Towards an Integrated Funding Model

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%

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%

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%

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

7. Major need for personal supports (HALS) • 35 % of all adults need aids / devices for mobility, seeing, hearing, speaking • Gap between need and usage

8. Need for cost offset (HALS) • 36 % of all adults have non-reimbursed costs for various disability supports

9. Need for cost offset (HALS) • Cost a reason why supports not more widely used

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

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

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

14. Family members providing support -- opportunity costs (HALS) • Family incomes are lower where family members provide support with everyday activities

15. Need to strengthen community capacity for inclusion (HALS) • Reasons why people aren’t doing more of the community activities that they want

16. Towards Solutions

17. Integrated model would...

18. 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

19. 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”

20. 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”

21. 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

22. 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)

23. 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

24. Program Principles • Accessibility • Equity • Adequacy • Portability • Responsiveness and consumer control • Public responsibility

25. 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

26. 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

27. Program Administration

28. Program Administration

29. 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

30. Strengthen community capacity for inclusion -- mix of options • Community-based • Non-profit • For profit

31. 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

32. 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

33. 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

34. 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

35. Conclusion: an integrated model would seek to...