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Towards an Integrated Funding Model. 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
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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
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%
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%
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%
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
Major need for personal supports (HALS) • 35 % of all adults need aids / devices for mobility, seeing, hearing, speaking • Gap between need and usage
Need for cost offset (HALS) • 36 % of all adults have non-reimbursed costs for various disability supports
Need for cost offset (HALS) • Cost a reason why supports not more widely used
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
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
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
Family members provide most support (HALS) • Nearly half of people needing support for everyday activities are helped by family members only
Family members providing support -- opportunity costs (HALS) • Family incomes are lower where family members provide support with everyday activities
Need to strengthen community capacity for inclusion (HALS) • Reasons why people aren’t doing more of the community activities that they want
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
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”
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”
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
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)
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
Program Principles • Accessibility • Equity • Adequacy • Portability • Responsiveness and consumer control • Public responsibility
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
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
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
Strengthen community capacity for inclusion -- mix of options • Community-based • Non-profit • For profit
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
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
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
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
