PROVISION OF BENEFITS

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					ONTA RIO WORKS


                                           PROVISION OF BENEFITS
                                              DIRECTIVE 31.0

Purpose of Directive .......................................................................................................4
Legislative Authority.......................................................................................................4
   Anatomy Act ................................................................................................................ 10
Intent of Policy .............................................................................................................. 11
Decision-Making Principles ....................................................................................... 11
Standards........................................................................................................................ 11
Audit Requirements ..................................................................................................... 12
Application of Policy.................................................................................................... 12
Mandatory Benefits ...................................................................................................... 12
   Drug Coverage ............................................................................................................ 13
   Dental Coverage for Dependent Children............................................................... 13
   Vision Care for Dependent Children ........................................................................ 13
   Diabetic Supplies, Surgical Supplies and Dressings ............................................ 15
       Diabetic Supplies       ......................................................................................................... 15
       Surgical Supplies and Dressings              ................................................................................... 16
   Travel and Transportation for Medical Purposes ................................................... 16
   Costs Related to the Assistive Devices Program .................................................. 17
   Winter Clothing and Back to School ........................................................................ 17
       Winter Clothing      ............................................................................................................ 18
       Back to School ............................................................................................................. 18

   Community Start-up Benefit ...................................................................................... 18
       Eligibility Criteria   .......................................................................................................... 18
       Allowable Start-up Situations           ........................................................................................ 19
       Allowable Residence Establishment Costs ..................................................................... 20

       Payment of the Community Start-up Benefit ................................................................... 21

       Participant Moving to a Different Delivery Site ................................................................ 21

   Employment Start-up Benefit .................................................................................... 22
       Eligibility Criteria   .......................................................................................................... 22



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     Definitions ....................................................................................................................23

     Allowable Employment Start-up Expenses ......................................................................23

  Employment Assistance Expenses ..........................................................................24
     Supports to People with Disabilities ................................................................................25

     Child Care Assistance ...................................................................................................26

  Northern Allowance .....................................................................................................27
  Advanced Age Item .....................................................................................................27
  Special Diets.................................................................................................................27
     Approval of Special Diet ................................................................................................27

     Special Diets Schedule ..................................................................................................28

     Special Diet Reassessment ...........................................................................................31

     Infant Formula       ..............................................................................................................31
  Guide Dog Benefit .......................................................................................................32
     Guide Dog Training School s under the Blind Persons' Rights Act .............................32

     Canada ........................................................................................................................32

     United States ................................................................................................................32

     International ..................................................................................................................33

  Extended Health Benefits...........................................................................................33
Discretionary Benefits – Health Related .................................................................35
  Dental Care for Adults.................................................................................................36
  Prosthetic Appliances .................................................................................................36
     Hearing Aids .................................................................................................................36

  Vision Care for Adults .................................................................................................36
  Funerals and Burials ...................................................................................................37
     Place of Residence .......................................................................................................37

     Non-Recipients of Social Assistance ..............................................................................37

     Recovery of Funeral Costs ............................................................................................38

Discretionary Benefits – Non-Health Related ........................................................38
  Vocational Training......................................................................................................39
  Transportation ..............................................................................................................39



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  Moving Expenses........................................................................................................ 39
  Northern Allowance .................................................................................................... 40
Discretionary Benefits - Other Special Items and Services .............................. 40
  Home Repairs.............................................................................................................. 41
     Determining Necessary Repairs .................................................................................... 42

     Assistance for Approved Repairs ................................................................................... 43

     Approved Home Repairs for First Nations Communities .................................................. 44




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DIRECTIVE #31.0: PROVISION OF BENEFITS


Purpose of Directive

This directive provides an overview of benefits available to eligible participants
through mandatory benefits of financial assistance and through the provision of
discretionary benefits.


Legislative Authority

Section 2 and Part I, Sections 8 and 10 of the Act state:

                                                   DEFINITIONS

2. In this Act, …

"benefits" means the prescribed items, services or payments; ("prestations") …

                                          WHO RECEIVES BENEFIT S

8. Benefits may be provided for,

         (a)        a recip ient or a dependant;

         (b)        a person eligible to receive income support under the Ontario Disability Support Program
                    Act, 1997 or a dependant; and

         (c)        members of the prescribed classes of persons. 1997, c. 25, Sched. A, s. 8.

                                      TEM PORA RY CARE ASSISTANCE

10. The administrator shall p rovide inco me assistance and benefits in accordance with the regulations to an
adult on behalf of a child if,

         (a)        the child is in the temporary care of the adult;

         (b)        the child is in financial need;

         (c)        the child is not a dependant under this Act or the Ontario Disability Support Program Act,
                    1997;

         (d)        the adult does not have a legal obligation to support the child, as prescribed;

         (e)        the child is not receiv ing residential care by a person who receives compensation for
                    caring for the child under the Child and Family Services Act; and

         (f)        the adult and the child meet any other prescribed conditions of eligib ility. 1997, c. 25,
                    Sched. A, s. 10.




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Part VI, Sections 41, 42 (1), 44 (1), (2) and (3) and Part VII, Sections 55, 57 (5),
58, 58.1 and 59 of Regulation 134/98 state:
                                  GENERA L BUDGETARY REQUIREM ENTS

41. The budgetary requirements for an applicant or recip ient to whom sections 43 and 44 do not apply shall
be equal to the sum of the following amounts: …

         4.        If an approved health professional certifies that a member of the benefit unit require s a
                   special diet and signs a statement setting out in detail the special diet required, an amount
                   which is the lesser of,

                            i.        the additional cost required to provide the special diet, and

                            ii.       $250. …

                                                   SHELTER

42. (1) In this section,

"shelter" means the cost for a dwelling place used as a principal residence with respect to any of the
following: …

         6.        Reasonable and necessary payments, approved by the admin istrator, for the preservation,
                   maintenance and use of the dwelling place. …

                       BUDGETA RY REQUIREM ENTS IN OTHER SPECIA L CASES

44. (1) The budgetary requirements for an applicant or recipient who receives board and lodging fro m the
same source and who is not a person whose budgetary requirements are determined under subsection (2) or
(3) or section 43 shall be equal to the sum of the fo llo wing amounts: …

         3.        If an approved health professional certifies that an applicant or a recipient or a dependant
                   requires a special diet and signs a statement setting out in detail the special d iet required,
                   an amount which is the less of,

                            i.        the additional cost required to provide the special diet, and

                            ii.       $250. …

(2) The budgetary requirements for an applicant or recipient who is a sole support parent to whom
subsection 11 (2) or (4) applies or is a sole support parent who is a dependant under the Ontario Disability
Support Program Act, 1997 shall be equal to the sum of the following amounts: …

         5.        If an approved health professional certifies that a dependant of the dependant requires a
                   special diet and signs a statement setting out in detail the special diet required, an amount
                   which is the lesser of,

                            i.        the additional cost required to provide the special diet, and

                            ii.       $250. O. Reg. 134/ 98, s. 44 (2); O. Reg. 227/ 98, s. 21 (4); O. Reg.
                                      165/99, s. 7.




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(3) The budgetary requirements for an applicant or recipient who resides in the same dwelling place as a
person who is his or her parent or the parent of his or her spouse or same-sex partner included in the benefit
unit shall be equal to the sum of the fo llo wing amounts: …

         3.        If an approved health professional certifies that an applicant or a recipient or a dependant
                   requires a special diet and signs a statement setting out in detail the special d iet required,
                   an amount which is the less of,

                            iii.      the additional cost required to provide the special diet, and

                            iv.       $250. …

                                                   BENEFITS

55. (1) The following benefits shall be paid with respect to each of the members of a recip ient's benefit unit
if the ad ministrator is satisfied that he or she meets the criteria for them and income assistan ce is being paid
on his or her behalf:

                                             HEA LTH BENEFITS

         1.        An amount for health benefits equal to the sum of,

                            i.        the cost for drugs prescribed for members of the benefit unit by an
                                      approved health professional if those drugs have been approved by the
                                      Minister of Health and purchased from a d ispensary during any month
                                      in wh ich the person requiring the drugs is a member of the benefit unit,

                            ii.       the cost for dental services and vision items and services for dependent
                                      children if those services and that cost have been approved by the
                                      Minister,

                            iii.      the cost for diabetic supplies, surgical supplies and dressings and
                                      transportation reasonably required for medical treat ment for a member
                                      of the benefit unit, if the cost of the item or service is not otherwise
                                      reimbursed or subject to reimbursement,

                            iv.       the amount a member of the benefit unit is required to pay for the
                                      consumer contribution for an assistive device under the Assistive
                                      Devices Program ad min istered by the Ministry of Health, up to the
                                      amount approved under that program,

                            v.        if an assessment is required to determine eligibility for an assistive
                                      device under that program and there is no other source of funding for
                                      the assessment, the amount determined by the administrator, and

                            vi.       the cost of batteries and necessary repairs for mobility devices used by a
                                      member of the benefit un it if the cost of batteries and repairs is not
                                      otherwise reimbursed or subject to reimbursement.




