Life-Threatening Health Needs

Overview

The ministry may provide access to medical equipment, medical supplies, or medical transportation to persons who are not otherwise eligible but who face a direct and imminent life-threatening health need and have no other resources to meet that need.  Health supplements for persons who face a direct and imminent life-threatening health need may be provided to:

  • BC Employment and Assistance recipients who are not otherwise eligible to access medical equipment, medical supplies, or medical transportation
  • individuals not eligible for income assistance, disability assistance, or hardship assistance

Policy

Effective:  April 1, 2010

Life-threatening health needs is a category of clients who are not otherwise eligible to access medical equipment, medical supplies, or medical transportation and are facing a direct and imminent life-threatening health need.

The life-threatening health needs category may be considered for:

  • BC Employment and Assistance recipients who are not otherwise eligible to access medical equipment, medical supplies, or medical transportation
  • BC residents not eligible for income assistance, disability assistance, or hardship assistance

A person is considered eligible as a life-threatening health needs client if the ministry is satisfied that all of the following criteria are met:

  • the person’s family unit is receiving any level of Medical Services Plan (MSP) premium assistance through the Ministry of Health  
  •  the medical equipment, medical supplies or medical transportation is necessary to meet a direct and imminent life-threatening health need based on information provided by a medical practitioner or nurse practitioner
  • there are no other resources available to the person to meet that need
  • Once approved as a life-threatening health needs client, the client must meet the eligibility criteria and follow the procedures outlined for the specific supplement that has been requested. 

Effective:  April 1, 2010

In order to be considered as a client with a life-threatening health need, the person’s family unit must be receiving any level of MSP premium assistance through the Ministry of Health.   Each time a person requests an item as a client with a life-threatening health need, receipt of MSP premium assistance must be verified.

Effective:  April 1, 2010

By regulation, the ministry is the payer of last resort.  All other resources should first be considered when determining eligibility. Other resources include (but are not limited to) meeting health-related needs or accessing funding through:

  • other government programs (e.g., PharmaCare, Health Authorities, ICBC, WorkSafeBC, Veterans Affairs Canada)
  • private insurance
  • charitable organizations (e.g., Red Cross Loan Cupboard)
  • family and friends
  • Publicly subsidized residential care facilities (when it is the client’s place of residence). Clients living in facilities funded by the Ministry of Health (MoH) are not eligible for medical equipment from the ministry.  These needs must be met through the facility.  Facility staff should be contacted to determine the funding source.

In addition, individuals who are not ministry clients must use assets in excess of the Persons with Disabilities asset limits [see Rate Table – Assets] before they will be eligible under life-threatening health needs.  Assets considered include (but are not limited to) cash balances, RRSPs and non-discretionary trusts.

Note: Bank loans, lines of credit and credit cards are not considered assets for the purposes of determining eligibility under life-threatening health needs.

If there are other resources available, the person will not be eligible under life-threatening health needs.  Co-funding may be considered when other available resources cannot pay the entire cost.

Effective:  April 1, 2010

Health supplements available to persons who face a direct and imminent life-threatening health need are strictly limited to:

  • medical equipment
  • medical supplies
  • medical transportation

The provision of eligible supplements is restricted to the specific item approved and must be necessary to address a direct and imminent life-threatening health need.

Effective:  April 1, 2010

A direct and imminent life-threatening health need refers to an immediate need for medical equipment, medical supplies, or medical transportation in situations where, verified by a medical practitioner or nurse practitioner, without the specific supplement, the person’s life is at risk.

Staff may consult with their management to determine what constitutes a direct and imminent life-threatening health need if necessary.  [see Authorities and Responsibilities]

Examples where a need may be considered a direct and imminent life-threatening health need:

Medical Equipment

  • A person with a severe sleep apnea and a serious heart condition requests a continuous positive airway pressure device.  Without the device, the person will likely suffer heart failure during sleep.

Medical Supplies

  • A person with infected 3rd degree burns requests burn treatment garments.  Without the garments, the infection will risk the person’s life.

Medical Transportation

  • A cancer patient requires transportation for chemotherapy.  Without the transportation, the person will not receive necessary treatment for the cancer that will risk the person’s life.

Examples where a need may not be considered a direct and imminent life-threatening health need:

Medical Equipment

  • A person is requesting a cane.  Without the cane, the person takes longer to accomplish day-to-day activities.  The person’s life is not directly and immediately at risk without the cane.

Medical Supplies

  • A person is requesting acetaminophen (Tylenol) to address headaches.  This person would not be eligible because:
    • acetaminophen is not an eligible item under medical supplies provided by the ministry, and
    • the person’s life is not directly and immediately at risk without acetaminophen.

Medical Transportation

  • A person requests medical transportation so that they are able to attend a routine visit with their medical practitioner or nurse practitioner.  This person would not be eligible because:
  • the person’s life is not directly and immediately at risk without the routine visit with their medical practitioner or nurse practitioner, and
  • routine visits with a medical practitioner or nurse practitioner are not considered extraordinary under the medical transportation policy.

