Community Services
Social Services Division
April 14, 1998
To:Community and Neighbourhood Services Committee
From:Commissioner, Community and Neighbourhood Services
Subject:Provision of Dental Services to Social Assistance Recipients
Purpose:
This report briefly updates Community and Neighbourhood Services Committee on recent Provincial announcements
regarding the provision of dental services for social assistance recipients in Toronto. It also provides information on the
larger review of changes in dental services provided by the municipality that is being undertaken jointly undertaken by
Toronto Public Health and Toronto Social Services.
Funding Sources, Financial Implications and Impact Statement:
The financial impact of the Provincial changes affecting municipal provision of dental programs for social assistance
recipients is currently under review and is not known at this time.
Recommendations:
It is recommended that this report be received for information.
Background:
Dental Programs for Adults in Receipt of Ontario Works:
The current municipal dental program, which was developed under the terms of the General Welfare Assistance (G.W.A.),
is a limited emergency program primarily geared to adult social assistance recipients. Under G.W.A., dental services were a
discretionary benefit provided through Special Assistance. Municipalities could choose whether to provide such a program,
and had substantial flexibility regarding its design and delivery. The program was cost shared on a 50/50 per cent.
provincial/municipal basis. The program is currently administered by a third party (The Great-West Life Assurance
Company).
Under the new Ontario Works Act, starting May 1, 1998, dental programs for adults in receipt of Ontario Works will
continue to be provided at the discretion of municipalities. Program cost sharing has changed to 80/20 provincial/
municipal. At this time, it is not known what standards will apply to the provision of dental services for adults.
Under the Provincial Family Benefits Program (F.B.A.), adults have historically had access to dental services through an
extended emergency dental program administered by a third party (the Ontario Dental Association). This program differs in
design and benefit structure, and, in general, provides somewhat more extensive coverage, than Toronto=s G.W.A. dental
program. Historically, there has been no municipal cost sharing of this program.
In June 1997, the Province announced that it was fundamentally reforming the social assistance system. Two new acts, The
Ontario Works Act (O.W.A.) and the Ontario Disability Support Program Act (O.D.S.P.A.), are scheduled to replace the
General Welfare Assistance Act (G.W.A.) and the Family Benefits Act (F.B.A.) in 1998. As a result of the introduction of
these Acts, and due to decisions implemented by the Province which download new responsibilities onto municipalities,
there will be substantial changes to the cost sharing and delivery of dental programs to social assistance recipients.
As a result of the assumption of financial responsibility for the provincial O.D.S.P. (which replaces F.B.A.), the
municipality will pay 20 per cent. of the cost of dental services provided to adults with disabilities who receive benefits
under the O.D.S.P. As noted earlier, the municipality will now be responsible for sharing 20 per cent. of the cost of dental
services for adults in receipt of O.W.
Dental Services Provided to Children in Receipt of Social Assistance:
Under the new social assistance legislation discussed above, starting May 1, it is mandatory for municipalities to provide
dental services to children under 18 who are in receipt of social assistance, whether through O.W. or the O. D.S. P. At that
time, the City will assume responsibility for sharing the costs of delivering dental services to these children.
Across Ontario, there have been a number of approaches to administering dental programs for children receiving social
assistance. Currently, in Toronto, children in receipt of social assistance receive treatment through the Children in Need of
Treatment (C.I.N.O.T.) program which is administered by Public Health. C.I.N.O.T. was specifically designed to meet the
needs of children up to Grade 8. Referrals to C.I.N.O.T. are generally made through schools when an emergency is
identified. Once in the program, the child will continue to receive treatment for emergencies in addition to preventative
maintenance.
Until January 1, 1998, the Ministry of Health provided 100 per cent funding for the C.I.N.O.T. Program. At that time, as
part of the Provincial AWho Does What@ process, responsibility for funding the C.I.N.O.T. program was devolved to the
municipality. The overall impact is twofold: first, there are financial implications related to the devolution of the C.I.N.O.T
program; and second, the impacts of the Provincial changes to provide for a mandatory dental program for children whose
families are on social assistance, which, in Toronto, is being provided through C.I.N.O.T. Municipal staff are currently
assessing the combined impacts of these changes.
New Provincial Dental Program Directions:
In March 1998, the Ministry of Community and Social Services (M.C.S.S.) forwarded a ADraft@ copy of a ASchedule of
Dental Services and Fee Schedule for The Mandatory Dental Coverage of Ontario Works Children and Ontario Disability
Support Program Beneficiaries@ for review. The purpose of this schedule is to define standards for the provision of
mandatory basic dental benefits in a way which ensures these clients groups have access to the same level of services across
the Province.
As part of the Province=s plan to implement new social assistance legislation, it is staff=s understanding that
municipalities will be required to provide access to basic dental care, as set out in the schedule, for children on social
assistance as of May 1, 1998.
Discussion:
To date, staff have not had sufficient time to assess the proposed changes, and the impacts on clients, budgets or service
delivery systems. A number of key issues will need to be addressed. For instance, it is not known how the new standards
announced by the Province compare with the those in place under the C.I.N.O.T. program. Also, it is not clear how benefits
will be delivered to children who will eligible for dental services under the new program announced by the Province, but
who are not now eligible under C.I.N.O.T., namely children between 13 and 18 years of age.
Recently, the Province has indicated that implementation of the new arrangements governing dental services will include
an initial transition phase, permitting more extensive consultations with municipalities regarding the proposed schedule of
benefits and other basic program design changes. On an interim basis, the Division=s understanding is that dental programs
for social assistance recipients will be administered by current plan providers, ensuring that there are no interruptions in the
provision of dental services to clients.
As a result of broader changes affecting Public Health, including the devolution of responsibilities under the Provincial
AWho Does What@ process, the amalgamation of Public Health departments, and the assumption of new responsibilities
in the dental services area, Public Health has been requested by Budget Committee to undertake a review, in conjunction
with Social Services, of the overall impacts of the above changes for the municipal provision of dental services. A report
back to Committee has been requested by July 1998. The review will consider a range of factors, including estimates of
how many people will be served, program costs, and the effects of particular design features, such as processes for
adjudicating dental claims.
Terms of reference for this review are now being developed. An important component of this process will be an
assessment of changes to programs providing dental services to children and adults in receipt of social assistance. Given the
number and complexity of variables that must be considered vis a vis changes affecting these programs, the Social Services
Division is collaborating with Public Health staff to plan and conduct this part of the review. With the additional changes
affecting dental services for social assistance recipients recently announced by the Province, it is anticipated that the
requested report will be tabled at Budget Committee in late summer 1998.
Conclusion:
This report updates Council on the changes in the cost sharing and provision of dental services for social assistance
recipients. Social Services Division will work with Public Health to complete their review of the impacts of changes to
current dental programs, and assess the implications for the municipality. The comprehensive report on dental services for
the City of Toronto requested by Budget Committee will be tabled in late summer.
Contact Name:
Heather MacVicar(phone 392-8952, fax 392-4214)
Heather MacVicar, General Manager, Social Services Division
Commissioner, Community and Neighbourhood Services
