APPEAL #
PART C – Decision under Appeal
The decision under appeal is the Ministry of Social Development and Social Innovation (Ministry)
reconsideration decision dated June 4, 2015 which held that the appellant was not eligible for
additional reimbursement of food and drink costs while traveling and receiving out of province
medical treatment the week of March 29, 2015 because she has already received the maximum
allowable meal allowance as set out in the Health Supplements and Programs Rate Table for 8 days
and because, contrary to Schedule C, Section 2(f)(vi) of the Employment and Assistance for Persons
with Disabilities Regulation, the family unit has other resources available
, specifically federal benefits.
PART D – Relevant Legislation
Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Section 62
Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Schedule C, Section
2(1)(f)
Health Supplements and Programs Rate Table (policy)
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PART E – Summary of Facts
With the consent of both parties, the hearing was conducted as a written hearing pursuant to section
22(3)(b) of the Employment and Assistance Act.
The following evidence was before the ministry at the time of reconsideration:
•
The appellant currently receives Medical Services Only (MSO) as a two person family unit.
•
The appellant completed and submitted an application for a special transportation subsidy,
dated May 31, 2015. The appellant wrote that she has severe and rare eczema on her hands
and feet and the only available location for allergy testing was an out of province hospital.
She requested transportation and accommodation reimbursement from March 29, 2015
through April 5, 2015. This included West Jet return airfare, baggage claim expenses, shuttle
bus return, accommodation, taxies, food and drink.
•
20 pages of documentation supporting the following expenses: return airfare – 399.91,
baggage costs – 50.00, shuttle bus – 30.00, outpatient accommodations – 175.00, food and
water for 8 days – 232.26, totaling $887.27.
•
The ministry found that the appellant was eligible for reimbursement of her medical
transportation costs for the flight, booking fees and shuttle totaling $529.91, accommodations
costs of $176.00, and $96.00 for meals ($4.00 per meal x 3 per day x 8 days).
•
The shortfall between claimed expenses and reimbursed expenses was $136.36, and this
difference was between the allowed food per diem provided and the food and drink receipts
substantiating actual expenses for the period March 29, 2015 and April 5, 2015.
Documents received after the reconsideration decision:
•
June 10, 2015 Notice of Appeal
•
June 25, 2015 submission by the appellant consisting of 48 pages including:
Family unit monthly income of $2,484.08
Statistics Canada printouts of Market Basket Measure (MBM) intended to
establish living costs specific to regions
Rent receipt for $736.00 for April 2015
Furniture payment receipt for $172.88 for May 30, 2015
Shaw invoice due June 2015 for $319.90.
•
July 14, 2015 email from the Ministry confirming no submissions would be provided.
The panel finds that the information provided by the appellant in the documents received after the
reconsideration decision is in support of the evidence that was before the ministry at the time of
reconsideration, and accordingly admissible pursuant to Section 22(4) of the Employment Assistance
Act.
APPEAL #
PART F – Reasons for Panel Decision
The decision under appeal is whether the Ministry’s reconsideration decision which held that the
appellant was not eligible for additional reimbursement of food and drink costs while traveling and
receiving out of province medical treatment the week of March 29, 2015 because she has already
received the maximum allowable meal allowance as set out in the Health Supplements and Programs
Rate Table for 8 days and because, contrary to Schedule C, Section 2(f)(vi) the family unit has other
resources available, specifically federal benefits, is reasonably supported by the evidence or a
reasonable application of the applicable legislation in the circumstances of the appellant.
