Social Assistance: OW ODSP Rights and Benefits

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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

[email protected]

Revised: June 17, 20104

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 Money2. How To Obtain These Benefits -

Mandatory vs. Discretionary 3. What if they say “NO’’

B. Income Support

1. Income Rates2. Earnings, Assets3. Exemptions – compensation plans,

pain & suffering, inheritances

C. Day to Day Benefits

1. Special Diet, - Pregnancy, B

reastfeeding

2. Drug & Dental 3. “Mandatory Special Necessities”4. Vision, Hearing, ADP Co-payment5. Community Start Up & Maintenance6. Personal Needs Allowances7. Discretionary Benefits (health and non-

health)

D. Employment Benefits

1. Employment Start Up Benefits2. Up Front Child Care3. Community Participation4. Employment Assistance Activities Benefits5. ODSP Employment Assistance Benefits6. Health Benefits 7. Rapid Re-instatement

E. Legal Assistance - Where to find help


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


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


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)


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.


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


•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)


Income, Earnings and Assets

•To Be Reported by the 7th of the Month for ODSP and the 21st 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


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

• Inheritances ODSP - $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


Questions? Part A/B

A. Know Your Benefits

1. Who Provides the Money2. How To Obtain These Benefits - Mandatory vs. Discretionary 3. What if they say “NO’’

B. Income Support

1. Income Rates2. Earnings, Assets3. Exemptions – compensation plans, pain & suffering,

inheritances


DAY TO DAY BENEFITS

(Mandatory and Discretionary)


• 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


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.


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)


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


“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


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…


• “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


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” d

esignated 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)


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 longerinsured)

– 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.


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.


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


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


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.


$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 AllowanceInterval & 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).


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.


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)


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”


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!


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.


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)


EMPLOYMENT BENEFITS


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


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)


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)


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).


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)


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


•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


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


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


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.


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 employmentEligible (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


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


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.

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