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                                WINTER CLOTHING FOR CHILDREN

       2.      An amount equal to $105 for winter clothing for each of the dependent children of a
               recipient who is eligib le for inco me assistance in the month of November and who has
               one or mo re dependent children in that month.

                                         BACK TO SCHOOL

       3.      An amount to be paid once in a year for back to school expenses of a recip ient who is
               elig ible for inco me assistance in the month of August and who has one or more dependent
               children in that month in an amount equal to,

                         i.      $69 for each dependent child who is four years of age or more and less
                                 than 13 years of age, and

                         ii.     $128 fo r each dependent child who is 13 years of age or o lder and who
                                 is or will be attending school.

                                     COMMUNITY START UP

       4.      An amount, not exceeding the amount determined under subsection (3), to establish a new
               residence if,

                         i.      a recip ient will be establishing a permanent residence whether within or
                                 outside the geographic area,

                         ii.     the admin istrator is satisfied that the recipient will need financial
                                 assistance to establish the residence,

                         iii.    the recipient,

                                          A.        is being discharged from an institution which
                                                    provided for his or her basic needs and shelter, or

                                          B.        has satisfied the admin istrator that it would be
                                                    harmful to his or her health or welfare to remain in
                                                    his or her current place of residence, and

                         iv.     there has not been a payment under this paragraph or under paragraph 4
                                 of subsection 44 (1) of Ontario Regulation 222/98 (General) made under
                                 the Ontario Disability Support Program Act, 1997 within the preceding
                                 12 months or there has been such a payment within the preceding 12
                                 months and the Director approves the additional payment.

                                               GUIDE DOG

       5.      If a member of the benefit unit has a guide dog, an amount not exceeding $64 for the care
               of the guide dog.




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                      EMPLOYM ENT AND TRAINING START UP ASSISTA NCE

         6.       If a recip ient, a spouse or same-sex partner included in the benefit unit or a dependent
                  adult who is not attending school full time begins or changes employment or begins an
                  emp loyment assistance activity, an amount determined by the administrator for expenses
                  approved by the administrator and reasonably necessary for the person to begin the new
                  emp loyment or act ivity, up to a maximu m in any 12-month period with respect to any one
                  person of $253.

                                         UP FRONT CHILD CA RE

         7.       If a recip ient, a spouse or same-sex partner included in the benefit unit or a dependent
                  adult who is not attending school full time begins or changes employment or begins an
                  emp loyment assistance activity and, in the opinion of the admin istrator, the person is
                  required to pay in advance for child care that is reasonably necessary to permit the person
                  to begin the new emp loyment or act ivity, an amount determined by the administrator, up
                  to a maximu m in any 12-month period of the amount that the person would be entitled to
                  as a deduction for child care under section 49. O. Reg. 134/98, s. 55 (1); O. Reg. 227/98,
                  s. 30 (1-4); O. Reg. 165/99, s. 13; O. Reg. 238/ 99, s. 1 (1); O. Reg. 32/ 00, s. 17.

(1.1) Despite paragraph 6 of subsection (1), the maximu m amount payable under that paragraph shall be
reduced by any amount paid under paragraph 6 of subsection 44 (1) of Ontario Regulation 222/98 (General)
within the applicable 12-month period. O. Reg. 227/98, s. 30 (5).

(1.2) Despite paragraph 7 of subsection (1), the maximu m amount payable under that paragraph shall be
reduced by any amount paid under paragraph 7 of subsection 44 (1) of Ontario Regulation 222/98 (General)
within the applicable 12-month period. O. Reg. 227/98, s. 30 (5).

(2) The amount paid under paragraph 7 of subsection (1) shall not constitute reimbursement for ch ild care
expenses for the purpose of determining deductions from inco me under section 49. O. Reg. 134/ 98, s. 55
(2).

(3) The maximu m amount payable under paragraph 4 of subsection (1) to establish a new residence is,

         (a)      $1,500, if the recip ient has one or more dependent children; or

         (b)      $799, in all other cases. O. Reg. 238/99, s. 1 (2).

                                   TEM PORA RY CARE ASSISTANCE

57. (5) For the purpose of subsection (4), the child's budgetary requirements are,   …

         (c)      If an approved health professional certifies that the child requires a special d iet and
                  signs a statement setting out in detail the special d iet required, an amount which is the
                  lesser of,

                           (i)      the additional cost required to provide the special diet, and

                           (ii)     $250; and …




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                   EXTENDED HEA LTH BENEFIT FOR APPLICANTS UNDER THE
                       ONTARIO DISABILITY SUPPORT PROGRAM ACT, 1997

58. A person is eligib le for the benefits set out in subparagraph i of paragraph 1 o f subsection 55 (1) for any
month in which,

         (a)      the person is not entitled to inco me assistance because his or her income determined under
                  sections 48 to 54 exceeds his or her budgetary requirements, and the person would
                  otherwise be entitled to it;

         (b)      the person's income determined under sections 48 to 54 is less than the person's budgetary
                  requirements plus the value of the benefits in subparagraph i of paragraph 1 of subsection
                  55 (1);

         (c)      the person or his or her spouse or same-sex partner included in the benefit unit has applied
                  for income support under the Ontario Disability Support Program Act, 1997 and that
                  application has not been finally disposed of;

         (d)      the person or his or her spouse or same-sex partner included in the benefit unit suffers
                  fro m a condition listed in subsection 8 (2) of Regulation 552 o f the Rev ised Regulations
                  of Ontario, 1990 made under the Health Insurance Act; and

         (e)      the person or his or her spouse or same-sex partner included in the benefit unit has not
                  previously applied for and been refused elig ibility fo r benefits under,

                            (i)      the Ontario Disability Support Program Act, 1997,

                            (ii)     clause 7 (1) (a), (b ), (c), or (e) of the Family Benefits Act, or

                            (iii)    subsection 2 (5) of Regulation 366 of the Revised Regulat ions of
                                     Ontario, 1990 made under the Family Benefits Act. O. Reg. 134/98, s.
                                     58; O. Reg. 227/98, s. 32; O. Reg. 32/00, s. 18.

EXTENDED HEA LTH BENEFITS FOR PERSONS RECEIVING PA YM ENTS UNDER THE 1986-1990
                    HEPATITIS C SETTLEM ENT A GREEM ENT

58.1 A person is eligible for the benefits set out in paragraph 1 of subsection 55 (1) for a month, even
though the income of the person's benefit unit for that month, as determined under this Regulation, exceeds
the benefit unit's budgetary requirements for that month, as determined under this Regulation, if,

          (a)   the excess results from the receipt by a member o f the benefit unit of a loss of inco me
                payment or a loss of support payment under the 1986-1990 Hepatit is C Settlement
                Agreement made as of June 15, 1999 among the Attorney General of Canada, Her Majesty
                the Queen in right of Ontario and others;

         (b)    the person is otherwise elig ible for inco me ass istance for that month; and

          (c)   on April 1, 1999 the person was,

                            (i)      a member of a benefit unit under this Act,

                            (ii)     a member of a benefit unit under the Ontario Disability Support
                                     Program Act, 1997, or




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                            (iii)     a recip ient or beneficiary under the Family Benefits Act. O. Reg.
                                      326/00, s. 5.

                                         DISCRETIONA RY BENEFITS

59. (1) A delivery agent may pay or provide one or more of the benefits set out in subsection (2) to or on
behalf of a person referred to in section 8 of the Act in the amount determined by the administra tor. O. Reg.
134/98, s. 59 (1).

(2) For the purposes of subsection (1), the benefits are the fo llo wing:

         1.        The cost of dental services.

         2.        The cost of one or more prosthetic appliances, including eye-glasses.

         3.        The cost of vocational training and retraining.

         4.        The cost of travel and transportation.

         5.        The cost of moving.

         6.        The cost of a funeral and burial and the extraordinary costs of transporting a deceased
                   person.

