Presentation on theme: "2010, Community Law School (Sarnia-Lambton) Inc. This webinar is brought to you by CLEONet www.cleonet.ca CLEONet is a web site of legal information for."— Presentation transcript:
2010, Community Law School (Sarnia-Lambton) Inc. This webinar is brought to you by CLEONet www.cleonet.ca CLEONet is a web site of legal information for community workers and advocates who work with low-income and disadvantaged communities in Ontario.
About our presenter… Catherine Manson is a Community Legal Worker and Licensed Paralegal with Flemingdon Community Legal Services with 22 years experience in the legal clinic system. She has been giving presentations on the Ontario Disability Support Plan (ODSP) and Ontario Works (OW) benefits since 2004. She is a member of the ODSP Action Coalition (Co-Chair of the Train the Trainer Committee), and past Chair of the Toronto Region ODSP Action Coalition.
Revised: June 17, 2010 3 ODSP/OW Benefits you should know about…! Original Presentation Created by HIV & Aids Legal Clinic Updated by Catherine Manson Flemingdon Community Legal Services firstname.lastname@example.org
Revised: June 17, 2010 4 Overview Let’s take a closer look at some Ontario Disability Support Program (ODSP) and OW Benefits: A.Know Your Benefits 1.Who Provides the Money 2.How To Obtain These Benefits - Mandatory vs. Discretionary 3.What if they say “NO’’ B.Income Support 1.Income Rates 2.Earnings, Assets 3.Exemptions – compensation plans, pain & suffering, inheritances C. Day to Day Benefits 1.Special Diet, - Pregnancy, Breastfeeding 2.Drug & Dental 3.“Mandatory Special Necessities” 4.Vision, Hearing, ADP Co-payment 5.Community Start Up & Maintenance 6.Personal Needs Allowances 7.Discretionary Benefits (health and non- health) D. Employment Benefits 1.Employment Start Up Benefits 2.Up Front Child Care 3.Community Participation 4.Employment Assistance Activities Benefits 5.ODSP Employment Assistance Benefits 6.Health Benefits 7.Rapid Re-instatement E. Legal Assistance - Where to find help
Revised: June 17, 2010 Who Provides/Administers the Money? ODSP (Ontario Disability Support Program) is an income support program funded by the Province of Ontario Ontario Works, aka Social Assistance aka Welfare is an income support of last resort funded in portion by the Province and by Municipalities (19.4 % of benefit costs, 50% of admin costs) Municipalities often provide monies for discretionary benefits. First Nation Reserves administer OW programs and 95 % is funded by the federal government. FIRST NATIONS
Revised: June 17, 2010 6 How does one access these benefits? In almost every case, in order to access benefits one must: –Know about them! –Ask for them! –If a specific form is required, ask for the form! –Know if the benefit is a Mandatory or Discretionary benefit –All “mandatory” benefits can be appealed to Social Benefits Tribunal *Discretionary benefits may not be appealed, but can still be reviewed by a Supervisor and then a Manager and/or Alternate Dispute Resolution Committee if available
Revised: June 17, 2010 7 What if they say NO? Appeal, appeal, appeal! One starts the appeal process by requesting an Internal Review which must be: –In writing – one sentence - “I want an internal review of this decision.” –Provide any missing information –As of May 1, 2009 – 30 days to Request an Internal Review –*Contact your local community legal clinic for help If the 30 day deadline is missed – request an “extension of time” to file the Internal Review (and you should)
Revised: June 17, 2010 8 What if they still say NO? AGAIN - All “mandatory” benefits can be appealed. One may appeal any variation in amount (underpayments, overpayments), suspension or cancellation of benefits. If the internal review is not successful, the Administrator will send a second letter of denial – which is called an Internal Review Decision. Within 30 days of receiving this Internal Review Decision, one must file an appeal form to the Social Benefits Tribunal (SBT) (www.sbt.gov.on.ca) **Contact your local community legal clinic for help.
