ODSP & OW “Extras”:

Benefits you may not know

about…!

Community Legal Workers

Legal Aid Ontario
1
 Overview
Let’s take a closer look at some
Ontario Disability Support Program (ODSP)
and Ontario Works (OW) Benefits:

• Special Diet
• Employment Start Up
• Community Participation
• Drug & Dental
• “Mandatory Special Necessities”
• Vision, Hearing, ADP Co-payment
• Community Start Up & Maintenance
• Women in Transition/Interval Houses
• Other Benefits (winter clothing, back-to-school, advanced age)

• OW Discretionary Benefits
• ODSP “Special Extras”

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 Resources
1. Legislation:
The ODSP & OW Acts are located
on-line (click on “+” sign beside the
Act to access the regulations)
www.e-laws. gov.on.ca/tocBrowseCL_E.asp?lang=en&selLetter=O#O

2. Policy Directives are also located on-line:

ODSP Directives - www.cfcs.gov.on.ca/CFCS/en/programs/IES/
OntarioDisabilitySupportProgram/ Publications/Odspisdir.htm

OW Directives - www.cfcs.gov.on.ca/CFCS/en/programs/IES/Ontario
Works/Publications/ow-policydirectives.htm

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 Special Diet Allowance
• A province-wide review of all ODSP/OW
special diets is currently under review

• The new schedule lists specific medical

conditions like HIV/AIDS, Diabetes, etc.

• Clients must re-confirm eligibility by

completing the revised “Application for
Special Diet Allowance” (Form 3059 &
3060)

• Clients have 90 calendar days to return

form – *during this period, clients are
still eligible for old amount, so advice is
to submit towards end of 90 day period
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 Special Diet Allowance
• Forms must be completed by an
approved health professional: doctor,
“nurse in the extended class” or a
dietician.

*In addition, midwives and traditional

Aboriginal midwives can approve the
pregnancy, breastfeeding, and infant
formula diets.

• *Weight-related conditions: Clients

whose special diet allowance has
helped them achieve & maintain a
health body weight (e.g. HIV/AIDS)
should continue to receive the same
amount, but up to the new maximums.
*In addition, they will not be subject
to review in the future.
(Based on new Ministry Bulletins – Dec 5
05 and April 06)
 Special Diet: What they don’t tell you...

• Clients who re-confirmed eligibility

for a special diet allowance before
the new Ministry Bulletins, should
ask for a review (file an Internal
Review, contact your community
legal clinic…)

• You can appeal a decision by a

worker if they say “NO”

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 Pregnancy Diet
• If you are pregnant, you are entitled to
receive a “pregnancy nutritional allowance” -
$50/month non-dairy, $40/month milk-based

• This is provided in addition to other special

diets and is not part of the maximum
calculation

• The worker should advise you of the

breastfeeding diet and that infant formula is
available to you under certain circumstances

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 “Employment Start-Up Allowance”
• For any eligible member of the OW or ODSP benefit unit. A
client must be:

– Starting or changing a job, in a training program, or doing another EA

activity under OW, &
– have proven expenses for the approved start up

• Maximum up to $500 in any 12 month period

(Before Nov. 1: was up to $253)

• Eligible expenses may be things like:

– tools and equipment; transportation costs;
– work wear; grooming costs;
– licensing fees, association costs; or
– any other item that, in the opinion of the Director, is a necessary
work or training related expense;

• Many community agencies where you may want to volunteer, help

people with letter requesting this Allowance
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 Employment Start Up:
Advanced Child Care Payment
• In addition to ESUB, clients can get an “advanced
child care payment”

• Where clients need to pay up-front for the

amount they would normally be entitled to
deduct for child care under the legislation:

OW & ODSP:
– actual child care cost for a licensed day care
facility, otherwise,
– up to $600/month for informal care

(ODSP – Before Nov. 1: was $390/month for

informal care, but now matches OW amount of
$600)

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Employment Assistance Expenses (EAE)
• EAE may be paid over and above
ESUB to cover cover out-of-
pocket expenses

• Maximum average of $250 per

month available (need approval for
costs above this) and a maximum
advance of $500

Includes funding for: •supplies & equipment

•short training costs
•travel •protective clothing

•clothing, grooming and •telephone expenses

special equipment •criminal checks and
•safety equipment medical exams or
certificates for community
•child care costs placement
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 ESUB, Advanced Child Care & EAE:
What they don’t tell you
• ESUB and Advanced Child Care
are “mandatory benefits” and
can be appealed if denied
(EAE can not be appealed)

• For ODSP, clients can also

qualify for a $300 deduction
from chargeable net
income/earnings for
“disability-related expenses”
(Before Nov. 1 – was $140)
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 “Full-Time Employment Benefit”
(FTEB) for OW
• OW recipients can receive $500 (max. in 12
month period) when beginning full-time
employment

