Towards an Integrated Funding Model

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Towards an Integrated Funding Model
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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

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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

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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

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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

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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

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Major need for personal supports (HALS)

• 35 of all adults need aids / devices for
  mobility, seeing, hearing, speaking
• Gap between need and usage

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Need for cost offset (HALS)

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

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Need for cost offset (HALS)

• Cost a reason why supports not more widely used

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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 doesnt
  vary much by income level
• But its harder to pay when poorer

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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

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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

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Family members provide most support (HALS)

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

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Family members providing support -- opportunity
costs (HALS)

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

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Need to strengthen community capacity for
inclusion (HALS)

• Reasons why people arent doing more of the
  community activities that they want

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Towards Solutions
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Integrated model would...
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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 Administration
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Program Administration
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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...