         7.        Any other special service, item or pay ment in addit ion to those set out in paragraphs 1 to 6
                   authorized by the Director. O. Reg. 134/98, s. 59 (2).

(3) An application for discretionary benefits shall be in the form and manner approved by the Director and
shall be made to the administrator for the geographic area where the applicant resides. O. Reg. 134/ 98, s. 59
(3).

(4) Beneficiaries under the Family Benefits Act and children on whose behalf financial assistance is provided
under section 49 of the Ontario Disability Support Program Act, 1997 are prescribed classes for purpos e of
clause 8 (c) of the Ontario Works Act, 1997. O. Reg. 227/ 98, s. 33.

(5) Ontario or a delivery agent is entitled to recover amounts paid under paragraph 6 of subsection (2) fro m
the persons or organizat ions liable for the payment of those costs. O. Reg. 134/ 98, s. 59 (5).


Anatomy Act

Section 11 of the Anatomy Act states:
                                    DUTY OF MUNICIPA LITY TO BURY

11. Subject to this Act, any unclaimed body found within the limits of a city, town, village or township shall,
at the request of the local inspector or, where there is no local inspector appointed under subsection 2 (2), of a
coroner, be disposed of at the expense of the corporation, but the corporation may recover the expense
thereof fro m the estate of the deceased or fro m any person whose duty it was to dispose of the body. R.S.O.
1990, c. A21, s. 11.




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Intent of Policy

Mandatory benefits are provided to eligible participants and discretionary benefits
are provided to Ontario Works participants and Ontario Disability Support
Program (ODSP) recipients at the discretion of the Administrator.


Decision-Making Principles

The following principles apply:

     "urgency" and "emergency" are used to establish the requirement for a
      home repair; and

     fairness and consistency is used in the provision of benefits to eligible
      applicants and participants.


Standards

The following standards must be met:

   mandatory benefits are provided to all eligible Ontario Works applicants or
    participants and his/her dependents;

   discretionary benefits can be issued to eligible Ontario Works participants and
    ODSP recipients in receipt of assistance;

   all benefits payable once within a twelve month period are paid only once
    within that period;

   where approved, Community Start-up Benefit shall be paid directly to the
    landlord or utility company;

   employment start up benefit is provided to all eligible Ontario Works
    participants for initial participation and employment expenses;

   Employment Start-up Benefit is not used for union initiation fees or for vision
    care; and

   benefits are not approved if the applicant or participant has already purchased
    the item.




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Audit Requirements

Random file reviews are completed to ensure that:

   extended health benefits under paragraph 1 of subsection 55 (1) are only
    provided where a person's income is in excess of their budgetary
    requirements and they are ineligible for assistance, and the excess results
    from the receipt by a member of the benefit unit of a loss of income payment
    or a loss of support payment under the 1986-1990 Hepatitis C Settlement
    Agreement, the person is otherwise eligible for income assistance for that
    month, and on April 1, 1999 the person was a member of a benefit unit under
    Ontario Works or ODSP or a recipient or beneficiary of Family Benefits; and

   receipts are on file to support payment for expenses that occur during
    employment, employment assistance activities and community participation.


Application of Policy

An application for assistance is deemed an application for benefits. Eligibility for
benefits is determined in accordance with the Act and regulations. The provision
of benefits is made to meet the budgetary requirements of the participant for
items not covered under income assistance (basic needs and shelter). Benefits
provided are either mandatory or discretionary benefits.

Mandatory benefits are provided to all eligible Ontario Works applicants or
participants and his/her dependents.

Discretionary benefits are provided at the discretion of the Administrator and may
include health and non-health related items.


Mandatory Benefits

Eligible participants may receive the following mandatory benefits:

     drug coverage;

     dental and vision care for dependent children;

     diabetic supplies, surgical supplies, dressings;

     medical transportation;




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     consumer contribution for an assistive device and eligibility assessment
      under the Assistive Devices Program;

     batteries and necessary repairs for mobility devices;

     winter clothing and back to school benefits for families with dependent
      children;

     Community Start-up Benefits;

     Employment Start-up Benefits;

     Northern Allowance amount for communities north of the fiftieth parallel;

     Advanced Age Item for each member of the benefit unit who is 65 years of
      age or older;

     guide dog allowance; and

     special diets.


Drug Coverage

Each eligible participant, spouse or same-sex partner and dependent is provided
with drug coverage for each month they are eligible for assistance. Health
coverage is limited to items covered by the Ontario Drug Benefit plan. Drug cards
are issued for one month only. Automated drug cards are attached to the
participant's monthly statement.


Dental Coverage for Dependent Children

The current MCSS Schedule of Dental Services and Fees for Mandatory Dental
Coverage (April 1, 1999) provides dental coverage as approved by the Minister.
Dependent children of eligible participants receive mandatory basic dental
coverage as outlined in the MCSS Schedule.


Vision Care for Dependent Children

Dependent children of eligible participants receive mandatory coverage.
Coverage is provided for the purchase and repair of lenses and frames. The
following is a comprehensive list of basic vision care coverage.




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 Standard Benefit        All dependent children can receive a new pair of frames
                         and lenses every 3 years.

 Replacement             Children can receive new lens(es) anytime there is a
 Lens(es)                change in prescription.

                         Note: The new lens(es) must be placed in existing
                         frames, however, if this is not possible, new frames may
                         be authorized as well.

 Replacement due to      Children may receive replacement lenses and/or frames
 Loss, Damage or         as needed without restrictions; however, cases are
 Negligence              subject to review where abuse is detected.

 Lenses                  There may be limitations of choice regarding bifocal
                         lenses. The lenses required are usually dictated by the
                         prescription.

                         The beneficiary may choose more expensive lenses
                         (e.g. tints, photogray, etc.) and pay the difference in cost
                         including the difference in dispensing fee directly to the
                         supplier. In cases where the item is a medical necessity,
                         it may be authorized (see Special Lenses/Frames).

 Frames                  Frames may be provided subject to a maximum amount.
                         However, the beneficiary may choose a more expensive
                         frame and pay the difference in cost directly to the
                         supplier.

 Special                 Where beneficiaries have special requirements or needs
 Lenses/Frames           (e.g., special frames and/or lenses) for medical reasons,
                         the item or service may be authorized with appropriate
                         proof.

                         Designated staff may authorize special lenses and/or
                         frames after receiving documentation from the prescrib-
                         ing ophthalmologist, optometrist or general practitioner
                         explaining the necessity of the service or item.

 Contact Lenses          As a general rule, contact lenses are not provided under
                         the basic vision care plan. If there is a situation where
                         contact lenses are considered a medical necessity,
                         written clinical rationale along with the prescription, are
                         to be submitted for approval. Medical necessity includes
                         the following conditions:



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                            Aphakia (post cataract surgery),
                            Corneal irregularities; or
                            Astigmatism (which is inadequately corrected by
                             eyeglasses).

 Prescription            The Ontario Health Insurance Plan (OHIP) pays for eye
 Process                 exams annually for those under age 20.

                         Most medically necessary eye examinations continue to
                         be insured regardless of age or frequency, for example,
                         treatments for infection, disease and injury. Patients
                         who wish periodic eye examinations that are not eligible
                         for OHIP coverage are billed directly by the optometrist
                         or physician.

                         Note: As the prescription process is handled under the
                         Health Insurance Act, benefit unit members must be
                         advised to deal with the Ministry of Health and Long-
                         Term Care in matters having to do with their
                         prescription.


Diabetic Supplies, Surgical Supplies and Dressings

An amount equal to the cost of the item, that is not going to be reimbursed from
another source, is added to the assistance of the participant, spouse or same -sex
partner or dependent. The Administrator must determine the most appropriate
payment process, either by adding the cost of the item to the participant's
assistance, or by a direct payment system to a vendor.


Diabetic Supplies

If a participant requires diabetic supplies, the worker requests a certificate from a
physician before an item can be ordered. A new prescription is required before a
change in the order can be completed. Prescriptions must include information
regarding the number of injections per day or number of syringes required per
day.

Diabetic supplies include:

     alcohol swabs;

     blood glucose monitors;




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     lancets;

     platforms;

     syringes; and

     test strips.


Surgical Supplies and Dressings

These are items required by a person being treated at home for an injury,
infection or congenital abnormality.

Surgical supplies and dressings include:

     accessories (adhesives, skin barriers);

     catheters;

     colostomy, ileostomy and urinary supplies;

     condoms;

     diapers;

     drainage bags;

     incontinence and ostomy supplies; and

     other surgical supplies as required.


