Ministry of Social Development and Poverty Reduction

APPEAL NUMBER 2021-0104

PART C – DECISION UNDER APPEAL

The decision under appeal is the Ministry of Social Development and Poverty Reduction (ministry) reconsideration decision dated May 12, 2021, which determined that the appellant was not eligible for Medical Services Only coverage as she was not eligible for income assistance as per the Employment and Assistance Act sections 1 and 4 and the Employment and Assistance Regulation, sections 1,10 and 28, schedules A and B and sections 66 and 67.

Specifically, the ministry determined that the appellant does not qualify for income assistance as her income is above the maximum allowable income assistance rate, and eligibility for income assistance must be met first in order to qualify for Medical Services Only coverage.

PART D – RELEVANT LEGISLATION Employment and Assistance Act (EAA) sections 1 and 4 Employment and Assistance Regulation (EAR) sections 1,10, 28, schedules A and B and sections 66.3 and 67

APPEAL NUMBER 2021-0104

PART E – SUMMARY OF FACTS

Relevant Evidence Before the Minister at Reconsideration Ministry records show:  The appellant is currently years of age and applied as a single applicant with no dependents.  The ministry stated that the appellant’s income assistance rate is $1231.42 per month for support and shelter; $856.42 for support and $375 for shelter.  The ministry determined the appellant’s monthly net income to be $1514.58 ($919.13 Old Age Security (OAS)/Guaranteed Income Supplement (GIS), $95.45 (Canada Pension Plan Disability (CPPD) and $500 spousal support.  The ministry advised the appellant she is ineligible for income assistance and would be ineligible for disability assistance even with the Persons with Disabilities (PWD) designation as her monthly income exceeds the assistance rate for income assistance and disability assistance.  The ministry notes that the appellant would also be ineligible for Medical Services Only (MSO).  On April 26, 2021 the ministry opened a new service request to review the appellant’s request as a Life-Threatening Health Needs supplement, as she was requesting help with medical equipment. To begin the application process, the appellant was sent the Medical Equipment Request and Justification form for completion. The application form has not yet been received.

Request for Reconsideration (April 29, 2021) The appellant stated she was applying only for the medical assistance, not for income assistance. She was told that she did not apply on time for PWD. She stated that she did not apply because she thought she was already approved as a PWD from 2005 when she lived in another province, became quadriplegic and started receiving CPPD. The appellant is separated. Her spouse does not live in BC. Besides paying rent, hydro and a communications provider, she has many other vital monthly expenses. All her medical equipment is vital to her.

Additional Information Appellant Submission (n.d.) The appellant provided the following submission regarding additional details on her budget.  The appellant’s monthly income is: $919.13 (OAS & GIS), plus $95.45 (CPPD), plus $500 (spousal support). Total: $1,514.58.  The disability assistance rate for a single person with the PWD designation is $1,358.42. Therefore, $1514.58 - $1358.42=$156.16.  The appellant pays $453 monthly for rent, instead of $375, and $453 - $375 = $78. Thus, her income is higher only by $156.16 - $78 = $78.  She spends around $150/month on necessary medical supplies and also needs to buy over the counter medication.  As she has cancer, she feels weaker than before, and needs to pay someone to accompany her to medical and dental appointments. As well, occasionally she needs to use a taxi to go to the medical appointments.

Notice of Appeal (May 17, 2021) The appellant stated that she is a high-level quadriplegic person with very limited function of her hands and must use a powerchair, ceiling lift, sling, commode, and hand braces. In addition to her severe quadriplegic disability, she has cancer. She had surgery on February 12, 2021 and now needs to go for

APPEAL NUMBER 2021-0104

treatment and follow up. The appellant also stated that it is crucial to keep her medical equipment in good working condition to attend these appointments.

She pays $453 monthly for rent, plus $200 for heat, power, and a communications provider. This leaves her with only $861.58. She spends around $150/month on necessary medical supplies. Taking all these expenses into consideration, the appellant states she has much less money left for living and eating than people on income assistance, and on this remaining amount she needs to repair and purchase vital medical equipment. She states medical equipment companies discriminate against her because she must argue with them on prices, and they make her repairs only after all repairs for people on medical assistance are done. In one instance, she waited three months to repair her power chair’s footrests because she did not have money for the emergency repairs, which are twice as expensive as the regular ones. She adds that it is very dangerous to use the power chair without footrests, especially when going to medical appointments.

