Advocacy Access Help Sheet 7 BC Disability Benefits	Download PDF English
Health Supplements for People with Disabilities
This Help Sheet funded by the Legal Services Society of BC, Human Resources and Skills Development Canada: Homelessness Partnering Strategy and the Health Sciences Association of British Columbia.
In This Sheet Who is eligible Medical Services Only (MSO) Direct and Life-threatening health need Health supplements: what you may be able to obtain Dental Other Diet & nutrition Right to Appeal		The Help Sheet series is prepared by BCCPD's Advocacy Access program.

If you have a disability, you may be able to access a range of medical services and supplies provided by the Ministry of Social Development (MSD). The BC Coalition of People with Disabilities has prepared this Help Sheet about health supplements to help you understand what services and supplies you may be eligible for from MSD.

You should talk to MSD about any of the services and supplies listed here. They will be able to explain how you apply for them.

It is important to understand that the MSD will not reimburse you for any of these services and supplies. The Ministry must provide authorization for most of the supplements listed in this Help Sheet before you may access them. Also, you may be asked if you can afford to pay for them yourself before they are provided to you.

Who is eligible

You may be eligible for a range of health supplements from the MSD if any of the following describes your situation:

• You are receiving the Persons with Disabilities (PWD) benefit
• You are a dependent of a person receiving PWD
• You are a single person receiving the Persons with Persistent and Multiple Barriers to employment (PPMB)
• You are living in a household where one or more adults receive PPMB
• You live in a special care facility or if you have been admitted to hospital for extended care
• You are the dependant of a person in special care

Medical Services Only (MSO)

You will be eligible for health supplements from MSD, if you fit into any of the following categories:

• you went off PWD benefits for employment and you are receiving Medical Services Plan (MSP) Premium Assistance
• you were receiving PWD or PPMB benefits and have turned 65, and you are eligible to receive the Guaranteed Income Supplement or federal Spouse’s Allowance
• you were receiving PWD benefits, but leave the program because your CPP disability benefits are higher than the PWD rate
• you were  receiving MSO benefits prior to 2002

However, you will not be able to access:

• diet supplement
• Monthly Nutritional Supplement
• natal supplement, or
• orthodontics

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Direct and imminent life-threatening health need

MSD may grant certain health supplements–medical supplies, medical equipment and devices, medical transportation–even if you do not normally qualify for health coverage, when the following conditions apply:

• you are facing a direct and imminent life-threatening need
• you have no other resources to meet that need
• you are receiving MSP Premium Assistance, and
• you meet all the regulatory requirements for the medical supplies, medical equipment
• or medical transportation

If you are still not sure whether you are eligible for health supplements from the MSD, contact MSD or an advocate.

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Health Supplements: what you may be able to obtain

There are different kinds of health supplements. Some require no pre-approval from the MSD. These are:

• Medical Service Plan (MSP)*
• Prescription drugs covered by Pharmacare*
• Eye glasses every 3 years for adults, with a prescription, or every year for dependent children*

*Everyone on income and disability assistance is entitled to this coverage.

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Dental supplements

Basic dental services

These services are provided based on a Schedule of Fee Allowances and are administered by Pacific Blue Cross. MSD pays only for the services listed in this schedule, at the amount listed. Dentists may charge an extra fee, if they think the MSD rate is not sufficient

• Adults are entitled to basic dental coverage of $1,000 over a 2-year period
• Dependent children receive $1,400 basic dental coverage over a 2-year period

Other dental supplements

• Crown and bridgework supplement: may be provided if your dental condition cannot be corrected  by basic dental services and it has been confirmed that you are unable to use a removable denture for major health reasons.
• Dentures: full and partial dentures may be provided or replaced if certain conditions are met. These conditions include whether you have had extractions in the past 6 months or whether you have been on assistance for at least 2 years. MSD can pay more than the basic dental coverage limit of $1,000 for dentures, in some cases. Generally, MSD will not pay for replacement dentures more than every 5 years, however, Health Assistance Branch may approve an exception to the 5-year rule, if loss or damage was beyond your control and new dentures are necessary to avoid health problems.
• Emergency dental and denture services for immediate relief of pain or to control infection or bleeding or other serious health problems may be provided.
• General anaesthetic or intravenous sedation provided in a dentist’s office may be authorized in special circumstances.
• Orthodontic services may be covered when strict eligibility requirements are confirmed by an orthodontist.

