Discretionary Benefits
Discretionary Benefits
Training Manual
History
Discretionary
Health Benefits
• Based on actual expenses
Discretionary NonHealth Benefits
• $8.75 per case per month
Discretionary Benefits
Prior to April 1, 2013, First Nations Ontario Works had two (2)
discretionary benefits fund with the following funding formula:
Effective April 1, 2013, discretionary benefits are no longer separated,
they are combined into one (1) discretionary benefits funding
allocation.
Prior to
April 1,
2013
• Discretionary Benefits allocation
were based on the fiscal year April - March
Effective
April 1,
2013
• Discretionary Benefits allocation
are based on the calendar year
due to the cost sharing formula.
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Cost Sharing
Discretionary Benefits issued on behalf of “status” recipients is cost
shared between Ministry of Social and Community Services (MCSS)
and Aboriginal Affairs Northern Development Canada (AANDC) based
on the cost-sharing formula.
2010
2011
2012
2013
2014
2015
2016
2017
2018
Ongoing
First
Nations
Share
19.4%
18.8
%
17.2%
14.2
%
11.4
%
8.6%
5.8%
2.8%
0%
0%
Provincial
Share
80.6%
81.2
%
82.8%
85.8
%
88.6
%
91.4%
94.2%
97.2%
100%
100%
Discretionary Benefits that are issued on behalf of Non-Status recipients
are cost shared at 100% provincial however, all expenses are allocated
and deducted from your Fiscal year Discretionary Benefits allocation.
2
Current Funding
Discretionary Benefits funding allocation is based on your caseload.
Caseloads determination is the combined monthly total of Ontario
Works (OW) and Ontario Disability Support Program (ODSP) recipients.
• First Nations that have less than 250 cases per month will be
allocated an amount of $2, 500 per month ($30, 000 annually)
for all health and non-health discretionary items.
250 or more Cases
• First Nations with 250 or more cases per month will be
allocated based on the capped funding forumal of $10.00 per
case per month for all health and non-health discretionary
items.
Discretionary Benefits
Less than 250 cases
Group Delivery
• Group Delivery Agents will recieve funding based on the
combined total of all First Nations caseload within thier
organization at a capped rate of $10.00 per case per month.
First Nation Ontario Works caseloads that vary from 250-250 + each
month, will be reconciled at the end of the fiscal year to determine an
annual average of the total cases.
3
Discretionary vs. Mandatory
First Nation Ontario Works Administrators must have the ability to
distinguish the difference between Discretionary Benefits and
Mandatory Benefits.
Discretionary Benefits is defined as assistance for non-health related
items, and health related for adult members such as dental and vision.
Decision of the issuance of Discretionary Benefits issuance cannot be
appealed. First Nation Ontario Works Administrations have the authority
to approve or deny the issuance of benefits.
Discretionary
Benefits
Mandatory
Benfits
• Issued on a case by case basis, based
on needs and funding availabilty
• Capped funding
• First Nation develops local policy to
guide decision making
• Issued to recipeints who meet
eligibility
• Based on acutual expenses
• MCSS approved list of benefits that
must be provided
It is importation to remember that the funding formula is only for
Discretionary Benefits.
4
Eligible Mandatory Benefits are not allocated to discretionary benefits
and do not effect allocation.
Mandatory Benefits
Mandatory
Benefits
include:
Dental for dependent children
Vision for dependent children
Surgical supplies and dressings
Guide dog allowance
Discretionary Benefits
Medical transportation
If a recipient meets eligibility requirements and has supporting
documentation to support the need of a mandatory benefit, it must be
issued. Denying mandatory benefits can be appealed.
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What Directive support Discretionary Benefits
Under the Ontario Works Directives, 7.1 (Summary of Benefits) provides
the following information on Mandatory and Discretionary Benefits.
Policy
Basic financial assistance includes mandatory and discretionary
benefits.
Mandatory benefits are provided to all eligible Ontario Works recipients
and/or members of the benefit unit.
Discretionary benefits are provided on a case-by-case basis at the
discretion of the First Nation Ontario Works Administrator to:
1. Persons in receipt of assistance under the Ontario Works Act,
1997, including children on whose behalf Temporary Care
Assistance (TCA) is being paid.