Revised: June 17, 2010 9 Appealable? Any Variation, Suspension or Cancellation of Support –Overpayments –Reduction in benefits Mandatory Benefits –Special Diet –Drug Card –Dental Card (not dependent adult) –Mandatory Special Necessities – diabetic, surgical supplies, transportation –Vision (not dependent adults) –Community Start Up and Maintenance Benefits Community Placement for ODSP recipients Discretionary Benefits - paid to OW or ODSP recipients – 3 categories: health related, non-health related, “other special items & services” Vocational Training & Employment related expenses if it does not affect eligibility Emergency Situations Payments to third parties YES NO
Revised: June 17, 2010 Ontario Disability Support Program Single Basic Needs $578 Shelter $464 $1042 Couple (1 disabled) (both dis.) Basic Needs $855 $1153 Shelter $729 $ 729 $ 1584 $1882 Double Disabled Couple Actual Entitlement$1742 2010 Income Support Rates Ontario Works Single Basic Needs $221 Shelter $364 $585 Couple Basic Needs $438 Shelter $572 $1010 IF you do not qualify for the CCTB program – you may be eligible for the Transitional Child Tax Benefit for each child OW (max $213) and ODSP (max $189)
Revised: June 17, 2010 11 Income, Earnings and Assets To Be Reported by the 7 th of the Month for ODSP and the 21 st of the month for OW All income including credit card cash advances: –Earnings, foreign pensions, child support, CAS support –Assets or windfalls (lottery winnings, inheritances, gift money, WSIB payments, LTD, EI, CPP and OAS payments, Child Tax Benefits) –Changes in address, –Changes people living or moving from home, rental income –Children turning 18 or Adults turning 65 –ODSP Assets over $5000 for Recipient, $2500 for Spouse, $500 for dependent child –OW Assets over – Single - $572, Couple -$989; Couple w 1 dependent - $1630; Single with one dependent - $1550; $500 for each additional dependent
Revised: June 17, 2010 12 Exempt Asset?? Principal Residence Pain & Suffering Awards ODSP - $100,000.00; OW - $ 25,000.00 –WSIB NEL award, & B165 payments –Car Accident, Family Law Awards, First Nation Awards, –Criminal Injuries Compensation, Hep C awards InheritancesODSP - $100,000.00 (held in trust) Lottery Winnings$5000 or less in a 12 month period Registered Education Savings Plans Registered Disability Savings Plans (must qualify for Federal Disability Tax Credit) Disability Related Education, Items or Services Disaster Relief payments Business or Self Employment Assets – OW - $10,000; ODSP - $20,000
Revised: June 17, 2010 Questions? Part A/B A.Know Your Benefits 1.Who Provides the Money 2.How To Obtain These Benefits - Mandatory vs. Discretionary 3.What if they say “NO’’ B.Income Support 1.Income Rates 2.Earnings, Assets 3.Exemptions – compensation plans, pain & suffering, inheritances
Revised: June 17, 2010 14 DAY TO DAY BENEFITS (Mandatory and Discretionary)
Revised: June 17, 2010 15 NOTE: although the government announced in March 2010 that they will be eliminating the special diet benefit, it is still in existence and people can still apply until further notice. The special diet schedule lists specific medical conditions like Diabetes, HIV/AIDS, etc. Each member of a benefit unit - can receive up to $250/month per person depending on the condition. Ask your worker for and complete the Application for Special Diet Allowance” (Form 3059 & 3060) The form must be completed by an “approved health professional. New – January 2010 - You will be required to sign a declaration that the information provided on the application is "to the best of your knowledge, true, correct and complete”. Special Diet Allowance
Revised: June 17, 2010 16 Pregnancy / Breastfeeding Nutritional Allowance and the Infant Special Diet If you are pregnant, you are entitled to receive a “Pregnancy/Breastfeeding Nutritional Allowance” - $50/month for non-dairy, $40/month for milk- based If you choose to breastfeed you may renew this allowance for an additional 12 months This is provided in addition to any other special diets and is not part of the maximum calculation of $250 If Breastfeeding is not possible, your infant is eligible for formula under the Special Diet Allowance.