The applicable legislation is summarized below:
General health supplements
62 (1) Subject to subsections (1.1) and (1.2), the minister may provide any health supplement set out
in section 2 [general health supplements] or 3 [medical equipment and devices] of Schedule C to
or for a family unit if the health supplement is provided to or for a person in the family unit who is
(a) a recipient of disability assistance,
(b) a person with disabilities who has not reached 65 years of age and who has ceased to be
eligible for disability assistance because of
(i) employment income earned by the person or the person's spouse, if either the person or
the person's spouse
(A) is under age 65 and the family unit is receiving premium assistance under the
Medicare
Protection Act, or
(B) is aged 65 or more and a person in the family unit is receiving the federal spouse's allowance or
the federal guaranteed income supplement,
(ii) a pension or other payment under the Canada Pension Plan (Canada),
(iii) money received by the person or the person's spouse under the settlement agreement approved
by the Supreme Court in Action No. S50808, Kelowna Registry, or
(iv) money or value received by the person or the person's spouse that is maintenance under a
maintenance order, maintenance agreement or other agreement, if either the person or
the person's spouse
(A) is under age 65 and the family unit is receiving premium assistance under the
Medicare
Protection Act, or
(B) is aged 65 or more and any person in the family unit is receiving the federal spouse's allowance
or the federal guaranteed income supplement,
(c) a person who was a recipient of disability assistance on the day he or she became 65 years of
age and a dependant of that person, if the dependant was a dependant of the person on that
day and remains a dependant of that person,
(d) a dependant of a person referred to in paragraph (a) or (b) (iii),
(d.1) a dependant of a person referred to in paragraph (b) (i) or (iv), if any person in the family unit
(i) is under age 65 and the family unit is receiving premium assistance under the Medicare
Protection Act, or
(ii) is aged 65 or more and any person in the family unit is receiving the federal spouse's allowance
or the federal guaranteed income supplement,
(d.2) a dependant of a person referred to in paragraph (b) (ii),
(d.3) a dependant of a person referred to in paragraph (f), if any person in the family unit
(i) is under age 65 and the family unit is receiving premium assistance under the Medicare
Protection Act, or
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(ii) is aged 65 or more and any person in the family unit is receiving the federal spouse's allowance
or the federal guaranteed income supplement,
(e) a dependent child of a recipient of hardship assistance,
(f) a person with disabilities who has ceased to be eligible for disability assistance because of an
award of compensation under the Criminal Injury Compensation Act
or an award of benefits under
the Crime Victim Assistance Act made to the person or the person's spouse, if
(i) the person is under age 65 and the family unit is receiving premium assistance under
the Medicare Protection Act, or
(ii) the person is aged 65 or more and any person in the family unit is receiving the federal spouse's
allowance or the federal guaranteed income supplement, or
(g) a person whose family unit ceases to be eligible for disability assistance because of
financial assistance provided through an agreement under section 12.3 of the Child,
Family and Community Service Act, during the term of the agreement.
(1.1) A person eligible to receive a health supplement under subsection (1) (b) (ii) or (d.2) may
receive the supplement
(a) while any person in the family unit is
(i) under age 65 and receiving a pension or other payment under the Canada Pension Plan, or
(ii) aged 65 or more and receiving the federal spouse's allowance or the federal guaranteed income
supplement, and
(b) for a maximum of one year from the date on which the family unit ceased to be eligible for medical
services only.
(1.2) A person eligible to receive a health supplement under subsection (1) (c) may receive the
supplement
(a) while any person in the family unit is receiving the federal spouse's allowance or the federal
guaranteed income supplement, and
(b) for a maximum of one year from the date on which the family unit ceased to be eligible for medical
services only.
(1.3) A person who was eligible to receive a health supplement under subsection (1) (b) (i) or (iv),
(d.1), (d.3) or (f) but ceases to be eligible for medical services only may continue to receive the
supplement for a maximum of one year from the date on which the family unit ceased to be
eligible for medical services only.
(2) A person referred to in subsection (1) (b) or (f) and his or her dependants and a person referred to
in subsection (1) (c) cease to be eligible for any supplement under this Division if the person's family
unit takes up residence outside British Columbia.
Schedule C - General health supplements
2 (1) The following are the health supplements that may be paid for by the minister if provided to a
family unit that is eligible under section 62 [general health supplements] of this regulation:
….
(f) the least expensive appropriate mode of transportation to or from
(i) an office, in the local area, of a medical practitioner or nurse practitioner,
(ii) the office of the nearest available specialist in a field of medicine or surgery if the person has
been referred to a specialist in that field by a local medical practitioner or nurse practitioner,
(iii) the nearest suitable general hospital or rehabilitation hospital, as those facilities are defined in
section 1.1 of the Hospital Insurance Act Regulations, or
(iv) the nearest suitable hospital as defined in paragraph (e) of the definition of "hospital" in section 1
of the Hospital Insurance Act,
provided that
(v) the transportation is to enable the person to receive a benefit under the Medicare Protection
Act or a general hospital service under the Hospital Insurance Act, and
(vi) there are no resources available to the person's family unit to cover the cost.