• Expenses are those approved

by the Administrator as
“reasonable and necessary”

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 *Other ODSP Changes as of
November 1, 2006*
• New automatic “Transportation Expense” benefit of
$100/mth issued to each ODSP recipient, spouse and
dependent adult who reports earnings or is in training
program

• New $500 “Employment Transition Benefit” (ETB)

will be paid if recipient leaves ODSP for employment
(FT or PT) or training

• New “Transitional Health Benefit” (THB) – for those

who are: ineligible for ODSP because their income is
too high; can’t get coverage through their employer;
and, they’re not eligible for the Extended Health
Benefit.
Will include drugs, dental and vision benefits.
Coverage continues until you are covered by employer
health plan. No time limit, but eligibility must be re-
established annually. 13
 Community Participation (CP)
• Unpaid volunteer placements
for OW and ODSP recipients

• In Toronto, we know that clients can

usually get $100 per month for such
things as:
– TTC pass,
– clothing and grooming,
– special equipment supplies &
equipment required for the placement.

• Clients can volunteer up to 70 hours each month (there

is no minimum), for up to 6 months (can request to
volunteer for longer)

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 Community Participation (CP):
What they don’t tell you...

• If a client qualifies for the $, this does not necessarily mean they are
ineligible for medical transportation. (However, if you get a TTC pass for
CP, and this covers your transportation to medical appointments, you will
not get additional funds for the TTC under medical transportation)

• Most ODSP recipients are not told they can voluntarily participate in CP
and get some
funding for it.

• As CP is voluntary for people on ODSP, it is not appealable to the Social

Benefits Tribunal.

• For OW clients, CP may be a required activity under their participation

agreement.

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 Drug Benefits
• A monthly drug card is provided to all
members of the *benefit unit for ODSP &
OW

• Covers the cost of prescription medication

(listed in the Ministry of Health’s Ontario
Drug Benefit Formulary)

• No cost to the client except the pharmacy

dispensing fee (clients can ask the pharmacy
if they can waive this fee)

(*“Benefit Unit” means a person and all of his or her

dependants on behalf of whom the person
receives or applies for income support)
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 Dental Benefits
• A dental card, providing coverage for dental
services, is only provided to:
– OW: dependent children
– ODSP: all recipients except dependent adults
18 and over, and

*All those not covered can apply for OW “discretionary

benefits” for dental coverage.

• The “MCSS Schedule of Dental Services and

Fees” sets out coverage of services

• Clients should talk to their dentist about the

services that are available to them and any
limitations with respect to services they require

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 Drug & Dental:
What they don’t tell you...
• A Drug Card can be issued to a non-compliant dependent adult who has
a serious illness or health condition

• ODSP recipients who have a health condition

that affects their teeth (disability,
medications or treatment) may be eligible
for the dental special care plan, which includes:
– more frequent cleanings and visits
– enhanced levels of coverage

• Clients should ask their dentist about the “MCSS Dental Schedule”
which talks about the plan.

• A dental special care service plan must be pre-determined through the

ODA. Once approved, plans are valid for 5 years.

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 “Mandatory Special Necessities”
(MSN)
• ODSP and OW use the term
“Mandatory Special Necessities” to
talk about 3 kinds of benefits:
– Diabetic Supplies
– Surgical Supplies/Dressings
– Medical Transportation

• To receive any of these benefits,

clients must fill out the “Mandatory
Special Necessities” form

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 MSN: Diabetic Supplies
• Clients can get coverage for supplies such
as:
• Needles, syringes, swabs, platforms,
lancets and blood glucose monitors.
(Insulin and test strips are covered
under the drug card as they are ODB
listings)

• *Clients must access other sources of

funding first as some of these supplies
may be fully or partially covered by the
Canadian Diabetes Association, the
Assistive Devices Program, the drug
card, or another program…

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 MSN: Surgical Supplies & Dressings

• “Surgical supplies and dressings”

are items prescribed by a
physician that are required as a
due to a surgical, radiological or
medical procedure or disease

• Again, ODSP & OW will pay for

these supplies if they can’t be
paid by another source (hospital,
Community Care Access Centre,
Easter Seals Society, Assistive
Devices Program, drug card)

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 MSN: Medical Transportation
• ODSP & OW will cover the cost of
transportation for medical purposes if
costs exceed $15 a month per benefit
unit

• Travel to any registered

health professional (designated under
the Regulated Health Professions Act,
1991)

This includes:

physician, optometrist, midwife, nurse, pharmacist,

occupational therapist, speech language pathologist,
physiotherapist, dentist, dental audiologist, medical laboratory
surgeon, dental technician, dental technologist, psychologist,
hygienist, denturist, optician, respiratory technologist,
dietician, medical radiation chiropractor, chiropodist, or
technologist, massage therapist, podiatrist 22
 Medical Transportation:
What they don’t tell you...
• Clients can get transportation covered for
AA or NA if a doctor/psychologist prescribes

• Clients can get transportation for mental health therapy and

counselling if it’s prescribed and supervised by a doctor, psychologist
or psychiatrist.