Revised: June 17, 2010 17 Drug Benefits A monthly drug card is provided to all members of the *benefit unit for ODSP & OW Covers the cost of prescription medication (listed in the Ministry of Health’s Ontario Drug Benefit Formulary) If not covered – ask Dr. about a Section 16 application – Request for Unlisted Drug Product – Exceptional Access Program (EAP) No cost to you except the pharmacy dispensing fee (you can ask the pharmacy if they can waive this fee) (*“Benefit Unit” means a person and all of his or her dependants on behalf of whom the person receives or applies for income support)
Revised: June 17, 2010 18 Dental Benefits A dental card is only provided to: –OW: dependent children –ODSP: all recipients, except dependent adults 18 and over, and *All those not covered can apply for OW “discretionary benefits” for dental coverage. An emergency dental card can be issued in exceptional circumstances Talk to your dentist about services that are available and what you may require. ODSP has a separate dental insurance provider & schedule from OW
Revised: June 17, 2010 19 “Mandatory Special Necessities” (MSN) OW and ODSP use the term “Mandatory Special Necessities” to talk about 3 kinds of benefits: –Diabetic Supplies –Surgical Supplies/Dressings –Medical Transportation To receive any of these benefits, a health professional must fill out the “Mandatory Special Necessities” form
Revised: June 17, 2010 20 MSN: Diabetic Supplies MSN coverage for supplies are for items such as: Needles, syringes, swabs, platforms, lancets and blood glucose monitors. (Insulin and test strips are covered under the drug card as they are ODB listings) *One must access other sources of funding first as some of these supplies may be fully or partially covered by: the Canadian Diabetes Association, the Assistive Devices Program, the drug card, or another program…
Revised: June 17, 2010 21 “Surgical supplies and dressings” are items prescribed by a physician that are required due to a surgical, radiological or medical procedure or disease Again, OW & ODSP will pay for these supplies if they can’t be paid by another source (hospital, Community Care Access Centre, Easter Seals Society, Assistive Devices Program, drug card) MSN: Surgical Supplies & Dressings
Revised: June 17, 2010 22 MSN: Medical Transportation OW and ODSP will cover the cost of transportation for medical purposes if costs exceed $15 a month per benefit unit Travel to any “registered health professional” designated under the Regulated Health Professions Act, 1991 Transportation will also cover: - AA, NA and/or Overeaters meetings, mental health therapy and counselling if it’s prescribed and supervised by a doctor, psychologist or psychiatrist. ODSP/OW will only pay for the cheapest possible mode of transport (public transit, taxi) – have doctor indicate need for a taxi if necessary. Emergency costs (ambulance or family member driving) can be covered based on receipts. A note from the recipient requesting reimbursement and specifying the destination and the mileage incurred is also acceptable; however, any receipts (e.g. parking receipt) should also be included if available. ODSP/OW can pay for accommodation and meals if you have to travel overnight for medical treatment (along with someone who needs to accompany you – if specified by the approved health professional)
Revised: June 17, 2010 23 Vision OW - only dependent children ODSP - all benefit unit members, except dependent adults *All those not covered can apply for “discretionary benefits” under OW Covered costs include: –eye exam every 24 months if not covered by OHIP (20-64 no longer insured) –new frames and/or lenses every 3 years –necessary repairs –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 Guide Dog Benefit – each member of the benefit unit can receive up to $70/mth to assist with care/feeding costs.
Revised: June 17, 2010 24 Assistive Devices Co-payments The ADP (Ministry of Health) provides financial assistance to people with long-term physical disabilities to obtain aids, devices & supplies. The ADP only covers 75% of schedule costs…so OW and ODSP will pay the remaining 25%, if there is no other source of funding. If there is an assessment required for an item, OW & ODSP will cover the cost of this assessment. Assessments along with batteries and repairs for assistive devices are covered. There is no appeal if you are denied this benefit.
