Legislation

This section is an excerpt from the Ontario Works Act, 1997 prescribed by the Province of Ontario.

OW Act

44. Each administrator shall carry out the following duties:

1. Receive applications for basic financial assistance from persons residing in his or her geographic area.

2. Determine the eligibility of each applicant for basic financial assistance.

3. If an applicant is found eligible for basic financial assistance, determine the amount of the assistance and direct its provision.

4. Determine eligibility for employment assistance and direct its provision.

5. Carry out the prescribed duties.

OW Reg.

36. (1) If a person who is requested to provide information under subsection (2) fails to do so, the administrator shall reduce the amount of income assistance for the benefit unit by the amount of the budgetary requirement for a special diet because of a medical condition under paragraph 4 of section 41, paragraph 3 of subsection 44 (1), paragraph 5 of subsection 44 (2), paragraph 3 of subsection 44 (3) or clause 57 (5) (c), as the case may be.

(2) An administrator may request that a member of a benefit unit who is receiving or is applying to receive an amount for a special diet because of a medical condition under paragraph 4 of section 41, paragraph 3 of subsection 44 (1), paragraph 5 of subsection 44 (2), paragraph 3 of subsection 44 (3) or clause 57 (5) (c) provide information respecting his or her requirement for a special diet because of a medical condition.

Prescribed Policy Statements

Medical Conditions Re: Special Diets

1. (1) For the purposes of paragraph 4 of subsection 41 (1), paragraph 3 of subsection 44 (1), paragraph 5 of subsection 44 (2), paragraph 3 of subsection 44 (3) and clause 57 (5) (c) of Ontario Regulation 134/98 (General) made under the Act, the following is the policy for interpreting and applying those provisions:

1. The only medical conditions requiring special diets are those set out in Column A of Schedule 1, subject to subsections (2) and (3).

2. The amount to be included in a recipient’s budgetary requirements if a member of the recipient’s benefit unit has a medical condition requiring a special diet shall be determined in accordance with section 2.

(2) If a member of a recipient’s benefit unit has gestational diabetes, the administrator shall include in the recipient’s budgetary requirements the amount for that condition determined in accordance with section 2 for the remainder of the member’s pregnancy and for a period of up to three months after the end of the pregnancy.

(3) If a member of a recipient’s benefit unit has the medical condition referred to in item 19 of Schedule 1 relating to breastfeeding infants, the administrator shall not include the special diet allowance for that condition in the recipient’s budgetary requirements after the first birthday of the infant in question.

Budgetary requirements re: special diets

2. (1) For the purposes of subparagraph 4 i of subsection 41 (1), subparagraph 3 i of subsection 44 (1), subparagraph 5 i of subsection 44 (2), subparagraph 3 i of subsection 44 (3) and subclause 57 (5) (c) (i) of Ontario Regulation 134/98 (General) made under the Act, the amount determined in accordance with Schedule 1 that the administrator shall include in the recipient’s budgetary requirements shall be, for each medical condition requiring a special diet that a member of the recipient’s benefit unit has,

(a) the amount set out in Column C of Schedule 1, subject to subsections (4) to (9); or

(b) if Column B of Schedule 1 indicates that the medical condition is a condition that may cause weight loss, the amount determined in accordance with subsections (2) and (3).

(2) If a member of a recipient’s benefit unit has a medical condition that may cause weight loss, as indicated in Column B of Schedule 1, the amount that shall be included in the recipient’s budgetary requirements shall be, subject to subsection (3),

(a) if the member has lost more than 5 per cent but no more than 10 per cent of his or her usual body weight, the amount set out in Column C of Schedule 1; or

(b) if the member has lost more than 10 per cent of his or her usual body weight, $242.

(3) If a member of a recipient’s benefit unit has more than one medical condition that may cause weight loss, as indicated in Column B of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had one such condition.

(4) If a member of the recipient’s benefit unit has more than one of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1:

1. Diabetes

2. Gestational Diabetes

3. Hypercholesterolemia or Hyperlipidemia

4. Hypertension

5. Extreme Obesity

6. Prader-Willi Syndrome

7. Congenital Heart Defect – have had Ross procedure or arterial switch procedures or have coexisting coarctation of aorta

(4.1) If a member of the recipient’s benefit unit has the medical condition referred to in Item 3.1 (Chronic Hepatitis C (BMI < 25)) of Schedule 1 and one or more of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1:

1. Chronic wounds or burns requiring protein

2. Renal Failure – Pre-Dialysis (GFR <30)

3. Renal Failure – Peritoneal/Hemodialysis

4. Any medical condition listed in Schedule 1 that is identified in Column B of the Schedule as a medical condition that may cause weight loss

(4.2) If a member of the recipient’s benefit unit has the medical condition referred to in Item 3.2 (Chronic Hepatitis C (BMI < 25) with interferon treatment) of Schedule 1 and one or more of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1:

1. Chronic Hepatitis C (BMI <25)

2. Chronic wounds or burns requiring protein

3. Renal Failure – Pre-Dialysis (GFR <30)

4. Renal Failure – Peritoneal/Hemodialysis

(5) If a member of the recipient’s benefit unit has both Stages 1 and 2 and Stages 3 and 4 chronic wounds referred to in Item 4 (Chronic wounds or burns requiring protein) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be $191.

