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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%
$0
$5,000
$10,000
$15,000
$20,000
$25,000
TotalIncome
WithDisabilities
W/ODisabilities
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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%
0%
10%
20%
30%
40%
50%
60%
Employed allyear
WithDisabilities
LTD
W/ODisabilities
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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%
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
Earnings
WithDisabilities
W/ODisabilities
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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
0%
5%
10%
15%
20%
25%
Need help
Need supt -okay
Need supt -moreneeded
Need supt -none recvd
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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
0%
5%
10%
15%
20%
25%
Aids / devices
Need aids -okay
Need aids -moreneeded
Need aids -none recvd
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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
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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
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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 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
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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
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
% who pay
Men LICO +
Women LICO +
Men < LICO
Men < LICO
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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
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