July 6, 1998

 To:Community and Neighbourhood Services Committee

 From:Commissioner, Community and Neighbourhood Services

 Subject:Elimination of Special Assistance and Supplementary Aid

 Purpose:

 This report discusses issues related to the elimination of Special Assistance and Supplementary Aid under the new Provincial Ontario Works regulations. Responses of other regional municipalities to the Provincial changes are briefly discussed, as are the intentions of the provincial government with respect to ameliorating the negative impacts on low income residents who will no longer be eligible for certain benefits.

 Financial Implications:

 The Department estimates that the cost to Toronto of replacing medical benefits previously available to non-social assistance recipients under Special Assistance and Supplementary Aid would be approximately $480,000.00 at 100 percent municipal cost sharing for 1998. Continuation of cost sharing (80 Provincial/20 percent municipal) would result in a budget impact of $480,000.00 gross/$96,000.00 net.

 Recommendations:

 It is recommended that:

 (1)City Council request the Province to re-instate the former level of services to low income families, including coverage of the cost of prescription drugs and medical items, provided through Special Assistance and Supplementary Aid;

 (2)the Commissioner of Community and Neighbourhood Services implement Provincial changes to Special Assistance and Supplementary Aid resulting from the introduction of the new Ontario Works regulations;

  (3)City Council continue to advocate to the Province that the Assistive Devices Program be modified to cover the full costs of medical items formerly covered through Special Assistance and Supplementary Aid; and

 (2)the appropriate City Officials be authorized and directed to take the necessary action to give effect thereto.

 Background:

 In its report entitled "Analysis of Impacts of Ontario Works Regulations", the Community and Neighbourhood Services Department discussed changes in the regulations which eliminated benefits that had historically been available under the General Welfare Assistance (G.W.A.)Act to certain low income residents of the city who were not eligible for social assistance. These benefits included:

 (a)drug cards which provided 100 percent of the cost of approved prescription drugs and drug products for low income earners with high drug costs; and

(b)a range of health care items (hearing aids, prosthetics, wheel chairs and repairs, respiratory equipment and ambulatory aids) provided through Special Assistance and Supplementary Aid under the former G.W.A. Act to low income earners and recipients of other government programs ( Canada Pension Plan, Old Age Security/ Guaranteed Income Supplement).

 At its May 21, 1998 meeting the Community and Neighbourhood Services Committee requested that the Commissioner report directly to City Council for its meeting on June 3,1998 on how the City would be able to:

 (a)continue the drug deductible for working parents; and

(b)continue to cover the 25 percent or extra cost for items that are applicable under Special Assistance and Supplementary Aid.

 The Department's May 28 report, entitled "Continuation of Benefits to Clients Impacted by Ontario Works Regulations" estimated the costs of to the City of not eliminating benefits, as well as related program administration issues.

 Subsequently, at its June 3 meeting, City Council, recommended that "the City of Toronto continue to cover drug cards for working parents until such time as the Ministry of Health implements a drug plan for low income families as it has announced". Council also recommended that "the "implementation of eliminating Supplementary and Special assistance be delayed and the Commissioner of Community and Neighbourhood Services be requested to submit a report to the Community and Neighbourhood services Committee for its meeting to be held on July 16,1998, on:

 (a)responses from other regional municipalities; and

(b) clarification of the intentions of the Provincial government.

 In response to Council's request, this report discusses these issues.

 Discussion:

 Dilemma Regarding Municipal Continuation of Special Assistance and Supplementary Aid:

 The Chair of the Community and Neighbourhood Services Committee and the Commissioner met with the Ministry of Community and Social Services political staff and officials in May 1998 to discuss issues related to the introduction of the new Ontario Works Act regulations, including the elimination of benefits provided to low income families under Special Assistance and Supplementary Aid. The Province noted that the purpose of these specific changes were to restrict the focus of O.W. to eligible social assistance recipients.