The appellant is requesting consideration of her life-threatening condition. She also stated that her income exceeds the requirement for medical assistance only by a little bit.

At the hearing, the appellant stated her only issue relates to MSO coverage as she has no resources to maintain her equipment. The companies that repair the equipment require payment first and if she finds a company with lower prices she has to wait longer. If her lift breaks, she cannot get out of bed. If her footrest breaks, it’s dangerous for her to go out for medical appointments. In short, she would be completely isolated; this is causing the appellant a lot of stress. If her income was a little higher it would make a difference in her life in a very big way. The appellant added that she had her power chair repaired and, at this time, all her equipment is working. Her concern is for future repairs. As well, the appellant added that the process for applying for Life-Threatening Health Needs would take several weeks, during which time she would not be able to function.

Ministry At the hearing, the ministry relied on its reconsideration decision and added that the appellant does not meet the criteria for MSO coverage. The threshold to qualify for MSO coverage must be met by first qualifying for income assistance, disability assistance or hardship assistance and the appellant’s income is in excess of the eligible amounts. The ministry added that the appellant did not apply for PWD. However, given her earnings, she would be in excess of the maximum amount allowable and therefore would not have qualified.

The panel determined that the additional information is reasonably required for a full and fair disclosure of all matters related to the decision under appeal and therefore is admissible under section 22(4) of the Employment and Assistance Act.

APPEAL NUMBER 2021-0104

PART F – REASONS FOR PANEL DECISION

The issue on appeal is whether the ministry’s reconsideration decision dated May 12, 2021, which determined that the appellant was not eligible for MSO coverage as she was not eligible for income assistance as per the EAA sections 1 and 4 and the EAR, sections 1,10 and 28, schedules A and B and sections 66.3 and 67, was reasonably supported by the evidence or was a reasonable application of the legislation in the circumstances of the appellant.

Specifically, did the ministry reasonably determine that the appellant does not qualify for income assistance as her income is above the maximum allowable income assistance rate, and that eligibility for income assistance must be met first in order to qualify for Medical Services Only coverage?

Relevant sections of the legislation can be found in the Schedule of Legislation. Appellant Argument The appellant argues that she has a severe quadriplegic disability as well as cancer and so good working medical equipment is crucial in keeping her medical appointments, including cancer treatment. She argues that it is very dangerous to use a power chair without footrests especially for medical appointments, and she has no resources to maintain her equipment. If her lift breaks, she cannot get out of bed. If her footrests are broken it is dangerous for her to go out for medical appointments. She would be completely isolated. This is causing a lot of stress.

The appellant states she pays $453 monthly for rent, plus $200 for heat, power, and a communications provider which leaves her with only $861.58 monthly. She spends around $150/month on necessary medical supplies and has much less money left for living and eating than people on income assistance, and on this remaining amount she needs to repair and purchase vital medical equipment.

The appellant also argues that her income exceeds the requirement for MSO coverage by only a little and it would make a difference in her life, in a very big way, if her income was a little higher.

Ministry Argument The ministry states that the amount of income assistance under the EAA is determined by deducting the net income as determined in Schedule B, from the assistance rate set out in Schedule A. Therefore, the ministry argues that, as the appellant’s net income exceeds the maximum allowable income assistance rate, she is ineligible for income assistance.

The ministry argues further that MSO coverage is only available to certain categories of former recipients who meet specific eligibility criteria. To be eligible for MSO coverage, a family unit must include a qualifying person on the date the family unit ceased to be eligible for income assistance and meet the applicable income test for MSO for the family unit. The threshold to qualify for MSO coverage must be met by first qualifying for income assistance, disability assistance or hardship assistance and the appellant’s income is in excess of the eligible amounts.

Analysis Sections 1 & 4 (EAA) – Income Assistance and Recipients Section 1 defines income assistance as an amount provided for support and shelter and section 4 defines a recipient as the person for whom the assistance is provided.