Revised: June 17, 2010 25 Hearing Benefit ODSP: all recipients, except dependent adults OW: Not provided *All those not covered can apply for “discretionary benefits” under OW Covers the cost of a hearing aid evaluation, the remaining cost of a hearing aid not covered by the Assistive Devices Program (the program covers 75%, OW/ODSP covers the last 25%), and replacement batteries and repairs. The hearing aid device can be replaced every 3 years (if device doesn’t work and can’t be repaired) The cost of a hearing assessment may be covered if it’s not already covered by OHIP. Cost of Visual Smoke Alert System and installation for each room in the house or apartment – must be hardwired
Revised: June 17, 2010 26 OW/ODSP- Extended Health Benefit (EHB) Mandatory Benefit For those who exit OW & ODSP because of excess income before deductions Monthly health related costs must be greater than your monthly entitlement Covers (all or partial) - Prescription drugs - Dental and Vision (for ODSP recipients and OW children only) -Routine Eye Exam every 24 months - Diabetic and Surgical Supplies - Batteries and repairs to mobility devices - Medical Transportation costs greater than $15.00 - Co-Payments for ADP program
Revised: June 17, 2010 27 Community Start Up & Maintenance Benefit (CSUMB) CSUMB is available through OW and ODSP for help with moving costs, paying rent/utility arrears, and to avoid being evicted. Up to a maximum of $799 for a single person or $1500 for a family with one or more dependent children. Available once in any 24 month period. Can apply again for emergencies.
Revised: June 17, 2010 $906 + $30 travel Home under the Homes for the Aged and Rest Homes Act An approved charitable home for the aged under the Charitable Institutions Act A nursing home under the Nursing Homes Act $914 +$30 travel A charitable institution under the Charitable Institutes Act, other than homes for aged A group home for people with developmental disabilities under the Developmental Services Act $128 Personal Needs Allowance Interval & Transition Homes for Abused Women... Are eligible for the “basic needs and shelter allowance” for the first 3 months (discretionary beyond 3 mth.) A Person must “preserve their right to return to their home” (principal residence) – i.e. still paying for the home If one does not maintain the right to return home, or the Director chooses not to extend the benefit beyond 3 months, OW will pay a $128 personal needs allowance per person ($4/day).
Revised: June 17, 2010 29 OW Discretionary Benefits OW has what it calls “discretionary benefits” which may be issued under the legislation. Discretionary benefits can be paid to OW or ODSP recipients 3 categories: health related, non-health related, & “other special items & services” Discretionary benefits are not appealable.
Revised: June 17, 2010 30 Discretionary Benefits – 1. Health-related –For OW adults: Dental care (emergency or to support participation requirements), vision care, hearing aids & batteries –Prosthetic appliances –Prescription drugs not listed under ODB –“cost of completing other medical forms” –Air conditioners for severe asthmatics –Funeral costs ($2500)
Revised: June 17, 2010 31 Discretionary Benefits - 2. Non Health-Related “Vocational training/retraining” –can be used after employment assistance expense funds are used up, and can include transportation costs. “Must be job specific and connected to a job available in the local labour market” Non health-related travel & transportation: –Transport to return to home outside of Ontario –To attend court to seek spousal support –To visit people at hospital or funeral for next of kin. Moving expenses –Can include storage…sometimes can even include storage charges you had before you applied for this benefit if the stored furniture is “essential to the family”
Revised: June 17, 2010 32 Discretionary Benefits – 3. Other special items & services Home repairs –For “urgent” or “emergency” situations, Invoice required, can be provided as payments included in shelter, and may be divided over a number of months to fit within maximum shelter allowance. Layettes and baby supplies Repair/replacement of essential furniture and appliances Replacement of household goods after emergency (fire, flood) Blood test in child support applications Cost of preparing a will where the cost cannot be paid by some other source *** “Any other service” – so always ask your caseworker - there is no harm in asking!
