1 Towards an Integrated Funding Model

2 Challenges to be addressed n Persisting low basic incomes of people with disabilities n Significant income difference even where working n Major need for personal supports and for cost offset n Involvement of families in providing informal support, and the direct costs and opportunity costs n Disincentives to employment bcs of support system n Need to strengthen community capacity for inclusion n Government fiscal limitations n Intergovernmental relations

3 Persisting low basic incomes (SLID) n Income difference of $7,600 per year – $9,400 if LTD n Below after tax LICO – w/disabilities 25% – LTD 29% – w/o disabilities 11%

4 Persisting low basic incomes -- major unemployment (SLID) n Employed all year – 26 % w/disabilities – 19 % LTD – 58 % w/o disabilities n NILF all year – w/disabilities 54 % – LTD 65 % – w/o disabilities 17%

5 Earnings difference if working all year (SLID) n Earnings difference of $5,800 per year (employed all year) – $7,200 if LTD n Below after tax LICO (earners) – with disabilities 9% – LTD 11% – w/o disabilities 6%

6 Major need for personal supports (HALS) n 53 % of all adults need help with one or more everyday activities n pay out of pocket - not reimbursed – 25% of helped - okay – 39% of more needed

7 Major need for personal supports (HALS) n 35 % of all adults need aids / devices for mobility, seeing, hearing, speaking n Gap between need and usage

8 Need for cost offset (HALS) n 36 % of all adults have non- reimbursed costs for various disability supports

9 Need for cost offset (HALS) n Cost a reason why supports not more widely used

10 Need for cost offset -- equity according to ability to pay? (HALS) n The 36 % of all adults who have non-reimbursed costs for various disability supports doesn’t vary much by income level n But its harder to pay when poorer

11 Need for cost offset -- equity according to gender? (HALS) n Differences in the extent to which men and women pay for disability supports and are not reimbursed n Regardless of family income status, women are more likely to pay

12 Disincentives to employment because of system design (HALS) n People not in the labour force: – 12% concerned about losing disability supports if employed – 20% concerned about losing disability income if employed

13 Family members provide most support (HALS) n Nearly half of people needing support for everyday activities are helped by family members only

14 Family members providing support -- opportunity costs (HALS) n Family incomes are lower where family members provide support with everyday activities

15 Need to strengthen community capacity for inclusion (HALS) n Reasons why people aren’t doing more of the community activities that they want

16 Towards Solutions

17 Integrated model would...

18 Low basic incomes n Measures to increase employment – job accommodation funding and incentives / info to employers – greater encouragement for employers to use present tax system – “human capital” exemptions n Better basic income support

19 Income gap even if working n Refundable tax credit that recognizes difficult to itemize additional costs of disability; advanced quarterly / monthly n Or other provincial or federal income program to deliver the same n Not only for people who are employed n Not subject to “claw backs”

20 General financial assistance to families who provide disability support n Refundable tax credit where providing direct support; available regardless of age of person supported and their labour-force status n Or other provincial or federal program to do the same n Not subject to “claw backs”

21 Disability Support Program n Aims: ensure access to disability supports – for citizenship and inclusion n to help overcome barriers to carrying out activities of daily living, and to social and economic participation (incl. political and cultural) -- barriers directly associated with a disabling condition

22 Disability Support Program n “Disability Support” – a good or service used to help a person overcome barriers associated with a disabling condition – no fixed set of goods and services – program would focus on supports that “attach” to individuals (but not exclusively)

23 Examples of disability supports n Human assistance for direct instruction, care, therapy (non-institutional) or assistance n Planning and counselling n Social development around individuals n Technological supports n Medications and health-related supplies n Environmental adaptations n Information and referral n Other

24 Program Principles n Accessibility n Equity n Adequacy n Portability n Responsiveness and consumer control n Public responsibility

25 Conditions of access -- need for disability support n Presence of need for a disability support would be the sole criterion n Not criteria such as – income level; age; employability; cause or category of disability; attachment to training, work or rehabilitation; residency n Not a welfare-based program

26 Conditions of access -- “disability” n Inclusive definition of disability: – hearing; seeing; speaking / being understood; mobility; flexibility / agility; pain; respiration; general cognition - intellectual disability; specific learning disability; memory / confusion; emotional / psychiatric; other

27 Program Administration

28 Program Administration

29 Equity in financing individuals n Disability support cost = unit price x number of units needed – Consistent and transparent pricing scheme for typically needed items and services; price quotes for less typical items and services – Peer review of units of service requested

30 Strengthen community capacity for inclusion -- mix of options n Community-based – Non-profit – For profit

31 Strengthen community capacity for inclusion -- key functions n Core capacity – core coverage of disability administration, training and office costs; portion of service cost to provider – conditional grants; periodic review – publicly subsidized user fees a major but not the only source of agency income – generic services (e.g., homemakers, counselling) eligible to increase generic capacity n Forecasting and planning

32 Strengthen community capacity for inclusion -- core financing n Enable community services to: – review and recommend individual claims – assist with individual planning, contracting and logistics – provide direct services to people with disabilities (specialized and generic) – provide counselling on disability issues – consult with employers and others on inclusion / accommodations

33 Strengthen community capacity for inclusion -- forecasting n Enable community services to: – research patterns in use of supports – forecast emerging demand for support – document approaches that work well and not so well – devise innovative support options on a demonstration basis – participate in policy process

34 Intergovernmental aspects n Intergovernmental accord n Guiding principles and objectives n Provincial scope to design and administer program consistent with regional needs and guiding principles n Reinvestment agreement: new federal funding not used to reduce provincial contribution n Positive profiles for payers

35 Conclusion: an integrated model would seek to...