Travel and Transportation for Medical Purposes

Workers must obtain medical verification, where appropriate, for requests to
assist with costs associated with travel to attend medical appointments,
rehabilitation (therapy), a healing lodge, or psychological counselling (e.g. AA
meetings or 12-step meetings). This may include the cost of meals and
accommodation en route, if necessary, and must be the most cost-effective
method. The worker must ascertain if transportation coverage is available from
the programs themselves.




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Eligible northern Ontario residents must apply for the "Northern Health Travel
Grant" for health related travel expenses and complete 2 forms, an Agreement to
Reimburse, form #2208 and an Assignment and Direction, form #2209.

A monthly payment equivalent to a transportation pass can be issued if the
participant is required to attend on-going medical appointments.

Participants who cannot use the usual mode of transportation due to physical
limitations may use wheel-trans, be provided with taxi fare, or other more
appropriate methods.

Medical transportation does not include travel costs associated with court,
appointments, child care, repatriation or school programs.


Costs Related to the Assistive Devices Program

The Assistive Devices Program (ADP) of the Ministry of Health and Long -Term
Care provides benefits to eligible participants, spouses or same -sex partners and
dependents. See Directive 31.1: Assistive Devices.

Both the consumer contribution for an assistive device and the eligibility
assessment under the Assistive Devices Program are considered mandatory
benefits of assistance if these costs are not otherwise reimbursed.

The Assistive Devices Program does not cover costs associated with the
maintenance of and repairs to assistive devices. Batteries and repairs for mobility
devices are therefore considered mandatory benefits of assistance for the benefit
unit if these costs are not otherwise reimbursed.


Winter Clothing and Back to School

Both the Winter Clothing and Back to School are mandatory benefits of
assistance for participants with dependent children. An eligible dependent in this
section is defined as a dependent child or a dependent child for whom temporary
care assistance is issued.

Eligible participants can receive the Winter Clothing and Back to School once in
any twelve-month period. A participant or any of his/her dependents is not eligible
if he/she only received emergency assistance or has received an Extended
Health Benefit.

In situations where joint custody exists, the primary caregiver is eligible for the
child benefits. Receipt of the Canada Child Tax Benefit determines the primary
caregiver. See Directive 29.0: Calculating Assistance.


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Winter Clothing

Eligible applicants or participants receive an amount of $105 for each of his/her
eligible dependent children in receipt of assistance in the month of November.
However, Administrators have flexibility and may issue this benefit in a month
other than November as a discretionary benefit.

Lack of appropriate winter clothing during the winter months may result in a
detriment to the health of the dependent children. Where a participant with
dependents requires assistance with winter clothing and where the participant
was not eligible to receive the winter clothing allowance in November,
Administrators may issue the winter clothing allowance as a discretionary benefit.

Care must be taken to ensure only one winter clothing benefit per eligible
dependent child is issued annually.


Back to School

The purpose of this benefit is to assist eligible participants, who have dependent
children in receipt of assistance in the month of August, with the additional
expense incurred when dependents return to school.

A participant who has one or more eligible dependent children attending school
shall be paid once in that year the following amounts:

     $69 for each eligible dependent who attains the age of four years or more
      but who has not attained the age of thirteen years in that year; and

     $128 for each eligible dependent who attains the age of thirteen years or
      more but has not attained the age of eighteen years in that year.


Community Start-up Benefit

The Community Start-up Benefit is a mandatory item of assistance. The delivery
agent must provide this benefit to eligible participants in start-up situations where
additional costs are incurred.


Eligibility Criteria

The applicant or participant must meet the following eligibility criteria:

     eligibility for Community Start-up Benefit is contingent upon eligibility for
      assistance;


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     the Administrator must be satisfied that it is necessary for the health and
      welfare of the person to leave the previous place of residence, and establish
      a new permanent residence in the community;

     for applicants or participants the "Start-up" event must occur within one
      month from the date of application for assistance or the establishment of a
      new permanent residence;

     the Administrator must be satisfied that the applicant or participant has a
      genuine intent to establish a permanent residence in the community and has
      a plan to do so;

     the applicant or participant is moving into a boarding or renting
      accommodation available in the community, not a per diem funded
      residence such as a group home or hostel; and

     the item may be paid to an applicant or participant only once in a twelve -
      month period. The worker must question the participant and where
      necessary by other means, such as checking with other delivery sites,
      determine that a Community Start-up Benefit has not been received during
      the twelve-month period preceding the application.


Allowable Start-up Situations

The following circumstances are the only situations in which the benefit is
provided:

     victims of family violence, including spousal, same sex partner or child
      abuse;

     persons who are homeless;

     uninhabitable premises where the uninhabitable conditions are not clearly
      evident, the worker must seek verification from a third party, e.g. a building
      or health inspector or physician;

     a move out of the home where the need has been clearly established. For
      example:

         a disabled person moving because of the incapacity or death of
          supporting, care-giving family member(s);

         overcrowding condition within the premises;



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         children and sole-support parents where there is documented need for
          them to relocate;

         persons faced with eviction from their premises;

         persons needing to move for reasons of employment or training; or

         a move to more affordable accommodations, e.g. situations in which an
          applicant or participant was experiencing undue hardship because of
          extreme shelter costs. A move to accommodations more within the
          current shelter ranges might then be considered; and

     persons being discharged from institutions such as:

         correctional facilities;

         hospitals;

         hostels;

         nursing homes;

         special care homes; or

         interval and transition homes.


Allowable Residence Establishment Costs

Examples of the cost of establishing residence in the community include the
following:

     clothing;

     fuel and hydro deposits;

     household furnishings;

     last month's rent deposit;

     moving and transportation to the home of the applicant or participant; or

     any other costs approved by the Administrator.




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Payment of the Community Start-up Benefit

The participant must meet eligibility for basic financial assistance before the
Community Start-up Benefit is approved and payment is made.

In all situations, the need for the participant to leave his/her residence must be
clearly identified and documented. There must be a reasonable plan in place that
identifies not only the situation, but also the need for the person to move. It is
important to review each participant's request for the Community Start-up Benefit
on its own merit in light of the policy intent and to provide it only where the needs
have been identified and where no other funds are available.

The amount of the Community Start-up Benefit payable, as determined by the
Administrator, is up to a maximum of $1500 for participants with dependent
children under 18 years of age, or up to a maximum of $799 for all other
participants. The approved amount is based on verifiable costs, which in the
opinion of the Administrator, are necessary to establish a permanent residence in
the community.

The payment of assistance for a rent deposit or utility deposit is made directly to
the landlord or utility company. The delivery agent can provide full or partial
payment prior to the date of departure from the previous place of residence (e.g.
rent deposit).

The Community Start-up Benefit does not need to be paid in one sum. The
benefit may be paid in separate amounts provided it accommodates only one
"Start-up" event and does not exceed the maximum amounts. The benefit does
not need to be paid within the first month after leaving the previous residence.

Generally, the Community Start-up Benefit must be approved for a participant
only once in a twelve-month period. However, there may be exceptional
situations in which there is a need to assist more than once within the twelve-
month time frame. For example, the Community Start-up Benefit could be issued
in situations where the participant moves from a hostel to interim housing, and
then on to a permanent residence. In this case, payment for two "Start-up" events
would be approved, provided the total amount of the Community Start-up Benefit
issued within the twelve-month period does not exceed the current maximum
amount. In addition, any items purchased or obtained during the interim move
must not be duplicated for the final move into the community (e.g. furniture
items).


Participant Moving to a Different Delivery Site

If a participant is moving from one delivery site to another, the normal practice is
to issue the Community Start-up Benefit from the delivery site which the


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participant is leaving. This would enable the participant to more easily establish
an address in the new community. This would include situations in which the
Administrator is already aware of the need and arrangements that are necessary
for the participant to relocate to another community. A pay direct to the landlord
must be made for the rental portion.

However, there may be situations in which the new delivery site needs to issue
the Community Start-up Benefit. For example, a participant has left in an
emergency and is already in the geographic area of the new delivery site.
Emergencies might include, but are not limited to, cases of family violence or
reasons involving health-related matters. A participant may require immediate
funds for last month's rent from the outgoing delivery site, then require further
access to the Community Start-up Benefit for other demonstrated needs from the
new delivery site.

Under no circumstances the participant is to be asked to return to the previous
community to access the Start-up Benefit. Unusual situations must be discussed
with the Administrator.


Employment Start-up Benefit

The Employment Start-up Benefit is a mandatory item of assistance. The delivery
agent must provide this benefit to eligible participants for initial costs or expenses
associated with approved participation and/or employment.