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Other health supplements

You should talk to MSD about the supplements listed below. To qualify for them, you may be required to supply medical information. Some of them also require you to provide financial information.

Optical

Eye Exams

MSD pays up to $44.83 for an optometrist’s exam and $48.90 for an opthamologist’s exam, every 2 years. To obtain an eye exam, you will need to provide your optometrist or opthamologist with your Care Card. The MSP may pay the full cost for an exam, if you have a particular medical condition. As well, you may be able to get an exam more often than every 2 years. Check with your opthamologist or optometrist to see if you qualify.

Basic Eyewear

• MSD may provide single vision or bi-focal lenses and frames every 3 years for adults or once a year for children, with a valid prescription.
• Eyeglass lenses more frequently than every 3 years: Your physician must confirm that you have a specific medical condition such as, for example, diabetes and your opthamologist or optometrist must confirm that you need a new prescription.
• Eyeglass repairs.
• Specialized eyewear, such as tinted lenses or contact lenses, if basic eyewear does not meet your needs. The need for the eyewear must be confirmed by your opthamologist or optometrist and pre-authorized by Health Assistance Branch.

Medical supplies

MSD may pay for medical or surgical supplies, if they are required for any of the following purposes:

• wound care
• ongoing bowel care
• catheterization
• incontinence
• skin parasite care
• limb circulation care

These supplies must be prescribed by a doctor or nurse practitioner, the least expensive appropriate supplies, and necessary to avoid an imminent and substantial danger to health. And, there must be no other resources available to you. MSD does not consider nutritional items or prescription drugs medical supplies.

Medical equipment and devices

MSD can pay for certain medical equipment or devices, if the following conditions are met:

• payment is approved in advance by the Ministry
• there are no other resources available
• the equipment is the least expensive appropriate medical equipment

In most situations, MSD will ask for a prescription from a doctor or nurse practitioner and/or an assessment from a health professional, such as an occupational therapist or physical therapist.

MSD can purchase or replace equipment, but they do not have to replace or repair equipment that they consider to be damaged through misuse.

MSD can pay for the following equipment and devices: [*Please note changes to Ministry policy in August 2011 regarding coverage of orthoses, in #10 below. Changes noted in bold text.]

1. canes, crutches, and walkers
2. wheelchairs
3. wheelchair seating systems
4. scooters
5. bathing and toileting aids
6. hospital beds
7. pressure relief mattresses
8. floor or ceiling lift devices
9. positive airway pressure devices (eg. CPAP machines)
10. orthoses (custom made or off-the-shelf foot orthotics, custom made footwear, a permanent modification to footwear, off-the-shelf orthopaedic footwear, an ankle brace, an ankle-foot orthosis, a knee-ankle-foot orthosis, a knee brace, an upper extremity brace, a cranial helmet, a torso or spine brace).
11. hearing aids

For some of the above categories of equipment and devices, MSD has also imposed additional restrictions such as spending limits (e.g. they will not pay more than $3,500 for a scooter) and replacement time limits (they will not replace a wheelchair for at least 5 years).

Extended therapy

Acupuncture, chiropractic, massage therapy, naturopathy, physiotherapy or podiatry visits: A physician must confirm that you have an acute need for the service. You must have used the 10 visits allowed under the Medical Services Plan. The Ministry can approve up to 12 extra visits in a 1-year period.

Medical transportation

If you have no other means of getting to a medical appointment, the Ministry can pay for transportation costs to a doctor’s office, clinic or hospital. The Ministry must agree to cover these expenses before your appointment. MSD can pay for transportation, meals and accommodation, if the only available medical treatment is at an out-of-town medical facility.