Revised: June 17, 2010 33 Discretionary Benefit: Energy Conservation One-time discretionary benefit up to $50, for ODSP and OW For low-cost energy conservation measures such as caulking, weather- stripping, insulating hot water pipes, etc. Seek approval in advance Can not be appealed Financial grants, items, or services that are issued for energy- conservation in homes by LDCs are not considered income or assets for the purposes of social assistance.
Revised: June 17, 2010 Questions: Part C? Day to Day Benefits Special Diet, - Pregnancy, –Breastfeeding Drug & Dental “Mandatory Special Necessities” Vision, Hearing, ADP Co-payment Community Start Up & Maintenance Personal Needs Allowance Discretionary Benefits (health and non-health)
Revised: June 17, 2010 36 Employment Deductions GROSS INCOME: Minus: - Mandatory deductions (CPP, EI, Fed Tax based on Revenue Canada formulas, not employers formulas); Minus - Daycare expenses, disability related expenses (max $300), self employment business expenses = POSITIVE NET EARNING Deduct 50% of Positive Net Earnings from OW/ODSP Income Support
Revised: June 17, 2010 37 Employment Start Up Benefits – Up Front Child Care Costs (OW, ODSP) Employment and Training Start Up Benefits (OW, ODSP) Other Employment and Employment Assistance Activities Benefit (OW) Employment Related Benefits (OW) Work Related Benefits (ODSP) Transitional Health Benefits (ODSP) Employment Transition Benefits (ODSP) Rapid Reinstatement (ODSP)
Revised: June 17, 2010 38 Employment Start Up: Up Front Child Care Payment When up-front child care expenses are required before one begins, changes or maintains employment or any other employment assistance activity. For both OW and ODSP: - the actual child care cost for a licensed day care facility, or - up to $600/month for informal care (family, friends, etc. *but not spouse or member of benefit unit)
Revised: June 17, 2010 39 Community Participation (CP) Unpaid volunteer placements for OW (and ODSP recipients will depend on the municipality) to assist with employment skills A person may be eligible for Other Employment and Employment Assistance Activities Benefits (max $500/mth) A community placement must be established as a requirement in the Participation Agreement before Employment and Participation Benefits can be paid Employment and Participation Benefits ($253 in a 12 month period ) may cover: –special supplies & equipment –required for the placement. –transit pass, clothing and grooming, If on OW one can volunteer up to 70 hours each month (there is no minimum), for up to 6 months (can request to volunteer for longer period if related to employment training/skills).
Revised: June 17, 2010 40 Employment and Participation Benefits Full Time Employment Benefit (FTEB) (mandatory) – –$500 in a 12-month period –For recipient, spouse or dependent adult to assist with starting a full time job of 30 hours a week or more –Have received OW for 3 consecutive months –Need assistance with start up costs (provide verification of expenses/new activity) Other Employment and Employment Assistance Activities Benefit (see slide 44) Employment-Related Expenses $250 per month, (discretionary) –with a maximum advance of $500 for out-of-pocket expenses associated but not limited to: –necessary transportation, protective/clothing, grooming, and special & or safety equipment, supplies and equipment, telephone expenses, criminal reference checks or medical examinations and certificates (where required as a condition of job referral or community placements), costs associated with obtaining a Pardon (for the removal of a criminal record to eliminate a barrier to employment), minor fees (e.g., certification charges, short training costs)
Revised: June 17, 2010 41 Employment Assistance Activities Benefit Benefit is a mandatory benefit For any eligible member of the OW or ODSP benefit unit. One must be: –Starting or changing a job, in a training program, or doing another “Employment Assistance” activity –have proven expenses for the approved start up ODSP Maximum up to $500 in any 12 month period OW Maximum up to $253 in any 12 month period Eligible expenses may include: –tools and equipment; transportation costs; work wear; –grooming costs; –licensing fees, association costs; or –any other item that, in the opinion of the Director, is a necessary work or training related expense; A letter may be required from the community agency, training program or employer to provide support for this benefit