Eligibility Criteria

A single person, head of family, spouse or same-sex partner or dependent adult
is eligible for an Employment Start-up Benefit if he/she:

      accepts full time, part time or casual employment;

      changes employment;

      is self-employed; or

      begins an approved employment assistance activity; and

      has initial costs or expenses, which must be met in order to facilitate
       employment or participation in an employment assistance activity including
       a training program.




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Definitions

Changed employment shall mean the beginning of a new job, with a current or
new employer, where the duties and responsibilities are substantially different
than the previous job. For example, a person works in a factory on an assembly
line and changes position from the line to an office setting where more formal
clothes are required.

Changed employment assistance activity may also mean the beginning of a new
training program, with different duties and responsibilities. It may also mean a
shift from job training to work experience. For example, a person completing the
academic portion of a program may move to the "on-the-job" training portion of a
program and require a uniform, work clothes or tools.

Approved employment assistance activity includes community participation and
employment measures activities that are documented in a participation plan.

The worker may require written verification to confirm an offer or acceptance of
employment. This may be done by memo or notation to the participant's file.


Allowable Employment Start-up Expenses

Expenses associated with accepting or changing either employment or an
employment assistance activity, including a training program, include but are not
limited to the following:

     appropriate work wear;

     grooming costs;

     licensing fees, association costs;

     tools and equipment;

     transportation costs; or

     any other items that in the opinion of the Administrator, is a necessary work
      or employment assistance related expense.

If child care costs are required to begin employment or comme nce an
employment assistance activity and the child care costs are not reimbursed or
reimbursable from another funding source, the child care Start-up costs are paid
in addition to the Employment Start-up Benefit. See Directive 16.5: Child Care
Deductions.


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The Administrator can approve Start-up costs up to a maximum $253 in a twelve-
month period. The benefit may be paid to a participant in a lump sum or over a
twelve-month period but may not exceed the maximum amount.

For example, if a participant starts a placement and requires work boots, the cost
of work boots could be issued as part of the Employment Start-up Benefit. If the
work boots cost $75, the balance of $178 may be paid any time in the twelve
months from the original payment.

The worker must verify that the Employment Start-up Benefit has not been issued
in the twelve-month period prior to the current request.

If a participant received a portion of the $253 from another delivery agent, the
balance may be issued at any time in the twelve months from the original
payment.


Employment Assistance Expenses

The delivery agent may issue funds in addition to the mandatory employment
start-up benefit to eligible participants to cover ongoing costs associated with
participation in employment assistance activities. Participation related expenses
are covered in order to support participants as they move along the service path.
Financial supports are also available for persons with disabilities and for child
care costs to help make participation possible.

Expenses associated with job search may be provided to participants in a
resource centre environment (e.g., supplies, equipment, and telephone
expenses).

The following criteria apply to the coverage of participation related expenses:

     where a participant is eligible for the mandatory Employment Start-up
      Benefit, that benefit must be accessed first;

     the fund must only support access to activities that are described within
      these directives as approved employment assistance activities in Ontario
      Works;

     payments are to cover out-of-pocket expenses associated with participation
      in employment assistance activities, including:

         necessary transportation;

         clothing, grooming, and special equipment;


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         safety equipment;

         supplies and equipment;

         protective clothing;

         telephone expenses;

         for community placements, where required as a condition of referral or
          placement, criminal reference checks or medical examinations and
          certificates;

         minor fees such as certification changes, short training costs; and

         child care costs.

     there is a maximum average of $250 per month per participant, with a
      maximum advance of $500; and

     funding to cover child care may be managed as part of participation
      expenses, provided that the child care funding is accounted for separately
      and treated as single-purpose funding.

Expenses generally fall within the maximum average of $250 per month per
participant. Some participants may have fewer expenses and others may have
more expenses to support their participation. Approval of the Administrator must
be obtained for expenses above the maximum average, with consideration given
to the necessity of the item to support the shortest route to employment for the
participant.


Supports to People with Disabilities

Technical aids or devices to support access to Ontario Works should be provided
for people with disabilities who wish to participate in Ontario Works voluntarily.

The following criteria apply to the use of employment assistance funds:

     they must not be available through the Assistive Devices Program of the
      Ministry of Health and Long-Term Care (e.g., reader, interpreter, low vision
      aid) See Directive 31.1: Assistive Devices; and

     the needs of people with disabilities who require more extensive supports
      are to be met through the ODSP employment supports, for example:



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         employment consultation and planning; and

         the tools and equipment necessary for a person's employment
          preparation and training or necessary for a person to begin employment.


Child Care Assistance

Delivery agents can provide fee assistance toward child care support for parents
participating in community placements and employment measures. Participants
can be reimbursed for the actual cost of licensed care. Participants can also be
reimbursed for the cost of informal or alternative child care (e.g. summer camp,
supervised homework programs) up to the established maximums:

     $390 per month for children ages 0 -5 years;

     $346 per month for children ages 6 -12 years; and

     an Administrator may approve costs up to $390 per month for children ages
      6 or older for special circumstances (i.e. special needs)

Where a participant has earnings from employment, the costs of child care for
both licensed and informal care may be recovered as an allowable expense. See
Directive 16.4: Earnings Exemptions.

Payments for informal care may not be made to the:

     father of the child or children;

     mother of the child or children;

     supporting person of the child or children; or

     a sibling of the child or children living with the participant who is under age
      18.

The delivery agent must establish a local policy for requiring receipts. The policy
must establish appropriate circumstances under which receipts are required and
address such issues as review procedures, storage, and retention schedules.

In situations where a participant, spouse or same-sex partner begins or changes
employment or an employment assistance activity, and an advance childcare
payment is reasonably necessary to permit this beginning or change, workers can
issue an advance payment. See Directive 16.5: Child Care Deductions.



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Northern Allowance

Northern Allowance is a mandatory amount paid to applicants or participants in
communities north of the fiftieth parallel without year round road access intended
to assist with the high costs for basic necessities for isolated communities. If the
applicant or participant resides north of the fiftieth parallel, the table in section 41
(2) of the Regulation provides the basic needs amount.


Advanced Age Item

Each member of the benefit unit who is 65 yea rs of age or older receives an
additional $30 per month.


Special Diets

Where there is a need, an amount for a special diet as prescribed by an approved
health professional may be issued to a participant in addition to the amount for
basic needs and shelter.

The special diet is payable even when the maximum basic needs is being paid.
Special diets may be provided up to the maximum of $250 per month for each
participant if required.

The special diet benefit does not cover:

     drugs, vitamins, minerals and herbal products;

     liquid formulated diets, calorie-reduced foods used in the treatment of
      obesity or weight loss, sports-related performance enhancement products,
      and dietary products used in experimental diets (i.e. the diet has not been
      validated in a clinical trial); and

     products covered under the Ontario Drug Benefit (ODB) plan or Health and
      Welfare Canada.


Approval of Special Diet

The Special Diets Schedule identifies frequently requested special diets, and
indicates whether assistance can be provided and the pre-approved monthly
amount that may be issued. Where the requested diet is unique and not included
in the Schedule, a registered dietician must be consulted to assess the diet,
determine its validity, and estimate the cost of providing the diet.



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Special Diets Schedule

         Diet                                                   Monthly Amounts
  A      Allergy Diets
         Chick en/Poultry Free                                  No benefit
         Corn Free                                              No benefit
         Egg Free                                               $ 10.00
         Fish Free                                              No benefit
         Food Colours Free                                      No benefit
         Histamines Free                                        No benefit
         Meat Free                                              No benefit
         Milk /Dairy Free
               Up to 2 years                                   $ 95.00
               2-10 years                                      $ 97.00
               11-18 years                                     $ 55.00
               19 years or older                               $ 35.00
         Peanuts, Nuts, Legumes Free                            No benefit
         Shellfish Free                                         No benefit
         Sulphites Free                                         No benefit
         Wheat Free
               Up to 2 years                                   $ 38.00
               2-10 years                                      $ 77.00
               11-18 years                                     $ 98.00
               19 years or older                               $ 57.00
         Yeast Free                                             No benefit
  B      Bland Diet                                             No benefit
         Breastfeeding Diet (Post partem - maximum 1 year)

          Only one of the following (A or B) may be funded

         A. Milk -based
                                                                $ 30.00
               or
         B. Non-dairy
                                                                $ 50.00
  C      Calcium (High)                                         $ 30.00
         Calorie (High) and Protein (High)