(6) If a member of the recipient’s benefit unit has the medical conditions referred to in Item 12 (Food Allergy- Milk/Dairy) and Item 13 (Food Allergy- Lactose Intolerance) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be the amount the member is entitled to receive for Item 12 (Food Allergy- Milk/Dairy).

(7) If a member of the recipient’s benefit unit has the medical conditions referred to in Item 14 (Food Allergy — Wheat) and Item 3 (Celiac Disease) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be $97.

(8) If a member of the recipient’s benefit unit has the medical conditions in Item 25.3 (Renal Failure (GFR < 30)), causing weight loss, and Item 26 (Renal Failure – Pre-Dialysis (GFR < 30)) or 27 (Renal Failure – Peritoneal/Hemodialysis) of Schedule 1, the amount to be included in the recipient’s budgetary requirements shall be the amount the member is entitled to receive for Item 25.3 (Renal Failure (GFR < 30)).

(9) If a member of the recipient’s benefit unit has the medical condition referred to in Item 27.1 (Rett Syndrome (BMI < 18.5)) of Schedule 1 and one or more of the following medical conditions, the amount to be included in the recipient’s budgetary requirements shall be determined as if the member only had the one condition that has the highest monthly amount as indicated in Column C of Schedule 1:

1. Chronic Hepatitis C (BMI <25)

2. Chronic wounds or burns requiring protein

3. Renal Failure – Pre-Dialysis (GFR <30)

4. Renal Failure – Peritoneal/Hemodialysis

5. Any medical condition listed in Schedule 1 that is identified in Column B of the Schedule as a medical condition that may cause weight loss.

More than one medical condition

3. Despite section 2, if a member of a recipient’s benefit unit has more than one medical condition that requires a special diet, the maximum amount that may be included in the recipients’ budgetary requirements with respect to all the medical conditions that the member has is $250.

Highlights

The following health professionals can certify that a Special Diet Allowance is required due to a medical condition:

  • Physician who is registered with the College of Physicians and Surgeons of Ontario
  • Registered Nurse in the Extended Class registered with the College of Nurses of Ontario
  • Registered Dietitian who is registered with the College of Dietitians of Ontario
  • Registered Midwife who is registered with the College of Midwives of Ontario (a Midwife may only confirm that a special diet is required for insufficient lactation to sustain breast-feeding and/or breast-feeding is contraindicated)
  • Traditional Aboriginal Midwife recognized and accredited by her or his Aboriginal community (a Traditional Aboriginal Midwife may only confirm that a special diet is required for insufficient lactation to sustain breast-feeding and/or breast-feeding is contraindicated).

The Prescribed Policy Statements set out medical conditions that require Special Diet Allowance(s) and the amounts to be paid.

The approved health professional will complete an Application for Special Diet Allowance indicating the medical condition(s) and the length of time a special diet is required for the medical condition(s). Eligibility will be reviewed at least once every 12 months.

Only the ministry-approved form (Application for Special Diet Allowance) is used. The participant can obtain the form by contacting his or her caseworker. The participant must sign the Applicant Declaration & Consent for Release of Information (Section IV) after the health professional completes the form. The participant is declaring that the information provided on the application is to the best of their knowledge “true, correct and complete” and to the release of any information in their “health records relating to the information provided on this application form”. If the allowance is for a child under 16, the participant or their spouse (if applicable) must sign the declaration for the child.

Administrative Guidelines

On receipt of an Application for Special Diet Allowance, the caseworker will:

  • Ensure that the Applicant Declaration & Consent for Release of Information (Section IV) is signed; and
  • Review the form submitted by the participant and all other family members (if applicable) to ensure that all regulatory criteria have been met.

If approved,

  • Compare the confirmed medical condition(s) with the Special Diets Schedule;
  • The approved amount will be added to the participant’s assistance effective the month the application was received with an expiry or renewal date; and
  • Advise the participant of the approved amount and review date.

If not approved,

  • A letter will be sent to the participant advising them of the reason.
  • The participant has a right to request an internal review and appeal of the decision.

When an approved health professional confirms more than one medical condition which requires a special diet for the same member of the benefit unit, the cumulative total of the Special Diet Allowance cannot exceed the maximum of $250 per month.

Eligibility for the Special Diet Allowance should be reviewed at least once every 12 months, unless the approved health professional specifies a shorter review period.

To continue the Special Diet Allowance, the participant will be required to have an approved health professional complete an Application for Special Diet Allowance.

If the Application for Special Diet Allowance is not received or the participant no longer has a medical condition that requires a special diet, the Special Diet Allowance will not be renewed and will be removed from the participant’s assistance.

If the approved health professional indicates at any point that the special diet is no longer required, the Special Diet Allowance will end.

Read a summary of the Special Diet Allowance and how to apply

Special Diet Schedule