33. Appeals The second step for appealing exists when:
The Internal Review answer still no, you can appeal that negative decision to Social Benefits Tribunal (SBT)
Within 30 days of receiving the Internal Review answer (
Denied ODSP or cancelled ODSP
Mandatory Benefits
Suspensions, changes or reductions in benefits
Discretionary Benefits = no further appeal beyond the Internal Review
Internal Review – you must sign yourself (even if you have a vision or mental health related disability)
Different caseworker than your own will review the decision you’re asking for a review of.
You have 30 days to request an internal review.

34. Appeals
Contact local community legal clinic for help with Internal Review & Appeal to Social Benefits Tribunal (SBT) (
If you appeal to the SBT, they will notify you of a hearing date
If your ODSP benefit is cancelled and you have appealed the decision, you can ask for Interim Assistance until the Social Benefits Tribunal (SBT) has made a decision
If you lose the appeal, you will have to pay back that Interim Assistance.
At the Social Benefits Tribunal hearing - you can talk about your situation and ask that they overturn the decision of your worker and their manager (the Internal Review)

35. Tips & Strategies Know about the benefits available
Ask in writing and keep a copy (of everything!)
Ask your worker if specific form needed (and get the form)
Pay attention to time limits (for ex, for appeals)
Keep letters, benefit statements, and work stubs
Make records about conversations, contacts, etc
Where possible and needed, get doctors or other professionals to support your requests in writing
Ask for help from your local community legal clinic
Note: Forms generally have no title on them, which can make things more confusing. But appeal forms do have titles on them.
A benefit statement tells you a lot of information (beyond the amount of money you receive): caseworker number, region, different categories of benefits (special diet, for example).

36. For more information
This presentation is very general and may not have answered your questions.
To find out more information about the work of the ODSP Action Coalition, please see our website: or our facebook page: facebook.com/ODSPACTION
To find your local community legal clinic for free legal advice on ODSP, as well as more information about applying for and receiving ODSP, see
Thank you!