BC Employment and Assistance Rate Tables
Health Supplements and Programs (Updated April 1, 2010)
Supplement
Item
Dental
Additional amount that children and adults with
the persons with disabilities designation who
require anaesthetic in a hospital or private facility
may be eligible for
Diet supplements
Restricted sodium diet
Diabetes
Kidney dialysis (when not eligible for kidney
dialysis service through Ministry of Health)
High protein diet
Gluten-free diet
Dysphagia
Ketogenic diet (Apr 1/10)
Phenylalanine diet (Apr 1/10)
Cystic fibrosis
Medical
Travel allowance related to vehicle transportation $0.20 per kilometre
transportation
supplement
Allowance for exceptional cases where
circumstances warrant a meal allowance
Monthly Nutritional
Dietary items
Supplement
Vitamins or minerals
Clients receiving less than this amount through
appeal awards under Schedule C may apply for
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Maximum Amount
$1,000 of basic dental
treatment per calendar
year
(Apr 1, 2010)
$10 per calendar
month
$35 per calendar
month (April 1/07)
$30 per calendar
month
$40 per calendar
month, plus $30
towards the purchase
of a blender
$40 per calendar
month
$40 per calendar
month, plus $30
towards the purchase
of a blender
$40 per month
$40 per month
$50 per calendar
month
$4 per meal
Up to $165 per
calendar month (Apr 1,
2010)
Up to $40 per calendar
month (Apr 1, 2010)
$205 per calendar
month
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the monthly nutritional supplement
(Apr 1, 2010)
Natal supplement
Single pregnancy or birth
$45 per calendar
month
Multiple pregnancy or birth
$90 per calendar
month
Optical services
Eye exam provided by an optometrist
$44.83
Eye exam provided by an ophthalmologist
$48.90
Extended Medical
Medical Services Plan rate for extensions to
$23 per visit
Therapies
acupuncture (April 22, 2008), chiropractic,
massage therapy, naturopathy (April 22, 2008),
podiatry and physiotherapy services
Supplement for
Per eligible recipient
$500 per calendar
alcohol and drug
year
treatment
The Ministry’s position
The Ministry argues that the appellant is not eligible for the $136.36 difference between the actual
cost of food and drink ($232.26) while receiving out of province medical care during the week of
March 29, 2015 and the amount paid ($96.00) because the Health Supplements and Rates Table
stipulates $4.00 per meal is the maximum allowable for those exceptional cases where
circumstances warrant a meal allowance and this was the amount paid. The Ministry paid $4.00 per
meal for 8 full days even though the appellant’s treatment finished prior to this and the appellant
traveled the day prior to her appointment; the reimbursement included breakfast on the day the
appellant traveled and dinner on the day returned, outside of normal practice, so they have
interpreted policy in the appellant’s favour.
Further, the Ministry argued that the family unit receives federal benefits, and there was insufficient
evidence to establish that the appellant could not have used any of this to meet her daily food and
drink needs, and the appellant would have had ongoing food costs each day whether she was
traveling or not. The Ministry accepted that because the appellant’s husband stayed home and she
had to purchase bottled water and eat at the hospital cafeteria her circumstances warranted the meal
allowance to assist with the extraordinary costs. The meal allowance however is not intended to
cover the entire cost for a person’s food at each meal.
The Appellant’s position
The Appellant argues that the family unit received federal benefits that meet their monthly expenses,
but because they had to pay out of pocket for traveling to the medical appointment - $887.27 – they
also had to borrow money to make ends meet until the Ministry repaid most of the expenses in May
2015. The Appellant argues that because she and her husband keep their food costs to a minimum
by being frugal, preparing their food at home, and finding deals whenever possible, it is not
reasonable to consider traveling food expenses as part of these general food expenses. While
attending the medical appointment, she had no refrigeration or available food preparation area. She
APPEAL #
had to use a cafeteria at the campus where she stayed for her food needs, and there were no other
food facilities available at lower costs. Bottled water and liquids were also required; these added
expenses were beyond her usual expenses. The appellant argued that she was told by the treating
specialist that because of the associated costs, other BC patients have had to decline referrals to
him. The appellant argued that this supported the extraordinary nature of her expenses.
The panel’s findings and conclusion
The panel finds that the Ministry’s reconsideration decision which held that the appellant was not
eligible for additional reimbursement of food and drink costs while traveling and receiving out of
province medical treatment the week of March 29, 2015 because she has already received the
maximum allowable meal allowance as set out in the Health Supplements and Programs Rate Table
for 8 days and because, contrary to Schedule C, Section 2(f)(vi) the family unit has other resources
available, specifically federal benefits, was reasonably supported by the evidence and a reasonable
application of the applicable legislation in the circumstances of the appellant.
The panel finds that EAPWDR Section 62 and Schedule C, Section 2(1)(f) allow for payment of
transportation expenses as a health supplement in the appellant’s circumstances. The policy created
concerning the medical transportation supplement allowance, intended for exceptional
circumstances, is not in conflict with the existing and enabling legislation, and establishes the amount
payable - $4.00 per meal. The Ministry accepted that the appellant’s circumstances were
exceptional, specifically noting that bottled water and cafeteria food were required by the appellant
while obtaining the necessary medical tests away from home. The Ministry interpreted policy broadly
in order to provide full per diem reimbursement for all 8 days the appellant was traveling. The
Ministry determined that the appellant qualified for the medical transportation supplement allowance,
and provided the maximum amount available to the appellant according to existing legislation and
policy. Therefore, the panel finds the Ministry reasonably determined the appellant was not eligible
for the difference between the food costs and the supplement amount. The panel also finds that is not
unreasonable to expect that a portion of monies that would otherwise be used for daily food and liquid
consumption over the course of 8 days would be a resource available to apply to the same expenses
while traveling.
The panel confirms the Ministry’s decision.
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.