Revised: June 17, 2010 42 The needs of a person with a disability who require more extensive supports are met through ODSP employment supports A maximum of $300 per month can be deducted from gross earnings for disability related work expenses if not paid by employer or other program: - specialized transit services, attendant care services, specialized equipment, sign-language interpreting, etc. - Verification and receipts required Technical aids or devices to support access to OW employment assistance activities should be provided for ODSP recipients who wish to voluntarily participate in Ontario Works. “Work Related Benefit” $100 per month if there is net positive earnings from employment or training “Employment Transition Benefit” (ETB) of $500 will be paid if recipient leaves ODSP for FT or PT employment or training and salary is greater than ODSP entitlement. There is no requirement that one exit ODSP for a minimum period of time in order to be eligible to receive the ETB. ODSP Employment Supports
Revised: June 17, 2010 43 OW/ODSP- Extended Health Benefit (EHB) Mandatory Benefit For those who exit OW & ODSP because of excess income before deductions Monthly health related costs must be greater than your monthly entitlement Covers (all or partial) - Prescription drugs - Dental and Vision (for ODSP recipients and OW children only) -Routine Eye Exam every 24 months - Diabetic and Surgical Supplies - Batteries and repairs to mobility devices - Medical Transportation costs greater than $15.00 - Co-Payments for ADP program
Revised: June 17, 2010 44 OW - Extended Employment Health Benefit (EEHB) Mandatory Benefit For those who exit OW for employment or training program Transition period up to 6 months or until employer provides – may be extended 6 months Person does not qualify for Extended Health Benefit (EHB) Covers (all or partial) -Prescription drugs, -Routine Eye Exam every 24 months - Diabetic and Surgical Supplies
Revised: June 17, 2010 45 ODSP - Transitional Health Benefit “Transitional Health Benefit” (THB) – for persons who become ineligible for ODSP because their employment/training program earnings income is too high; and can’t get coverage through their employer. Do not qualify for the Extended Health Benefit Includes drugs, dental and vision benefits. Coverage continues until you are covered by employer health plan No time limit, but eligibility must be re- established annually.
Revised: June 17, 2010 46 RAPID REINSTATEMENT In certain circumstances where a person has exited the ODSP Program and now wants TO RE-APPLY to receive ODSP income support, INDIVIDUALS MUST BE FINANCIALLY ELIGIBLE Previously FBA Grandparented Recipients (prior to 1998) Former recipient exits ODSP for employment Eligible (no time limit) Former recipient exits ODSP for any other reason Not eligible – must be adjudicated Previously ODSP Adjudicated Recipients Former recipient who did not have a review date Eligible – regardless of reason for exit or time off ODSP Former recipient who had a review date who exits ODSP before review date has passed. –And reapplies before review date or –reapplies after review date has passed but –file has not yet been reviewed by Director Eligible
Revised: June 17, 2010 Questions: Part D? Employment Benefits Employment Start Up Benefits Up Front Child Care Community Participation Employment Assistance Activities Benefits ODSP Employment Assistance Benefits Health Benefits Rapid Re-instatement
Revised: June 17, 2010 48 Where to Find Help… For information about benefits or for help at anytime – especially when a Caseworker says “NO” Contact your nearest Community Legal Clinic or community legal advocate!!! Legal Aid Ontario 1-800-668-8258, TTY – 1-866-641-8867 For OW – Contact your Municipal Councillor or local Client Services for the Municipality For ODSP - Contact your local Member of Provincial Parliament If all appeals and negotiations fail: - Contact the Ontario Ombudsman –Ombudsman cannot order a change in the Directors’ decisions – can investigate “systemic” issues
2010, Community Law School (Sarnia-Lambton) Inc. This webinar was brought to you by CLEONet For more information visit the Social Assistance and Pensions section of CLEONet at www.cleonet.cawww.cleonet.ca For more public legal information webinars visit: http://www.cleonet.ca/training