         A. Calories/Prot ein Acquired in Food
             Up to 750 Kcal                                    $ 75.00
             751+ Kcal                                         $150.00

          Only one of the following (B, C or D) may be funded

         B. Prepared Supplements Required such as:
            Carnation Instant Break fast, Meritene.
            (Person is Lactose Tolerant )
             1 serving/day                                     $   24.00
             2 servings/day                                    $   48.00
             3 servings/day                                    $   72.00
             4 servings/day                                    $   96.00




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         Diet                                               Monthly Amounts
         C. Prepared Supplements Required such as:
             Boost, Ensure, Resource.
             (Person is Lactose Intolerant)
              1 serving/day                                $ 60.00
              2 servings/day                               $120.00
              3 servings/day                               $180.00
              4 servings/day                               $240.00

         D. Specialized Prepared Supplement Required such
            as: Resource Beverage Brands.
             1 serving/day                                 $ 60.00
             2 servings/day                                $120.00
             3 servings/day                                $180.00
             4 servings/day                                $240.00
         Calorie (High) and Protein (Restrictions)          $ 30.00
         Cranberry Juice                                    $ 32.00
         Cystic Fibrosi s Diet

          Only A may be funded

         A. Extra Calories Acquired in Food
             Up to 750 Kcal                                $ 75.00
             751+ Kcal                                     $150.00

         B. Extra Calories Acquired in Prepare d            Refer to Special Drugs
            Supplements                                     Program, Ministry of Health or
                                                            to Group T Hospitals
  D      Diabetic Diet (includes low fat, high fibre and
         unsweetened products)                              $ 42.00
  E      Enteral/Tube Feeding                               Refer to ODB
  F      Fat/Cholesterol Restrictions and/or Fibre          $ 22.00
         Fluid (High)                                       No benefit
         Folic Acid (High)                                  No benefit
  G      Gluten Free
              Up to 2 years                                $ 58.00
              2-10 years                                   $ 115. 00
              11-18 years                                  $ 147. 00
              19 years or older                            $ 131. 00
  I      Infants Formula

         Prescriptions for:                                 Refer to ODB
              Alimentum Liquid
              Neoc ate Powder
              Nutramigen Liquid
              Nutramigen Powder
              PediaSure Liquid
              Peptamen Junior Liquid
              Portagen Powder
              Pregestimil Powder
              RCF Liquid
              Resource Just For Kids
              Vivonex Pediatric Powder




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         Diet                                                    Monthly Amounts
         (Formulas other than the above may be approved if
         the formula is prescribed for therapeutic purposes or
         if breastfeeding is contraindicated.)

                Cows milk-based formula                         $ 75.00
                Soy-based formula only for vegan
                 vegetarians or infants with galactosaemia       $ 83.00
         Iron Rich Foods                                         $ 30.00
  K      Ketogenic                                               $ 30.00
  L      Lactose – Reduced                                       Refer to ODB
  M      MCT Oil (Medium Chain Triglycerides)                    Refer to ODB
  O      Organic Diet                                            No benefit
  P      Phosphorous (Re strictions)                             $ 10.00
         Potassi um (High)                                       No benefit
         Potassi um (Re strictions)                              No benefit
         Pregnancy Diet (to delivery date)

          Only one of the following (A or B) may be funded

         A. Milk -based                                          $ 30.00
                 or
         B. Non-dairy                                            $ 50.00
         Probiotics (addition of yogurt with active culture)     $ 24.00
         Protein (High)
         Calories/Prot ein Acquired in Food
              Up to 750 Kcal                                    $ 75.00
              751+ Kcal                                         $150.00
         Protein (Re strictions)                                 No benefit
         Protein (Re strictions) and Phosphorous                 $ 30.00
         (Re strictions)
         Prunes                                                  $ 10.00
         Pureed Food                                             One time benefit of $75.00 to
                                                                 purchase blender
         Purine (Restrictions)                                   No benefit
  R      Reflux (Anti)                                           No benefit
         Residue (Re strictions)                                 $ 12.00
  S      Sodium/Salt (Restrictions)
             No Added Salt                                      No benefit
             2g/87 mE q                                         $ 12.00
             1g/43mE Q or less                                  $ 44.00
         Sugar Free/Unsweetened Products                         $ 20.00
  T      Thickened Products                                      Refer to Dietician for
                                                                 Assessment
         Tyramine (Restrictions)                                 No benefit
  V      Vitamin K (Low)                                         No benefit

If the diet has been approved, the participant must be advised of the approved
amount and review date. The worker must add the approved amount to the
participant's assistance with an expiry or renewal date.




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When a physician prescribes more than one special diet for the same beneficiary,
the cumulative total of the special diet benefit must not exceed the maximum of
$250 per month.


Special Diet Reassessment

The dietary requirements of the participant must be reviewed at least once every
12 months, unless a physician specifies a shorter review period to continue the
benefit for the special diet.

If the reassessment is not completed one month prior to the review date, the
special diet benefit is not renewed and automatically deleted from the participant's
assistance.

At any point if the physician indicates that a special diet is no longer required, the
special diet benefit is deleted.


Infant Formula

A special diet benefit is not provided for standard infant formula (e.g. Enfalac,
Similac), where it is recommended for the normal development of healthy infants.
The basic needs amount provides for this cost.

A special diet benefit for infant formula that is prescribed by a physician may be
provided:

     if the health of the mother makes it impossible to breast feed due to the
      inherent dangers to the health and well being of the infant (e.g. the mother
      has a history of prolonged drug use or has a communicable disease);

     if the health of the infant makes it impossible to breast feed due to the
      inherent dangers to the health and well being of the mother (e.g. adopted
      infants who are HIV positive); or

     if a caloric amount exceeding the normal intake of an infant is required or
      where highly specialized formulas are prescribed.

The special diet benefit for infant formula is based on the cost of powdered, as
opposed to concentrate or ready to use, infant formulas, wherever possible,
unless otherwise specified as being required by a physician for therapeutic
purposes.




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Guide Dog Benefit

The guide dog benefit is provided to an applicant or participant who is either blind
or deaf and who has a trained guide dog, for the routine care and feeding of this
dog.

The dog must meet the definition in the Blind Persons' Rights Act and trained in
one of the schools listed in the Regulation or trained by Hearing Ear Dogs of
Canada or another hearing-ear guide dog school which provides an identification
or certification card.

Verification that the dog is a guide dog can be either a certificate from the training
school or a registration card from the Ministry of the Attorney General. Only guide
dogs trained at the schools listed in the Regulation of the Blind Persons' Rights
Act can be registered.

The guide dog benefit may be paid up to $64 per month. No receipts with respect
to the care provided to the dog are required. The worker must ensure that the
guide dog is still with the applicant or participant before co ntinuing the benefit.


Guide Dog Training Schools under the Blind Persons' Rights Act


Canada

Canadian Guide Dogs for the Blind
P.O. Box 280, Rideau Valley Dr. N., Manotick, Ontario, K4M 1A3
613-692-7777

Canine Vision Canada
P.O. Box 907, Oakville, Ontario, L6J 5E8
905-842-2891


United States

Eye Dog Foundation for the Blind
512 N. Larchmont Blvd. Los Angeles, California, 90004
213-468-8856

Guide Dog Foundation for the Blind
371 East Jericho Turnpike, Smithtown, New York, 11787
631-265-2121




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Guide Dogs for the Blind Inc.
P.O. Box 151200, San Rafael, California, 94915-1200
415-499-4000

Guiding Eyes for the Blind Inc.
611 Granite Springs, Yorktown Heights, New York, 10598
914-245-4024

International Guiding Eyes Inc.
13445 Glenoaks Blvd., Sylmar, California, 91342
818-362-5834

Leader Dogs for the Blind
1039 South Rochester Road, Rochester, Michigan, 48307
248-651-9011

Pilot Dogs Inc.
625 West Town Street, Columbus, Ohio, 43215
614-221-6367

The Seeing Eye Inc.
P.O. Box 375, Morristown, New Jersey, 07963-0375
973-539-4425

Eye of the Pacific Guide Dogs & Mobility Services Inc.
2723 Woodlawn Drive, Honolulu, Hawaii


International

Guide Dogs for the Blind Assoc. (Head Office - total of 5 locations)
Alexandra House, 9-11 Park Street, Windsor, Berkshire, England


Extended Health Benefits

A participant who receives payment for loss of income or support under the 1986-
1990 Hepatitis C Settlement Agreement who as a result is ineligible for financial
assistance will be eligible for extended health coverage if the following criteria are
met:

   the person's ineligibility is the direct result of receiving a payment for loss of
    income or a loss of support made under the Agreement;

   the person is otherwise eligible for assistance in the month; and



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   on April 1, 1999, the person was a member of the benefit unit under the
    Ontario Works Act, Ontario Disability Support Program Act, or Family Benefits
    Act .