2. Persons in receipt of income support under the Ontario
Disability Support Program Act, 1997 or
3. A member of a prescribed class, such as a person in receipt of
Assistance for Children with Severe Disabilities (ACSD)
The First Nation Ontario Works Administrator determines the amount
provided for discretionary benefits.
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What are allowable Discretionary Benefits?
Discretionary Health Related
1. Dental Care for adults:
Benefits
2. Vision care for adults (eye glasses, including
lenses and frames, repairs or replacements)
when necessary as a result of a significant
change in prescription or to support the
person’s employability or participation
requirements
3. Prosthetic appliances (the recommendation
of an approved health professional and
estimate of the cost of such appliances are
required)
Discretionary Benefits
a. Emergency dental care which is
necessary to relieve pain for medical or
therapeutic reasons
b. Dental care which supports the
person’s employability or participation
requirements
4. Funerals and Burials (recommended
maximum of $2250 for funeral and burial or
cremation costs)
5. Heating payments and payments for low-cost
heating energy conservation measures (may
be provided to recipients who are home
owners or renters when recipient is responsible
for utility)
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Non-Health Related
1. Vocational training and retraining (when
costs do not meet the parameters of training
under Employment Related Expenses)
2. Travel and Transportation that is not for
health-related purposes (when administrators
considers reasonable and appropriate, for
example domestic violence, etc.)
3. Moving expenses (The Administrator may
approve payments to cover the costs of
moving household furniture from one place of
residence to another)
4. Any other special service, item or payment
authorized by the Director. The following
special services, items or payments are
currently approved by the Director:
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o Chiropractic services
o Northern allowances for communities
north of the 50th parallel without year
round road access
o Wheelchair and mobility devices (e.g.
lifts) batteries, replacement batteries,
and necessary repairs)
o Provision, replacement and repairs of
hearing aids including batteries for the
portion not covered by the Assistive
Devices Program
o Certification of a learning disorder by a
qualified medical doctor or
psychologist
o Cost of an alerting shaking (e.g. lightflasher, bed-shaker or other
appropriate alerting mechanism) if the
o
o
o
o
o
o
o
o
o
o
o
Discretionary Benefits
o
recipient or a member of the benefit
unit is deaf or hearing impaired
Cost for completing medical forms not
covered by OHIP, as required to verify
eligibility for assistance, benefits or
other required purposes
Replacement of repair of essential
household furniture and appliances
Replacement or purchase of smoke
alarms and batteries for recipients who
own their homes and are not in receipt
of the maximum shelter allowance
Replacement of household items and
personal effects in emergency
situations (e.g. fire, flood, storms)
Electric beds to avoid bedsores for
persons confined to a bed
Air conditioners for severe asthmatics
Electric breast pumps
Layettes and baby supplies
Blood tests required for Applications for
Support where the cost cannot be paid
by some other means (e.g. Legal Aid)
Cost of preparing a will where the cost
cannot be paid by some other means
(e.g. Legal Aid)
Initial deposits required by landlords or
others for rent, hydro and heating
where necessary
Payments for continuation of hydro or
heating service, or to prevent eviction,
payments for low-cost energy and
water conservation measures.
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Non-Health Related Discretionary Benefit example
Form
Name of Applicant:
Ontario Works
Are you currently in receipt
of:
ODSP
Other
Explain:
Reason for Request:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Funds requested:
Travel and Transportation
$
Special Services, Items and
Payments
$
Non-health related (up to $250)
$
Total Amount Approved
$
Verification Attached (documentation to support issuance) For
example: Doctor or professional note, estimates, etc.
Applicant Signature:
Date:
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For in office only:
Approved
Denied
Yes
No
How do I record Discretionary Benefits?
First Nation Ontario Works delivery agents must ensure their software
has the capacity to track, monitor and report on all discretionary
benefits issued.
Under the current system of AD Morrison you will be able to locate
the Discretionary Benefits tracking tool by the following:
Discretionary Benefits
1. Click on Reporting the main task bar.
2. Another menu will drop down and click on
Q. Discretionary Benefits Tracking Tool
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3. The Discretionary Benefits Tracking Report will appear.