Procedures 

Effective:  April 1, 2010

To assess eligibility for a health supplement for persons with a life-threatening health need (LTHN), follow these steps:
 

  1. Ensure that the client requesting medical equipment, medical supplies, or medical transportation has provided detailed medical information from a medical practitioner or nurse practitioner indicating all of the following:
  • what is the direct and imminent threat to the client’s life
  • which supplement (within medical equipment, medical supplies, or medical transportation) is required to meet the client’s need
  • how would this supplement prevent the direct and imminent threat to their life
  1. Complete a financial assessment detailing the current income and assets available to the client. 
  • If the applicant is an existing client, a re-application can be done to  note details.
  • If the person is not receiving assistance, complete a Self Serve Assessment and Application and note details.  Have the person sign an HR0080 and HR0080A to allow the ministry to verify and obtain information to confirm eligibility. 
  1. Determine if the non-client, or applicant, is in receipt of MSP Premium Assistance.  For clients, assume they are in receipt of MSP Premium Assistance if they qualify for MSP.  Proof of eligibility for premium assistance is required in order to be eligible for supplements under LTHN.  To confirm MSP Premium Assistance coverage, contact the Ministry of Health.
     
  2. Determine if the applicant or client has other available resources.  There must be a clear indication that no funding sources are available, including medical insurance coverage.  Other resources include (but are not limited to) meeting health-related needs or accessing funding through:
  • other government programs (e.g., PharmaCare, Health Authorities, ICBC, WorkSafeBC, or Veterans Affairs Canada)
  • private insurance
  • charitable organizations (e.g., Red Cross Loan Cupboard)
  • family and friends
  • Publicly subsidized residential care facilities (when it is the client’s place of residence). Clients living in facilities funded by the Ministry of Health  (MoH) are not eligible for medical equipment from the ministry.  These needs must be met through the facility. Facility staff should be contacted to determine the funding source.
  1. Individuals who are not ministry clients must use assets in excess of the PWD asset limits (see Rate Table – Assets) before being eligible under life-threatening health need.  Assets considered include (but are not limited to) bank accounts, RRSPs and non-discretionary trusts.

    If the individual has assets over the allowable asset level for a PWD designated family unit, deduct the allowable asset amount from the available amount to determine the amount of contribution to be made.

    Note: Bank loans, lines of credit and credit cards are not considered assets for the purposes of determining eligibility under life-threatening health need.

    If there are other resources available, the person is not eligible for assistance through the ministry.  Co-funding may be considered when other resources cannot pay the entire cost.
     
  2. Run the Assisted Eligibility tool
  3. Determine if the LTHN is for a one-time issue or if it is an ongoing need. 
  4. Ensure that only the determined need is addressed. 
  5. Obtain the appropriate approval.  [see Authorities and Responsibilities]
  6. Ensure the recipient meets the eligibility criteria and follow the procedures outlined for the specific health supplement that has been requested:

Related Links – Medical Equipment and Devices Related Links – Medical Supplies

Related Links – Medical Transportation

Related Links – Medical Equipment – Orthoses

Effective:  April 1, 2010

When providing ongoing health supplements for life-threatening health needs, follow the procedures outlined for the specific health supplement and perform eligibility reviews by confirming:
 

  • the person resides in BC and is in receipt of MSP premium assistance;
  • availability of assets – any amount over the PWD applicable asset level should be applied to the item requested for non-client applicants
  • medical practitioner or nurse practitioner or verifies that the medical condition is the same or worse and still requires assistance to meet a direct and imminent life-threatening health need.

Authorities and Responsibilities

April 2, 2012

Health Supplements for Persons With a Life-Threatening Health Need

EAW

  • Verifying that the person’s family unit is receiving MSP premium assistance through the Ministry of Health
  • Verifying that there are no other resources available to the person to meet that need
  • Verifying that documentation from a medical practitioner or nurse practitioner confirms that the requested item(s) is necessary to meet a direct and imminent life-threatening health need. The documentation must also clearly describe how the supplement will meet the need and for how long the supplement will be needed. 

Manager

  • Reviewing the medical documentation and verifying with the medical practitioner or nurse practitioner how the supplement will meet the need and for how long the supplement will be required.
  • Approving equipment or supplies up to $500
  • Approving the medical transportation supplement to travel within BC
  • Determining what constitutes a direct and imminent life-threatening health need (consulting with HAB when necessary).

Director

  • Approving the medical transportation supplement to travel within Canada.

Health Assistance Branch

  • Assessing eligibility for medical supplies for requests over $500
  • Assessing eligibility for medical equipment for requests over $500
  • Assisting staff , when required, in determining what constitutes a direct and imminent life-threatening health need.

A summarized Authority Level matrix is available in Resources for Staff.