 Provincial officials indicated that the intention was to serve low income families outside of the Ontario Works program, through existing programs such as the Assistive Devices Program and the Trillium Drug Plan, and through new initiatives such as the National Child Benefit Supplement. Announcements were expected within one month describing the types of services and benefits that would be provided to low income families affected by the new O.W. regulations. The Department continued to provide benefits to these families pending the Provincial announcements.

 However, based on the steps taken to date, provincial efforts are not adequate to meet the needs of low income families that will no longer receive benefits under Special Assistance and Supplementary Aid. As discussed below, the deductible remains under the Trillium Drug Plan. Neither have changes been announced for the Assistive Devices Program, which covers only a portion of the costs of medical items.

 At the same time, if the City of Toronto continues to fund current benefits at 100 percent, a number of key concerns are raised:

 (a)A primary purpose of the provincial reforms has been to disentangle and streamline the new welfare program by serving disabled people and low income families outside of O.W. Continued funding of benefits to low income families will clearly re-entangle the O.W. program within the City.

 (b)100 percent funding of benefits provided under an income redistribution program, such as social assistance, are inappropriate on the property tax base. The former Metro government consistently opposed supporting income redistribution programs on the local tax base.

 (c)100 percent funding by the City is also inappropriate given that the municipal portion of social assistance costs are now shared on a pooled basis across the Greater Toronto Area (G.T.A.).

  For these reasons, the Department recommends that the City no longer provide benefits to non-social assistance recipients. Further discussions should, however, be pursued with Provincial officials to ensure there are minimal impacts on vulnerable low income families that have been affected by the regulatory changes.

 Drug Deductible for Working Parents:

 As noted in previous reports, low income persons with high drug could receive a drug card under the former G.W.A. program which covered the cost of prescription drugs and related items. This benefit has been eliminated, although existing cases will continue to receive the benefit until the end of 1998. The Provincial government has indicated that the Trillium Drug Plan is the appropriate vehicle to cover the drug costs of low income persons. However, the Trillium Plan has relatively high deductibles (e.g. for example, a single person with an annual income of less than $6,500.00 ($541.00 per month) must cover the first $350.00 in drug costs).

 In 1997, approximately 300 cases per month received drug cards in Toronto to cover the cost of prescription drugs. Based on the mix of individuals and families eligible for drug cards, and their incomes, the Social Services Division estimates that, if the City was to cover the cost of the Trillium Drug Plan deductible, the budget impact would be approximately $110,000.00 per annum. No Provincial cost-sharing would be available, so the City would need to fund 100 percent of this amount.

 The Department position continues to be that the deductible should be waived for persons or families with high drugs costs who would have been eligible for the extended health benefit. At this time, Ministry of Health officials have indicated that it is unlikely that there will be any changes to the Trillium Drug Plan this year. It is therefore necessary that Council continue to advocate to the Province to ensure that low income families and individuals who would have been eligible for a drug card under the former G.W.A. program are not worse off than before the elimination of this benefit.

 Continued Coverage of Special Assistance and Supplementary Aid Items:

 Under the former G.W.A. Act, low income earners, through Special Assistance, and recipients of other government programs (Canada Pension Plan, Old Age Security/ Guaranteed Income Supplement),through Supplementary Aid, could access specific benefits although they were ineligible for G.W.A. Both programs were cost shared by the Province and municipalities at the following ratios: Special Assistance 50/50; Supplementary Aid 80/20. Under the new O.W.A. regulations, Special Assistance and Supplementary Aid are no longer available to these groups.

 Benefits provided under Special Assistance and Supplementary Aid included a range of health care items such as hearing aids, prosthetics, wheel chairs and repairs, respiratory equipment and ambulatory aids. The bulk of funding for these items is covered under the Ministry of Health's Assistive Devices Program (A.D.P.). Eligible individuals can be reimbursed for 75 percent of the costs of specific items, above $100.00 per item per month. The A.D.P. program also establishes maximum amounts for expenditures on eligible items which do not necessarily reflect the true cost of these items to individuals who must purchase them. Through Special Assistance and Supplementary Aid, Social Services subsidized the remaining 25 percent, and covered items under $100.00, for eligible cases.

