1

Towards an Integrated Funding Model

2

Challenges to be addressed

Persisting low basic incomes of people with disabilities Significant income difference even where working Major need for personal supports and for cost offset Involvement of families in providing informal support,

and the direct costs and opportunity costs Disincentives to employment bcs of support system Need to strengthen community capacity for inclusion Government fiscal limitations Intergovernmental relations

3

Persisting low basic incomes (SLID)

Income difference of $7,600 per year– $9,400 if LTD

Below after tax LICO– w/disabilities 25%– LTD 29% – w/o disabilities 11%

$0

$5,000

$10,000

$15,000

$20,000

$25,000

TotalIncome

WithDisabilities

W/ODisabilities

4

Persisting low basic incomes -- major

unemployment (SLID)

Employed all year– 26 % w/disabilities– 19 % LTD– 58 % w/o disabilities

NILF all year– w/disabilities 54 %– LTD 65 % – w/o disabilities 17%

0%

10%

20%

30%

40%

50%

60%

Employed allyear

WithDisabilities

LTD

W/ODisabilities

5

Earnings difference if working all year (SLID)

Earnings difference of $5,800 per year (employed all year)– $7,200 if LTD

Below after tax LICO (earners)– with disabilities 9%– LTD 11%– w/o disabilities 6%

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

Earnings

WithDisabilities

W/ODisabilities

6

Major need for personal supports (HALS)

53 % of all adults need help with one or more everyday activities

pay out of pocket - not reimbursed– 25% of helped - okay– 39% of more needed

0%

5%

10%

15%

20%

25%

Need help

Need supt -okay

Need supt -moreneeded

Need supt -none recvd

7

Major need for personal supports (HALS)

35 % of all adults need aids / devices for mobility, seeing, hearing, speaking

Gap between need and usage

0%

5%

10%

15%

20%

25%

Aids / devices

Need aids -okay

Need aids -moreneeded

Need aids -none recvd

8

Need for cost offset (HALS)

36 % of all adults have non-reimbursed costs for various disability supports

0%

10%

20%

30%

40%

50%

60%

70%

80%

% of thosewho pay

Medications

Disposableitems

Specializedaids

Unins. healthsvcs

Resident.Mods.

Transp.

Personalsvcs.

Other

9

Need for cost offset (HALS)

Cost a reason why supports not more widely used

0%

10%

20%

30%

40%

50%

60%

% who needaids not

using bcs ofcost

For hearing

For seeing

For mobility

10

Need for cost offset -- equity according to ability to pay? (HALS)

The 36 % of all adults who have non-reimbursed costs for various disability supports doesn’t vary much by income level

But its harder to pay when poorer

0%

5%

10%

15%

20%

25%

30%

35%

40%

% who pay

$4,000 /year

Below LICO

Above LICO

$50,000 + /yr

11

Need for cost offset -- equity according to gender? (HALS)

Differences in the extent to which men and women pay for disability supports and are not reimbursed

Regardless of family income status, women are more likely to pay

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

% who pay

Men LICO +

Women LICO +

Men < LICO

Men < LICO

12

Disincentives to employment because of system design (HALS)

People not in the labour force:– 12% concerned about losing disability

supports if employed– 20% concerned about losing disability

income if employed

13

Family members provide most support (HALS)

Nearly half of people needing support for everyday activities are helped by family members only

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Who helps?

Family only

Friends only

Family &friendsFamily, friends,agencyFamily &agencyFriends &agencyAgency only

Not hlpd -needed

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Family members providing support -- opportunity costs (HALS)

Family incomes are lower where family members provide support with everyday activities

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Whohelps?

W/disab. -- needno helpFamily only

Family & friends

Family, friends,agencyFamily & agency

No disability - nohelp provided

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Need to strengthen community capacity for inclusion (HALS)

Reasons why people aren’t doing more of the community activities that they want

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Why notdoing more

High cost

Lack programs /facilities

Help not avail.

Transp. notaccessible

Progs. notaccessible

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Towards Solutions

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Integrated model would...