APPEAL NUMBER 2021-0104

Sections 1, 10 & 28, schedules A & B (EAR) – Calculation of Net Income  Section 1, which defines unearned income, includes CPP benefits, “maintenance under a court order, a separation agreement or other agreement” and OAS and GIS.  Section 10 states a recipient is not eligible for income assistance if the net income under schedule B exceeds the amount under schedule A.  Section 28 states the maximum amount of assistance that can be paid is the amount determined under schedule A minus the amount under schedule B.

 Schedule A shows the monthly allowable allowances for support and shelter. Ministry records show that the appellant’s income assistance rate would be $1231.42 per month for support and shelter; $856.42 for support and $375 for shelter. The panel notes the amount shown under schedule A for a sole recipient and no dependent children, where the recipient is 65 or more years of age to be $856.42 and the amount under schedule B for shelter, for one person, as $375. Therefore, the panel finds the amount under schedule A = $1231.42 ($856.42 + $375).

 Schedule B provides a list of deductions and exemptions for unearned income used to calculate net income. - Section 1 lists all the deductions and exemptions. The panel notes the only exemption in this section that apply to CPP payments are orphan's benefits and a disabled contributor's child's benefit, and also notes there are no deductions or exemptions that apply to OAS or GIS. - Section 6 states the only deductions permitted from unearned income are income tax deducted at source from employment insurance benefits and essential operating costs for renting self-contained suites. The panel notes there are no deductions permitted for CPP, OAS or GIS under this section. - Section 7 lists unearned income that is exempt and the only exemption that applies to CPP is a formula for calculating income tax exemption. The panel notes that no exemption for OAS or GIS is listed.

 In her appeal submission, the appellant stated that her monthly income is: $919.13 (OAS & GIS), plus $95.45 (CPPD), plus $500 (spousal support). Total: $1,514.58.

The ministry argues that, as the appellant’s net income of $1514.58 exceeds the income assistance rate, she is ineligible for income assistance. The appellant argues that her income exceeds the requirement for MSO coverage by only a little bit and it would make a difference in her life, in a very big way, if her income was a little higher.

The panel finds, as per schedule A of the EAR, the monthly total support and shelter allowance is $1231.42. As there are no allowable deductions, the amount under schedule B is $1,514.58 (OAS, GIS, CPPD and spousal support). $1231.42 (schedule A) $1,514.58 (schedule B) As the amount for schedule B is greater than the amount for schedule A, the panel finds the ministry reasonably determined that there are no income assistance benefits payable to the appellant under section 10(2) of the EAR.

Sections 66.3 and 67 (EAR) – Medical Services Only Sections 66.3 and 67 provide the requirements for access to MSO coverage for recipients considered “continued persons” – and states that MSO coverage is available for recipients who “ceased to be eligible for income assistance”.

APPEAL NUMBER 2021-0104

The appellant argues that she has a severe quadriplegic disability as well as cancer and so it is crucial that her equipment is in good working condition for keeping her medical appointments, including treatment. It is very dangerous for her to use her power chair without footrests, especially for medical appointments. She has no resources to maintain her equipment and this is causing her a lot of stress. She pays $453 monthly for rent, plus $200 for heat, power, and a communications provider which leaves her with only $861.58 monthly. She spends around $150/month on necessary medical supplies and has much less money left for living and on this remaining amount she needs to repair and purchase vital medical equipment.

The ministry argues that to be eligible for MSO coverage, a family unit must include a qualifying person on the date the family unit ceased to be eligible for income assistance and meet the applicable income test for MSO for the family unit. The threshold to qualify for MSO must be met by first qualifying for income assistance and the appellant’s income is in excess of the eligible amounts.

The panel finds that, as the appellant does not qualify for income assistance, she cannot then have “ceased to be eligible for income assistance”, as is required under section 66.3 of the EAR.

The panel finds the ministry reasonably determined that, as the appellant’s income exceeds the maximum income assistance amount payable, she is not eligible to receive income assistance. And, as the appellant is not eligible to receive income assistance, the panel finds the ministry reasonably determined she cannot be considered eligible for MSO benefits under sections 66.3 and 67 of the EAR.

Although the panel acknowledges the appellant’s difficulties, the panel is bound by the legislation. Conclusion In conclusion, the panel finds the ministry’s reconsideration decision, which determined that the appellant was not eligible for MSO benefits, as she was not eligible for income assistance as per the EAA sections 1 and 4 and the EAR, sections 1,10 and 28, schedules A and B and sections 66.3 and 67, was a reasonable application of the legislation in the circumstances of the appellant.