• ODSP/OW will only pay for the cheapest possible mode of transport
(public transit, taxi)

• ODSP/OW can pay for accommodation and meals if you have to travel
overnight for medical treatment (along with someone who needs to
accompany you - as specified by the approved health professional)

• You can appeal a decision about medical transportation

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 Extended Health Benefit (EHB)

• Available for both ODSP and OW

• If a client’s income is too high to

qualify for OW or ODSP, but
they have high health costs,
they may be eligible for the
Extended Health Benefit
(i.e. HIV+ client with extraordinarily
high prescription drug costs)

• Talk to your OW/ODSP Caseworker

(or Community Advocate) for more
details
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 EHB: What they don’t tell you...
• Often, that it even exists and is available to people

• Clients can get their pharmacy to produce a list of

medications for the past six months or year to figure out
average monthly drug costs which will help determine
eligibility

• A decision about EHB can be appealed

• The Trillium Drug Program is an option

if not eligible

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 Vision
• OW - only dependent children
• ODSP - all benefit unit members, except dependent
adults
*All those not covered can apply for “discretionary
benefits” under OW

• Covered costs include:

– eye exam every 24 months if not
covered by OHIP (20-64 no longer
insured)
– new frames and/or lenses every 3 years
– necessary repairs
– replacement for loss or damage for kids, but not
for adults except if no fault loss/damage

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Vision Benefit: what they don’t tell you
• There is a lot of discretion in the policy to
approve the cost of glasses

• You can appeal a decision regarding

coverage for glasses.

• Guide Dog Benefit – each member of the

benefit unit can receive up to $66/mth to
assist with care/feeding costs.
*Note: This benefit is not limited to
persons with a visual or hearing
impairment, but can apply broadly to
persons with autism, cerebral palsy,
muscular dystrophy, ABI, MS

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 Hearing Benefit
• ODSP: all recipients, except dependent adults
• OW: Not provided
*All those not covered can apply for
“discretionary benefits” under OW

• Covers the cost of a hearing aid evaluation,

the remaining cost of a hearing aid not
covered by ADP, and replacement batteries
and repairs.

• The hearing aid device can be replaced every

3 years (if device doesn’t work and can’t be
repaired)

• The cost of a hearing assessment may be

covered if it’s not already covered by OHIP.
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 Assistive Devices Co-payments

• The ADP (Ministry of Health) provides financial

assistance to people with long-term physical
disabilities to obtain aids, devices & supplies.

• The ADP only covers 75% of costs…so OW and

ODSP will pay the remaining 25%, if there is no
other source of funding for these items.

• Assessments along with batteries and repairs

for assistive devices are covered.

• There is no appeal if you are denied this

benefit.

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 Community Start Up & Maintenance
Benefit (CSUMB)
• CSUMB is available to OW and
ODSP clients for help with moving
costs, paying rent/utility arrears,
to avoid being evicted.

• Up to a maximum of $799 for a

single person or $1500 for a
family with one or more
dependent children.

• Available only once in any 24

month period.
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 Community Start Up & Maintenance
Benefit (CSUMB)
Clients will need to prove they need $ to set up a
new, permanent home -or- remain in their existing
home and:
•they’ve been evicted or need $ to prevent eviction or
•they are coming out of an institution that provided
basic needs and shelter (e.g. hospital, nursing home) or
•it would be harmful to their health or welfare to stay in
their current place or
•they need $ to assist with utility arrears/re-
connections or prevent utilities from being shut off or
•they are required to move, or need assistance moving,
because of a disability or
•any other situation deemed to be an “exceptional
circumstance” approved by the Director…
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 CSUMB: What they don’t tell you...
• It is possible to receive CSUMB more
than once in a 24 month period, up to
the maximum amount of $799 or
$1500

• You can appeal a decision about

CSUMB.

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Women in Interval & Transition Homes...
• If a client is temporarily living in a
shelter for abused women, she is
eligible for the “basic needs and
shelter allowance” for the first 3
months (discretionary beyond 3 mths)

• Client must be “preserving her right to

return to home” (principal residence) –
i.e. still paying for the home

• If client does not maintain her right to

return home, or the Director chooses
not to extend basic need and shelter
benefit beyond 3 months, she and each
of her children will receive a personal
needs allowance of $116/month

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 Other Benefits - Winter Clothing
Allowance (WCA)
• Both OW and ODSP clients are eligible to receive
a mandatory winter clothing allowance of $108
-once per year (effective Oct/Nov 2006).
• This allowance is only available for dependent
children who are eligible for assistance in the
months of Oct-Dec (ODSP) or Nov-Dec (OW).
• Not available if benefit unit only getting
emergency assistance or EHB.