Address low basic incom es

Close incom e gap even if w orking

Provide general assistance to fam ilies

Eligibility reviewand settlem ent

Costs ofdirect supports

Finance disability supports

Core operatingcapacity

Forecastingneeds

Strengthen com m unity capacity

Integrated M odel

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Low basic incomes

Measures to increase employment– job accommodation funding and

incentives / info to employers– greater encouragement for employers to

use present tax system– “human capital” exemptions

Better basic income support

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Income gap even if working

Refundable tax credit that recognizes difficult to itemize additional costs of disability; advanced quarterly / monthly

Or other provincial or federal income program to deliver the same

Not only for people who are employed Not subject to “claw backs”

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General financial assistance to families who provide disability support

Refundable tax credit where providing direct support; available regardless of age of person supported and their labour-force status

Or other provincial or federal program to do the same

Not subject to “claw backs”

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Disability Support Program

Aims: ensure access to disability supports– for citizenship and inclusion

to help overcome barriers to carrying out activities of daily living, and to social and economic participation (incl. political and cultural) -- barriers directly associated with a disabling condition

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Disability Support Program

“Disability Support”– a good or service used to help a person

overcome barriers associated with a disabling condition

– no fixed set of goods and services

– program would focus on supports that “attach” to individuals (but not exclusively)

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Examples of disability supports Human assistance for direct instruction, care,

therapy (non-institutional) or assistance Planning and counselling Social development around individuals Technological supports Medications and health-related supplies Environmental adaptations Information and referral Other

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Program Principles

Accessibility Equity Adequacy Portability Responsiveness and consumer control Public responsibility

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Conditions of access -- need for disability support

Presence of need for a disability support would be the sole criterion

Not criteria such as– income level; age; employability; cause or

category of disability; attachment to training, work or rehabilitation; residency

Not a welfare-based program

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Conditions of access -- “disability”

Inclusive definition of disability:– hearing; seeing; speaking / being

understood; mobility; flexibility / agility; pain; respiration; general cognition - intellectual disability; specific learning disability; memory / confusion; emotional / psychiatric; other

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Program AdministrationAction

- determine needs

Who’s Responsible

- applicants, peerreview, approvedassessors

- estimate costs - ditto, based on pricinginfo and units needed

- recommend forfunding

- ditto

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Program AdministrationAction- settle / approveclaims

- hear appeals ofdecisions abouteligibility or funding

Who’s Responsible- funder (gov’t agency)

- agency / committee atarm’s length fromgov’t

- contracting - consumer, funder,vendor / provider

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Equity in financing individuals

Disability support cost = unit price x number of units needed

– Consistent and transparent pricing scheme for typically needed items and services; price quotes for less typical items and services

– Peer review of units of service requested

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Strengthen community capacity for inclusion -- mix of options

Community-based – Non-profit– For profit

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Strengthen community capacity for inclusion -- key functions

Core capacity– core coverage of disability administration, training

and office costs; portion of service cost to provider– conditional grants; periodic review– publicly subsidized user fees a major but not the

only source of agency income– generic services (e.g., homemakers, counselling)

eligible to increase generic capacity

Forecasting and planning

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Strengthen community capacity for inclusion -- core financing

Enable community services to:– review and recommend individual claims– assist with individual planning, contracting

and logistics– provide direct services to people with

disabilities (specialized and generic)– provide counselling on disability issues– consult with employers and others on

inclusion / accommodations

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Strengthen community capacity for inclusion -- forecasting

Enable community services to:– research patterns in use of supports– forecast emerging demand for support– document approaches that work well and

not so well– devise innovative support options on a

demonstration basis– participate in policy process

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Intergovernmental aspects

Intergovernmental accord Guiding principles and objectives Provincial scope to design and administer

program consistent with regional needs and guiding principles

Reinvestment agreement: new federal funding not used to reduce provincial contribution

Positive profiles for payers

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Conclusion: an integrated model would seek to...

Address low basic incom es

Close incom e gap even if w orking

Provide general assistance to fam ilies

Eligibility reviewand settlem ent

Costs ofdirect supports

Finance disability supports

Core operatingcapacity

Forecastingneeds

Strengthen com m unity capacity

Integrated M odel