Alcohol and drug treatment supplement

Up to $500 a year can be paid to cover the cost of alcohol and drug counselling, and treatment services.

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Monthly diet supplements

There are 9 monthly diet supplements you may be eligible for. There is no special application form for these supplements. To qualify, your doctor must state your medical condition in writing, the kind of diet you require and how long you need it. MSD can ask you to renew the request every 12 months or 24 months. Because MSD will only pay for one diet supplement at a time, apply for the highest diet allowance you think you are eligible for.

The supplements and their special requirements are as follows:

1. High protein diet: You may be eligible for a monthly high protein diet supplement of $40 a month. In order to qualify, your physician must say that you have 1 or more of the following conditions:

• Cancer (if you are receiving therapy or medical treatment)
• Chronic bacterial infection
• Chronic inflammatory bowel disease
• Crohn’s disease
• Hepatitis B or C
• HIV/AIDS
• Hyperthyroidism
• Osteoporosis
• Tuberculosis
• Ulcerative colitis

You may also qualify for a supplement, if your physician, dietician, or nutritionist state that you need either of the following:
2. Gluten-free diet ($40 per month)
3. Low-sodium diet ($10 per month)
4. Ketogenic diet ($40 per month)
5. Phenylalanine diet ($40 per month)

Or, if you have one of the following conditions:
6. Cystic fibrosis ($50 per month)
7. Diabetes ($35 per month)   
8. Dysphagia ($40 per month)
9. Kidney dialysis ($30 per month)


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Monthly Nutritional Supplement (MNS)

You may be eligible for a monthly nutritional supplement of up to $205 a month, if you are receiving PWD–people receiving PPMB are not eligible. The nutritional supplement is divided into 2 parts for a total of $205 a month:

1. Nutritional items: $165. This part of the benefit will only be provided if you need to supplement your regular diet. You cannot receive both this supplement and a diet supplement (e.g. high protein diet).
2. Vitamin or mineral supplementation: $40.

To receive the nutritional allowance you must have a chronic and progressive deteriorating condition causing at least 2 of the following symptoms:

• Significant deterioration of a vital organ
• Immune suppression (moderate to severe)
• Malnutrition
• Significant muscle mass loss
• Significant neurological degeneration
• Significant weight loss
• Underweight status

To qualify for the nutritional items or the vitamin/mineral supplementation, your doctor must state that you need each of these supplements to alleviate your identified wasting symptoms and to prevent t an imminent danger to your life. This means your health will deteriorate significantly without the nutritional supplement. Contact MSD and ask for a Monthly Nutritional Supplement application form. Ask your doctor to complete the form, and return it to MSD.

MSD can require you to re-apply for the MNS.

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Short term nutritional supplement

Provides nutritional supplementation products, such as Ensure or Boost, for a 3-month period. Your doctor must confirm an acute short-term need for a caloric (nutritional) supplement to prevent critical weight loss resulting from 1 of the following:

• Serious disease
• Severe injury
• Surgery
• Treatment side effects

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Natal supplement

If you are pregnant, you will be eligible for a natal allowance during your pregnancy and until your child reaches 7 months of age. To qualify for this allowance, you must provide documentation from a medical practitioner or a midwife registered with the College of Midwives. You will receive:

• $45 a month, if you are pregnant with one child
• $90 a month, if you are pregnant with more than one child

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Infant formula

MSD can also provide infant formula for children under 12 months of age if:

• a child has a medical condition where a specialized infant formula is required, or
• the child is at risk of contracting a transmittable disease from the mother’s breast milk.

Tube feed nutritional supplement

MSD can provide nutritional products to people whose primary source of nutrition is through tube feeding.

Right to appeal

If your application for any of these health goods and services is denied you have the right to appeal. Contact MSD immediately after you receive your denial. You may want to ask an advocate to help you with your appeal

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