Specifically, the panel finds the ministry reasonably determined that the appellant does not qualify for income assistance as her income is above the maximum allowable income assistance rate, and that eligibility for income assistance must be met first in order to qualify for MSO coverage.

The appellant is not successful on appeal

APPEAL NUMBER 2021-0104

Schedule of Legislation Income Assistance Employment and Assistance Act Interpretation (1)In this Act: "income assistance" means an amount for shelter and support provided under section 4 [income assistance and supplements];

"recipient" means the person in a family unit to or for whom income assistance, hardship assistance or a supplement is provided under this Act for the use or benefit of someone in the family unit…

Income assistance and supplements 4 Subject to the regulations, the minister may provide income assistance or a supplement to or for a family unit that is eligible for it.

Employment and Assistance Regulation Definitions 1 (1)In this regulation: "unearned income" means any income that is not earned income, and includes, without limitation, money or value received from any of the following: … (f)any type or class of Canada Pension Plan benefits … (p)maintenance under a court order, a separation agreement or other agreement; … (u)Federal Old Age Security and Guaranteed Income Supplement payments;

Limits on income 10 … (2)A family unit is not eligible for income assistance if the net income of the family unit determined under Schedule B equals or exceeds the amount of income assistance determined under Schedule A for a family unit matching that family unit.

APPEAL NUMBER 2021-0104

Amount of income assistance 28 Income assistance may be provided to or for a family unit, for a calendar month, in an amount that is not more than (a)the amount determined under Schedule A, minus (b)the family unit's net income determined under Schedule B

Schedule A Income Assistance Rates (section 28 (a) ) Maximum amount of income assistance before deduction of net income 1 (1)Subject to this section and sections 3 and 6 to 10 of this Schedule, the amount of income assistance referred to in section 28 (a) [amount of income assistance] of this regulation is the sum of (a)the monthly support allowance under section 2 of this Schedule for a family unit matching the family unit of the applicant or recipient, plus (b)the shelter allowance calculated under sections 4 and 5 of this Schedule. …

Monthly support allowance 2 … (1)A monthly support allowance for the purpose of section 1 (a) is the sum of (a)the amount set out in Column 3 of the following table for a family unit described in Column 1 of an applicant or a recipient described in Column 2…

Item Column 1 Column 2 Column 3 Family unit composition Age or status of applicant or recipient Amount of support 3 Sole applicant/recipient and no dependent Applicant/recipient is 65 or more years $856.42 children of age Monthly shelter allowance 4 (1)For the purposes of this section:…

"warrant" has the meaning of a warrant in section 15.2 [consequences in relation to outstanding arrest warrants] of the Act.

APPEAL NUMBER 2021-0104

(2)The monthly shelter allowance for a family unit to which section 15.2 of the Act does not apply is the smaller of (a)the family unit's actual shelter costs, and (b)the maximum set out in the following table for the applicable family size: Item Column 1 Column 2 Family Maximum Unit Size Monthly Shelter 1 1 person $375 Schedule B Net Income Calculation (section 28 (b) ) Deduction and exemption rules 1 When calculating the net income of a family unit for the purposes of section 28 (b) [amount of income assistance] of this regulation, (a)the following are exempt from income: (i)any income earned by a dependent child attending school on a full-time basis; (ii)Repealed. [B.C. Reg. 96/2017, App. 1, s. 2 (a).] (iii)Repealed. [B.C. Reg. 48/2010, Sch. 1, s. 1 (b).] (iv)a family bonus, except the portion treated as unearned income under section 10 (1) of this Schedule; (iv.1)the Canada child benefit, except the portion treated as unearned income under section 10 (1) of this Schedule; (v)the basic child tax benefit; (vi)a goods and services tax credit under the Income Tax Act (Canada); (vii)a tax credit under section 8 [refundable sales tax credit], 8.1 [climate action tax credit] or 8.2 [BC harmonized sales tax credit] of the Income Tax Act (British Columbia); (viii)individual redress payments granted by the government of Canada to a person of Japanese ancestry; (ix)individual payments granted by the government of Canada under the Extraordinary Assistance Plan to a person infected by the human immunodeficiency virus;