 There are also medical items not covered by A.D.P., but provided for under Special Assistance and Supplementary Aid. Over the past several years, the Division also covered the costs of items delisted under the Assistive Devices Program.

 In its May 28 report to Council, the Department estimated that the gross cost to the City of replacing Special Assistance and Supplementary Aid would be approximately $480,000.00 per annum. Continuation of cost sharing (80 Provincial/20 percent municipal) would result in a budget impact of $480,000.00 gross/$96,000.00 net. It was also noted that there would also be program administration implications related to the delivery of benefits to people who will no longer be eligible for social assistance.

 In response to Council's request, the Division contacted other staff from regional municipalities regarding implementation of changes to Special Assistance and Supplementary Aid. Six of the eleven regional municipalities contacted are continuing to provide benefits to low income families. In most cases, this is being done on an interim basis, pending an assessment of the financial impacts, and an assessment of future actions taken by the Province. Only one of the four municipalities within the outer G.T.A. is considering continuing benefits.

 Given the elimination of Special Assistance and Supplementary Aid under the new Ontario Works regulations, the Department recommends that the City no longer provide benefits to non-social assistance recipients. In light of the Provincial changes, the City currently has no mandate to provide such benefits through the Ontario Works program. Continuation of benefits would also in effect represent a further down loading of Provincial costs onto the municipality.

 In initial discussions with Ministry of Community and Social Services (M.C.S.S.) staff, they indicated that the current Assistive Devices Program is the appropriate vehicle for assisting low income individuals with medical needs. However, no changes are contemplated by the Province to replace the benefits to low income persons that were previously provided through Special Assistance and Supplementary Aid. At this time, further discussions are required with Provincial officials to advocate that the Program be modified to cover the full costs of medical items formerly covered through Special Assistance and Supplementary Aid.

 Finally, it must also be noted that, under the Anatomy Act, the municipality is responsible for burial costs of the indigent poor. These costs have traditionally been shared on a 80 Provincial /20 municipal basis under Special Assistance. In 1997, gross Divisional expenditures for funerals was approximately $2.7 million. Under the new regulations, the Province will no longer cost share burials

for non-social assistance recipients. The municipality will of course fulfill its statutory obligations, and continue to provide burials for low income persons.

The Department's position is that any individual who is in indigent circumstances, and who is therefore eligible for coverage of funeral costs, should automatically be considered to be in need, and should, by definition, be considered social assistance recipients. Funeral expenses would then be shared on an 80 Provincial/20 municipal basis. Ministry staff are currently reviewing these issues, and discussions are continuing.

 Conclusion:

 In previous reports to City Council, the Department has noted the possible hardship low income earners and people on fixed incomes may face resulting from the Provincial elimination of Special Assistance and Supplementary Aid. In certain cases, people who are not now social assistance recipients may be forced to give up their employment so they can apply to Ontario Works to retain benefits they previously received. These changes appear to be counterproductive to the overall goal of the Ontario Works program, which is to ensure people become and remain independent of social assistance.

 Given the elimination of Special Assistance and Supplementary Aid under the new Ontario Works regulations, municipal delivery agents currently have no mandate to provide benefits to non-social assistance recipients through the Ontario Works program. Continuation of benefits would also in effect represent a further down loading of Provincial costs onto municipalities. For these reasons, the Department recommends that the City no longer provide benefits to non-social assistance recipients. However, further discussions should be pursued with Provincial officials to seek appropriate authority and cost sharing under Ontario Works to reduce impacts on vulnerable City residents that have been affected by the regulatory changes.

 Contact Name:

Heather MacVicar, General Manager

392-8952

 General Manager, Social Services Division

  Commissioner, Community and Neighbourhood Services