The monthly tracking tool will automatically populate at the end of
each month that is closed.
First Nation Ontario Works must track and monitor expenditures to
ensure expenditures are within funding allocations. Once the First
Nation depletes the Discretionary Budget, the budget will remain at
ZERO until the new Discretionary reporting year. Any unused funds
cannot be carried over into the fiscal year.
12
The Ministry of Community and Social Services have made it a
requirement that all First Nation Ontario Works delivery agents ensure
that they make monthly submissions on the twentieth (20th) of each
month to report all Ontario Works expenditures for the month.
Discretionary Benefits
Discretionary Benefits are tracked on the subsidy
claim form. For example;
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Develop A Local Policy
First Nation Ontario Works delivery agents have the authority to create
local Discretionary Benefits policies to identify:
Eligible Expenses
Set rates and
amounts for
services and
payments
Identify priority
use of funding
Determine limits
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Funerals and Burials
Funerals and Burial costs of Ontario Works/ODSP recipients up the
guideline amount of $2,250.00 are charged to Discretionary Benefits.
First Nation Ontario Works Administrators will need to
fill out the Application for Monthly Payment of
Provincial Subsidy for Assistance (FORM 5).
Capture the Funeral and Burial (up to the provincial guideline
amount) in Section 2A
Discretionary Benefits
Any funerals and burials costs above the $2, 250.00 is 100% provincially
reimbursed and must be claimed in the correct line of the subsidy
claim.
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Funeral and Burials Form 5 example
1. Guideline amount should be inserted into 2A – Funerals and Burials
1st $2250 of funeral expenses claimed here
2. Above the Guideline Amount should be inserted 4 Line Item “Other”
Any costs above $2250 claimed here
16
Any approved expenses above the guideline amount of $2250.00 are
allocated to Section 4- “Other” line item in the 100% provincially funded
tab.
Recovery of Funeral and Burials or Cremations Costs
First Nation Ontario Works delivery agents must recover any amount
paid for a funeral, burial or cremation from any person or organization
liable for the payment of these expenses.
When the First Nation Ontario Works recovers any amount paid for a
funeral, burial or cremation from any person or organization liable for the
payment of these expenses. Recovery will ensure that:
1. The 100% Provincially Funded portion is repaid first
2. The Funeral and Burial (up to provincial guideline)
of $2, 250.00 is recovered.
Discretionary Benefits
Complete an Assignment of Benefits Form for Canada Pension Plan
(CPP) or Old Age Security (OAS) for which the decreased is eligible or
may make a claim against the estate.
17
Audit Requirements
To ensure First Nation Ontario Works delivery agents are meeting audit
requirements, the following is needed on file:
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1.
Review Ontario Works Discretionary Benefits funding to
ensure sufficient funds to allow you to provide funding to
community members who are social assistance recipients
living in municipalities (or another First Nation community)
and wish to be buried in their home community (First
Nation)
2.
First Nation Ontario Work Administrators must demonstrate
that all available resources are exhausted or denied to
cover the cost of the funeral, and the funeral burial. In
addition, ensure that expenses are cost efficient.
3.
Allocate the provincial guideline amount of $2, 250.00 for
funeral and burial or cremation costs out of your Ontario
Works Discretionary Benefits funding.
4.
Any approved expenses above the provincial guideline
amount of $2, 250.00 is allocated to 100% provincially
funded expense item.
5.
Proper documentation must be on file to ensure a
complete record of monies received from the estate and
the repayment is captured on the Application of Monthly
Subsidy Form 5, in the month that it is received.
Where do I send my Form 5
First Nation Ontario Works delivery agents must send their Form 5
submission by the 20th day of the following month to the Ministry. First
Nation Ontario Works delivery agents can submit the signed original
claims by mail to the following address:
MCSS – Business Unit
Sudbury, Ontario
P3N 1E5
Email a copy to Aboriginal Affairs and Northern Development Canada
(AANDC)
Discretionary Benefits
199 Larch Street, Suite 1002
reportsontario@aandc-aadnc.gc.ca
If you require further clarification on Discretionary Benefits and or
Funerals and Burials contact your MCSS Program Supervisor and/or
ONWAA at (705) 942-3157.
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