APPEAL NUMBER 2021-0104

(x)individual payments granted by the government of British Columbia to a person infected by the human immunodeficiency virus or to the surviving spouse or dependent children of that person; (xi)individual payments granted by the government of Canada under the Extraordinary Assistance Plan to thalidomide victims; (xii)money that is (A)paid or payable to a person if the money is awarded to the person by an adjudicative panel in respect of claims of abuse at Jericho Hill School for the Deaf and drawn from a lump sum settlement paid by the government of British Columbia, or (B)paid or payable to or for a person if the payment is in accordance with the settlement agreement approved by the Supreme Court in Action No. C980463, Vancouver Registry; (xiii)the BC earned income benefit; (xiv)money paid or payable under the 1986-1990 Hepatitis C Settlement Agreement made June 15, 1999, except money paid or payable under section 4.02 or 6.01 of Schedule A or of Schedule B of that agreement; (xv)a rent subsidy provided by the provincial government, or by a council, board, society or governmental agency that administers rent subsidies from the provincial government; (xvi)Repealed. [B.C. Reg. 197/2012, Sch. 1, s. 22 (a).] (xvii)money paid or payable to a person in settlement of a claim of abuse at an Indian residential school, except money paid or payable as income replacement in the settlement; (xvii.1)money that is paid or payable to or for a person if the payment is in accordance with (A)the Sixties Scoop Settlement made November 30, 2017, or (B)the Federal Indian Day Schools Settlement made March 12, 2019, as amended May 13, 2019; (xviii)post adoption assistance payments provided under section 28 (1) or 30.1 of the Adoption Regulation, B.C. Reg. 291/96; (xix)a rebate of energy or fuel tax provided by the government of Canada, the government of British Columbia, or an agency of either government; (xx)Repealed. [B.C. Reg. 85/2012, Sch. 1, s. 5.] (xxi)payments granted by the government of British Columbia under section 8 [agreement with child's kin and others] of the Child, Family and Community Service Act; (xxii)payments granted by the government of British Columbia under the Ministry of Children and Family Development's At Home Program;

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(xxiii)Repealed. [B.C. Reg. 85/2012, Sch. 1, s. 5.] (xxiv)payments granted by the government of British Columbia under an agreement referred to in section 93 (1) (g) (ii) of the Child, Family and Community Service Act, for contributions to the support of a child; (xxv)a loan that is (A)not greater than the amount contemplated by the recipient's business plan, accepted by the minister under section 77.2 of this regulation, and (B)received and used for the purposes set out in the business plan; (xxvi)payments granted by the government of British Columbia under the Ministry of Children and Family Development's (A)Autism Funding: Under Age 6 Program, or (B)Autism Funding: Ages 6 — 18 Program; (xxvii)Repealed. [B.C. Reg. 148/2015, App. 1, s. 1 (a).] (xxviii)payments made by a health authority or a contractor of a health authority to a recipient, who is a "person with a mental disorder" as defined in section 1 of the Mental Health Act, for the purpose of supporting the recipient in participating in a volunteer program or in a mental health or addictions rehabilitation program; (xxix)a refund provided under Plan I as established under the Drug Plans Regulation; (xxx)payments provided by Community Living BC to assist with travel expenses for a recipient in the family unit to attend a self-help skills program, or a supported work placement program, approved by Community Living BC; (xxxi)a Universal Child Care Benefit provided under the Universal Child Care Benefit Act (Canada); (xxxii)money paid by the government of Canada, under a settlement agreement, to persons who contracted Hepatitis C by receiving blood or blood products in Canada prior to 1986 or after July 1, 1990, except money paid under that agreement as income replacement; (xxxiii)money withdrawn from a registered disability savings plan; (xxxiv)a working income tax benefit provided under the Income Tax Act (Canada); (xxxv)Repealed. [B.C. Reg. 180/2010, s. 1 (b).] (xxxvi)the climate action dividend under section 13.02 of the Income Tax Act; (xxxvii)money paid or payable to a person under the Criminal Injury Compensation Act as compensation for non-pecuniary loss or damage for pain, suffering mental or emotional trauma, humiliation or inconvenience that occurred when the person was under 19 years of age;