Participants who are eligible for extended health benefits because they received
payments for loss of income or support under the 1986-1990 Hepatitis C
Settlement Agreement are eligible for: prescription drug coverage; dental
coverage and vision care for dependent children; the cost for diabetic supplies,
surgical supplies and dressings and transportation reasonably required for
medical treatment for a member of the benefit unit; the consumer contribution for
an assistive device under the Assistive Devices Program; an assessment
required to determine eligibility for an assistive device under that program; and
the cost of batteries and necessary repairs for mobility devices used by a member
of the benefit unit.

If the participant is eligible for the extended health benefits, the worker can issue
a drug card or issue direct payment to the service provider. The worker must
verify the health costs prior to issuing the benefit. Workers must provide
participants with information to access the Trillium Drug Program, the Ministry of
Health and Long-Term Care's Special Drugs Program (1-800-268-1154), or
Health and Welfare Canada where eligible.

Applicants may also be eligible for extended health coverage if:

   their income exceeds budgetary requirements;

   their income is less than the sum of their budgetary requirements and their
    monthly prescription drug costs;

   they or their spouse or same-sex partner has applied for ODSP;

   they or their spouse or same-sex partner suffers from a catastrophic illness
    listed in the Health Insurance Regulation and they have the matching
    prescribed drug; and

   they or their spouse or same-sex partner have not been refused eligibility for
    benefits under ODSP or the Family Benefits Act (FBA).

In this case, only prescription drugs are considered as health related costs. See
Directive 11.0: Referrals to ODSP.




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Discretionary Benefits – Health Related

Discretionary benefits may be issued only to persons in receipt of assistance
under the Ontario Works Act and the Ontario Disability Support Act. The
issuance of discretionary benefits is at the discretion of the Administrator. The
intent of this discretion is to allow the Administrator to make decisions on an
individual basis.

Health-related benefits include:

   dental care under MCSS fee schedule for Ontario Works adults;

   prosthetic appliances such as back braces, surgical stockings, and artificial
    limbs (provision, replacement, and repairs);

   wheelchairs and repairs for the portion not covered through ADP;

   hearing aids and batteries (co-payment under Ministry of Health and Long -
    Term Care's Assistive Devices Program (ADP) for the provision, replacement,
    and repairs to hearing aids);

   vision care for adults;

   prescription drugs where outside of the Drug Formulary (e.g., experimental
    Aids drugs);

   funerals and burials;

   surgical supplies (where not otherwise covered);

   cost of completing other medical forms; and

   winter clothing allowance where the participant was not eligible to receive the
    allowance in November and lack of appropriate winter clothing during the
    winter months may result in a detriment to the health of the dependent
    children.

Other items approved individually and requiring medical documentation include
such health-related items as:

   electric beds to avoid bed sores for persons confined to bed;

   air conditioners for severe asthmatics; and

   electric breast pumps.


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Dental Care for Adults

Dental care for adults is discretionary. Delivery agents may provide dental
services to applicants and participants for emergency dental care (i.e. dental
services which are necessary to relieve pain or for medical or therapeutic
reasons), and dental care which would support the participation requirements for
the participant who is actively looking for work and is job ready . Services
provided for cosmetic reasons, such as orthodontic treatment and appliances,
are not included.

The delivery agent may enter into an agreement with the Ontario Dental
Association (ODA) for one of three levels of service. The delivery agent is billed
directly by the ODA and pays for the services required.

In areas where delivery agents choose not to join the ODA plan, the participant
must obtain an estimate of the cost before approval to proceed is given. It is not
necessary to ask the participant to obtain more than one estimate unless the
administrator feels the estimate submitted is exorbitant.


Prosthetic Appliances

Any device that replaces or strengthens a bodily function is considered a
prosthesis, including wheelchairs and inhalators. Prosthetic appliances may
include such items as back braces, surgical stockings and artificial limbs. In
providing any of these items, the recommendation of an approved health
professional and an estimate of the cost must be obtained. See Directive 31.1:
Assistive Devices.


Hearing Aids

The provision for the cost of hearing aids or batteries is a discretionary benefit.
Administrators may provide for costs of hearing aids or batteries that are not
provided for under any other governmental program, i.e. Assistive Devices
Program (ADP). ADP pays for a portion of the hearing aid or battery. The
remaining portion may be provided for as a discretionary benefit.


Vision Care for Adults

The provision of vision care is a discretionary benefit for adults. Eyeglasses,
including lenses and frames, can be purchased from an ophthalmologist,
optometrist or optician. The cost of the lenses is generally dictated by the type
and severity of the eye problem. However, frames vary greatly in price. (See
chart on pages 14-15 above.)


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Funerals and Burials

The cost of a funeral and burial is a discretionary benefit. An amount of $2,250
has been established as a maximum guideline. A tombstone is not included in
these costs; however, grave markers, as required by a cemetery, and a
"perpetual care" charge would be included as part of the funeral and burial costs.

The delivery agent may add the charge of a grave plot to the funeral and burial
costs if the delivery agent owns a cemetery, or part of a cemetery. The charge of
the grave plot must not be greater than the amount charged to any other party for
a similar plot.


Place of Residence

In cases where a person resides in one municipality and dies in another, his/her
place of residence is defined as the place in which he/she ordinarily resides.

A transient or homeless person is deemed to reside in the geographic area in
which he/she applies for assistance. If the participant was a transient and the
family wants the body returned for burial in another municipality, the delivery
agent where he/she died is responsible for preparing the body and any
transportation costs. The delivery agent to whom the body is returned pays for
burial and cemetery costs.

If an Administrator feels that the costs of the funeral and burial are the
responsibility of another delivery agent, he/she must discuss the matter with the
other Administrator.


Non-Recipients of Social Assistance

The cost of a funeral or burial for a person not receiving social assistance is not
cost shared. The Ontario Works Act and regulations place no responsibility on
delivery agents for the burial of needy persons or unclaimed bodies.

Municipalities are required by the statutes of the Public Hospitals Act and the
Anatomy Act to cover the funeral and burial expenses for persons who die in
hospitals and for unclaimed bodies where the deceased would normally have
resided within their jurisdictions. If a body has not been claimed by a relative for
disposition, or by any other person who gives a bona fide undertaking to dispose
of the body, it is the responsibility of the municipality within whose limits the body
was found to meet the cost of burial.

The Federal government manages the cost of all funerals or burials for persons
on First Nations delivery sites who are not in receipt of social assistance. Indian


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and Northern Affairs Canada (INAC) compensate First Nations for funeral and
burial expenses of status Indians who were not in receipt of social assistance
while living on-reserve in Ontario.


Recovery of Funeral Costs

The Province of Ontario, a delivery agent or an approved band can recover any
amount paid for a funeral or burial from any person or organization liable for the
payment of the funeral expenses or any portion thereof.

Proper funeral expenses are payable out of the property of the deceased person
in priority to any other charge on the deceased's estate. However, a delivery
agent does not have any right to simply seize the assets of a deceased person to
satisfy its charge for the cost of the funeral. Reimbursement must be sought from
the person responsible for administering the estate, i.e., the executor if one is
appointed under a will or if there is no executor, a court appointed administrator.

If the delivery agent wishes to recover its cost out of the deceased's estate, then
the delivery agent may assign benefits from Canada Pension Plan (CPP) or Old
Age Security (OAS) for which the deceased is eligible to receive or make a claim
against the estate. If the delivery agent simply seizes the assets of the deceased,
or otherwise closes a deceased person estate, the delivery agent leaves itself
open to possible legal action by others with an interest in the estate.

Care must be taken to maintain a complete record, preferably in the case file, of
monies or assets received in reimbursement to guard against excess recovery.
Any monies received in excess of the assistance issued must be returned to the
estate of the deceased to be distributed in accordance with the normal rules of
distribution.


Discretionary Benefits – Non-Health Related

Non-health related items are provided as discretionary benefits at the discretion
of the Administrator.

Non-health related items include:

   vocational training and retraining;

   travel and transportation that is not undertaken for health related purposes;

   moving expenses; and




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    Northern Allowance (discretionary only for those eligible communities south of
     the 50th parallel).