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 Back-to-School Allowance
• Both OW & ODSP clients are
eligible to receive a mandatory
“Back-to-School” allowance for
dependent children in the benefit
unit.

• Payable in July-December (ODSP)

or August-December (OW) and
only available once per year
(*but can be paid if you come on the
program between August and
December)

• The benefit is $71 for every

child ages 4 -12, and $131 for
every child ages 13-17 who is or
will be attending school.
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 Advanced Age Item
• OW also contains an additional benefit of $31 for
each member of the benefit unit who is older
than 65 years of age, for personal needs.

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 OW Discretionary Benefits
• OW has what it calls
“discretionary benefits” which
may be issued under the
legislation.

• Discretionary benefits can be

paid to OW or ODSP recipients

• 3 categories: health related,

non-health related, & “other
special items & services”

• Discretionary benefits are not

appealable.
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 Discretionary Benefits –
1. Health-related
– For OW adults: Dental care (emergency
or to support participation
requirements), vision care, hearing aids &
batteries
– Prosthetic appliances
– Prescription drugs not listed under ODB
– “cost of completing other medical forms”
– Air conditioners for severe asthmatics
– Funeral costs
• max of $2250
• no gravestone included, but markers and
care charges are included
• cost of the grave plot only if the
administrator also owns the cemetery!

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 Discretionary Health Benefits -
2. Non Health-Related
• “Vocational training/retraining”
– can be used after employment assistance expense funds are used up,
and can include transportation costs. “Must be job specific and
connected to a job available in the local labour market”

• Non health-related travel & transportation:

– Transport to return to home outside of Ontario
– To attend court to seek spousal support
– To visit people at hospital or funeral for next of kin.

• Moving expenses
– Can include storage…sometimes can even include storage charges
incurred prior to application if stored furniture is “essential to the
family”

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 Discretionary Benefits –
3. “Other special items & services”
• Home repairs
– where not providing would be
detrimental to health and well-being
– paid only once invoiced
– usually approved only if “urgent” or
“emergency”
– can be provided as payments included
in shelter, and may be divided over a
number of months to fit within
maximum shelter allowance.

Continued…
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• layettes and baby supplies
• repair/replacement of essential
furniture and appliances
• replacement of household goods
after emergency (fire, flood)
• blood test in child support
applications
• the cost of preparing a will where the
cost cannot be paid by some other
source
• *** “Any other service” – so always ask
your caseworker - there is no harm in
asking!
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 Discretionary Benefit: Energy
Conservation
• One-time discretionary benefit
up to $50, for ODSP and OW

• For low-cost energy

conservation measures such as
caulking, weather-stripping,
insulating hot water pipes, etc.

• Seek approval in advance

• Can not be appealed 42

 ODSP “Extras”
• ODSP recipients may also be
eligible for benefits such as:
• Necessary home repairs (can appeal
if say “no”)
• Costs for second residence:
– If you maintain your normal place of
residence but have to temporarily
change residences for training in a
program that will improve your
chances of getting employment
– the amount will be the lower of:
• the costs of maintaining your normal
place of residence during the
training and not available elsewhere
• $455
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 How do I get these benefits?

• In almost every case, in order to access these

benefits you must:
– Know about them!
– Ask for them!
– If a specific form is required, ask for the form!

– If a decision is made and they say no, ask for it in

writing!!!!!

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 What if they say NO?
• Appeal, appeal, appeal!

• You start the appeal process by requesting

an Internal Review which must be:
– in writing – one sentence - “I want an
internal review of this decision.”
– submitted within 10 days of getting the “no”
decision from the Caseworker

– *Contact your local community legal clinic

for help

• You can request an extension if you’re past

the 10 days (and you should)

• *Even decisions which are not appealable

can be internally reviewed.
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 What if they still say NO?

• If your internal review is not successful, you can file an appeal to

the Social Benefits Tribunal (SBT) (www.sbt.gov.on.ca)

• You must submit the appeal form within 30 days of the internal
review decision. *Contact your local community legal clinic for help.

• All “mandatory” benefits can be appealed: CSUB, ESUB,

drug/dental card, vision, hearing, mandatory special necessities,
special diet, necessary home repairs, child care costs.

• *Discretionary benefits may not be appealed, but if you are in

Toronto you can still apply to the “Decision Review Committee of
Ontario Works” to have your case reviewed

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 Community Legal Clinics

• For information about benefits or for help

at anytime – especially when a Caseworker
says “no” - contact your nearest
Community Legal Clinic!!!

• To find you nearest Clinic,

go to www.legalaid.on.ca/en/contact.asp
OR call 1-800-668-8258

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