Vocational Training

Vocational training is used for training that is not accommodated by funds
provided through employment assistance. Vocational training may be used when
employment assistance funds have been depleted. Any training approved for
assistance through vocational training must be job specific and connected to a
job available in the local labour market. The Administrator may approve the
payment of transportation costs, if necessary.


Transportation

This covers any cost of travel and transportation that is not undertaken for health
related purposes and that the Administrator considers reasonable and necessary.

Examples:

1.      Transportation for a participant to return to his/her home outside of
        Ontario.

        Repatriation to another province or country is provided at the discretion of
        the Administrator and is considered at the request of the participant and if
        the move is in his/her best interest.

2.      Transportation of a participant to another municipality, if it has been
        verified that the relocation is in his/her best interest (e.g. the participant
        has obtained employment).

3.      Transportation of a participant going to court to obtain support from his/her
        spouse or same-sex partner.

4.      Transportation cost for hospital visits or funeral attendance of next of kin.


Moving Expenses

This includes the cost of moving household furniture and effects from one place
of residence to another.

Storage charges incurred prior to application are not usually acceptable unless
the stored furniture is essential to the family.



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Northern Allowance

The Director must approve the issuance of the Northern Allowance as a
discretionary benefit to people south of the fiftieth parallel who reside in
communities without year round road access.


Discretionary Benefits - Other Special Items and Services

The legislation allows for the provision of other special services not specifically
stated if approved by the Director and currently include:

     layettes and baby supplies (non-health related);

     necessary repairs to homes owned by applicants;

     replacement or repair of essential household furniture and appliances;

     replacement of household items and personal effects in emergency
      situations (e.g., fire, flood, storms);

     blood tests in Applications for Support 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 absolutely necessary. Payments can be made prior to the move if
      required to secure the accommodation or service;

     payments required to ensure continuation of hydro or heating service, or to
      prevent eviction; and

     the cost of preparing a will where the cost cannot be paid by some other
      means (e.g., Legal Aid).

Administrators have the authority to provide special services, items and payments
where approved by the Director. Where not specifically indicated as a health-
related item, Ontario Works Administrators will need to determine if the item or
payment required is for health-related purposes.

Health-related purposes can include the provision of a service, item or payment
where if not provided will result in a detriment to the health of the participant or a
member of the benefit unit.

The Director has approved the provision of special services, items or payments
for health related purposes where the Administrator has:


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     made a determination of need based on verifiable documentation; and

     where failure to provide would result in a detriment to the health of the
      participant or a member of the benefit unit.

The provision of other special services where not previously approved by the
Director for non-health related benefits:

     the Administrator has the discretion to approve on a case by case basis;
      and

     non-health related benefits up to a maximum of $250 without the prior
      approval of the Director.


Home Repairs

A payment for necessary repairs for the preservation and maintenance of a
dwelling place may be paid as a shelter expense where not providing it would be
detrimental to the health and well-being of the participant and any dependents
living in the dwelling place. Home repairs are a discretionary item of assistance.

The repairs benefit can only be provided to those participants who own and
occupy the home. Ownership can be determined by viewing the deed to the
property, mortgage papers, etc. If the participant's name or the name of a
member of the benefit unit is not on any of the official papers, repairs are not
provided.

If the participant proves that he/she owns the home, the participant must also
reside there or use the property as the principal residence. If the participant does
not live there, repairs cannot be approved.

If a participant is a part owner in the property, only the participant's share of the
repairs may be approved. For example, if a participant owns the home with
another person, the participant would only be eligible for one-half of the repair
cost. Again, the participant must be residing on the premises to be eligible for the
repair benefit.

Repairs can only be made on items that already exist in the home. Additions or
renovations to a home are not considered repairs and are not eligible for the
repair benefit. This not only applies to the addition of new rooms to the home but
also to items like water filtration systems. If these items do not already exist in the
home they can not be provided by the home repairs benefit.




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Although repairs may be considered urgent, the extent to which they are made
can vary. A roof leak may be determined to be an urgent repair depending on its
severity. However, when approving these repairs, the whole roof does not have to
be re-shingled. Repairs must be made to any damage that may affect the safety
of the participant; repairs must be made to the extent that the danger is
eliminated. Additional aesthetic changes must not be included.

Loans or mortgages borrowed for the purpose of home repair, though allowed as
shelter costs are considered income in the month received. See Directive 16.0:
Income.

The worker must ensure that the participant has explored the availability of
assistance from other programs (e.g. Ministry of Municipal Affairs and Housing,
First Nations housing fund, local projects) before approving the home repair.


Determining Necessary Repairs

The terms urgent and emergency are used to establish the requirement that a
repair needs immediate action or attention to ensure the participant is able to
continue to reside safely on the premises. Examples include:

     damage to an entrance door, which compromises the security of the
      premises. Depending on the extent of the damage it may not be necessary
      to replace the whole door. (i.e. if the lock is malfunctioning only the lock is to
      be fixed); and

     damage to a plumbing fixture, which causes flooding. A broken water line is
      considered an urgent repair, whereas a leaky drain pipe would not.

If repairs are being requested, the worker must determine whether repairs require
immediate attention and whether or not they pose a risk to the participant and the
benefit unit. Workers must consider the following when making a determination:

     Would the participant be forced to vacate the premises if these repairs were
      not completed?

     Are the needed repairs posing a risk to the health and well being of the
      participant and the benefit unit?

     Do the repairs have to be completed immediately?

     If the repairs are not completed immediately would they lead to a risk to the
      participant or the benefit unit in the next 90 days?




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If the answer to any of these questions is yes, the repairs must be considered
urgent or an emergency.

Examples of approved home repairs may include but are not limited to:

     electrical wiring repair or replacement if there is a potential fire hazard;

     window or door repairs or replacement (if required) to identical item of
      replacement (no enhancements);

     roof repair or replacement (shingles) depending on the state of the roofing
      material;

     furnace or wood stove repair or replacement depending on the
      circumstances; and

     emergency plumbing repairs, e.g. broken water pipes.


Assistance for Approved Repairs

Once repairs have been approved and completed, the worker must ensure that
the repairs have been completed and have the participant sign a declaration that
they are satisfied with the repairs. Before the benefit is provided to the
participant, they must provide an invoice from the vendor showing the work
completed and the cost. Payment cannot be provided without an invoice.
Estimates are not acceptable as an invoice. A copy of the invoice must be on file.

Assistance for approved repairs may be given in one of two ways. Payments for
home repairs may be included in the shelter. If the cost of shelter is less than the
maximum shelter amount and assistance is expected to continue on a long term
basis, then the total cost of the repairs may be divided into monthly payments and
included in the assistance up to the maximum shelter amount.

Example:

A person with three children owns his/her home. The house needs repairs to the
water pump and plumbing. The repair costs $1512. Monthly payments for
mortgage, taxes, fire insurance and fuel cost $350/month.

The maximum shelter for a family of four                   $602/month
Monthly payments                                       -    $350/month
Repair costs included in the shelter amount                $252/month

It would take six months to cover the total repair costs of $1512.


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Approved Home Repairs for First Nations Communities

Assistance for approved repairs may be given to participants who live in First
Nations communities and who:

1.     Have a Certificate of Possession for the property or have a Location Ticket
       for the home. (Location Tickets were issued until 1951. Section 20(3) of
       the Indian Act (Canada) indicates that a First Nation person who had a
       Location Ticket as of September, 1951, is deemed to have a Certificate of
       Possession for the property);

2.     Occupy the property according to the First Nation's custom and the
       community considers the house to belong to the participant; and

3.     Have a Certificate of Occupation for the home. A First Nation Council can
       issue a Certificate of Occupation to a member authorizing the person to
       reside on the property for two years, with possible extension to four years.
       These Certificates are generally issued requiring the person to make
       improvements to the property as set out by the Council. If the conditions
       are met, the person is given a Certificate of Possession for the property. If
       the conditions are not met, the First Nation Council can reclaim the home
       and provide it to another community member.

       When a participant has a Certificate of Occupation, repairs required to
       enable him/her to continue residing in the home are considered. If
       renovations or improvements to the property are required to obtain a
       Certificate of Possession the Ministry does not provide for the costs.

Repairs would not be provided when:

1.     The participant is paying rent or a mortgage to the Band for Canada
       Mortgage and Housing Corporation (CMHC) funded housing.

2.     The participant is leasing the home and paying rent to the person who
       holds legal title to the property.




PROVISION OF B ENEFITS               DIR 31.0 - 44                    SEPTEMBER 2001