Medical Services Only

Effective:  January 1, 2020

The ministry provides Medical Services Only (MSO) coverage to assist former recipients to maintain access to specific health supplements when they no longer qualify for  income assistance (IA) or disability assistance (DA) due to income in excess of assistance rates.

MSO coverage is only available to certain categories of former recipients who meet specific eligibility criteria. To be eligible for MSO coverage, a family unit must:

1.Include at least one of the following persons on the date the family unit ceases to be eligible for IA or DA (continuation date):

• IA family units, must include a qualifying person.  A qualifying person is either:
  • a person with persistent multiple barriers, or
  • a recipient residing in a special care facility
• DA family units, must include a person with the  Persons with Disabilities (PWD) designation;

Note: this person is referred to in regulation as the main continued person

2. Cease to be eligible for IA or DA for one of the reasons outlined in Table 1 or 2 below; and

3. Meet the applicable income test for the family unit. 

Table 1: MSO Eligibility – Income Assistance
MSO Eligibility Criteria	Income Test	Period of Coverage
A family unit containing either: a PPMB, or a person residing in a  special care facility, that ceases to be eligible for income assistance because a person in the family unit is age 65 or older	If all persons in the family unit are over age 65, family unit must be in receipt of a qualifying federal benefit If any person in the family unit is under age 65, family unit’s annual adjusted net family income does not exceed $42,000 (the income test for MSP supplementary benefits)	As long as eligibility criteria and income test are met
A family unit containing either: a PPMB, or a person residing in a  special care facility, that ceases to be eligible for income assistance as a result of an award from Crime Victim Assistance
A family unit containing either: a PPMB, or a person residing in a  special care facility, that ceased to be eligible for income assistance due to receiving a lump sum payment as part of the CPP mediated class action settlement agreement	No income test	Retains MSO coverage indefinitely
Persons who were designated MSO under BC Benefits (prior to 2002)

 

Table 2: MSO Eligibility – Disability Assistance
MSO Eligibility Criteria	Income Test	Period of Coverage
A family unit in receipt of disability assistance that ceases to be eligible for disability assistance because a person in the family unit is age 65 or older	If all persons in the family unit are over age 65, family unit must be in receipt of a qualifying federal benefit If any person in the family unit is under age 65, family unit’s annual adjusted net family income does not exceed $42,000 (the income test for MSP supplementary benefits)	As long as eligibility criteria and income test are met
A family unit in receipt of disability assistance that ceases to be eligible for disability  assistance as a result of a pension or other payment under the Canada Pension Plan (CPP)	If all persons in the family unit are over age 65, family unit must be in receipt of a qualifying federal benefit If any person in the family unit is under age 65, family unit must be in receipt of a pension or other payment under the CPP	As long as eligibility criteria and income test are met
A family unit in receipt of disability assistance that ceases to be eligible for disability assistance as a result of employment income	If all persons in the family unit are over age 65, family unit must be in receipt of a qualifying federal benefit If any person in the family unit is under age 65, family unit’s annual adjusted net family income does not exceed $42,000 (the income test for MSP supplementary benefits)	As long as eligibility criteria and income test are met
A family unit in receipt of disability assistance that ceases to be eligible for disability assistance as a result of family maintenance income
A family unit in receipt of disability assistance that ceases to be eligible for disability assistance as a result of an award from Crime Victim Assistance
A family unit in receipt of disability assistance that ceases to be eligible for disability assistance as a result of financial assistance provided under the Ministry of Children and Family Development’s Agreements with Young Adults.	No income test	Retains MSO coverage for the duration of their agreement
A family unit in receipt of disability assistance that ceased to be eligible for disability assistance due to receiving a lump sum payment as part of the CPP mediated class action settlement agreement	No income test	Retains MSO coverage indefinitely
Persons who were designated MSO under BC Benefits (prior to 2002)

Note: As of January 1, 2020, the income test policy for some categories of MSO coverage changed. This was due to the elimination of MSP premiums and premium assistance programs. There was no impact to clients as the actual income level did not change.

A family unit may have more than one source of income that makes them eligible for MSO. Where a family unit has a combination of income, only one of which makes them eligible for MSO, the family unit is still eligible for MSO at the time they are no longer receiving assistance.

For example: A PWD family unit received income from two sources: monthly ICBC settlement payment and employment.  The total income received is over disability assistance rates.  As the family unit reported employment income, they would qualify for MSO coverage. 

Dependants on MSO cases

All adults and children on the MSO case on the continuation date receive access to MSO coverage as long as they remain a dependant.  In regulation, they are referred to as a dependent continued person.

Under the EA regulation and for the purposes of eligibility for MSO for a family unit receiving income assistance, a dependent continued person is a person who was:

• a dependant of a main continued person on that main continued person’s continuation date, and
• is currently a dependant of that person.

Under the EAPWD regulation and for the purposes of eligibility for MSO for a family unit receiving disability assistance, a person is a dependent continued person if:

• the person was a dependant of a main continued person, who left DA because a person in the family unit was age 65 or older, on that main continued person’s continuation date and is currently a dependant of that person, or
• the person is a dependant of a main continued person as a result of having been part of a family unit who ceased to be eligible for DA as a result of income from the following sources:
  • Canada Pension Plan
  • Employment
  • Family Maintenance
  • Crime Victim Assistance
  • MCFD’s Agreements with Young Adults

Failing to meet the income test

If family unit no longer meets the applicable income test, they may continue to receive MSO coverage for one year from the date they became ineligible for MSO [For more information, see Procedures]. 

Residency and MSO eligibility

As assistance can only be provided to residents of BC, MSO coverage ceases if an individual or family unit takes up residence outside BC. If a person or family unit subsequently re-establishes residency in BC, they would have to complete a reapplication to determine ongoing eligibility for MSO coverage.

Recipients leaving Hardship Assistance are not eligible for MSO [see Related Links – Eligibility for Hardship Assistance].

Effective: January 1, 2020

Clients eligible for Medical Services Only (MSO) may have access to only the following health supplements provided that they meet the eligibility criteria of the specific supplement [see Related Links]:
 

• medical supplies
• medical equipment and devices
• dental services
• optical (basic eyewear and repairs)
• eye examinations (if not already covered by MSP)
• infant formula supplement
• extended medical therapies
• medical transportation
• Medical Services Plan (MSP) coverage  
• No deductible PharmaCare coverage
• tube feed supplement (if the person is in receipt of the tube feed supplement at the time their family unit transitions to MSO)
• alternative hearing assistance supplement

Effective:  April 30, 2010

Persons with MSO cases are not eligible for any of the following (this list is not all-inclusive):
 

• diet supplements
• monthly nutritional supplement
• nutritional supplements (except infant formula)
• tube feed supplement (if the person is not in receipt of the tube feed supplement at the time their family unit transitions to MSO)
• natal supplements

Effective:  January 1, 2020

Recipients of Medical Services Only (MSO) who are requesting income assistance, disability assistance or hardship assistance may apply for assistance as follows:

• If they have not received income assistance in any of the preceding six months, complete an application by using the Eligibility Review process and signing an HR0080R.
• If they have received income assistance in any of the preceding six months, and their file is open, the ministry has discretion to use either the streamlined reapplication process, or where needed the, Eligibility Review process and signing an HR0080R. 

 [For more information, see Related Link – BCEA Streamlined Application (Returning within Six Months)]

Recipients of MSO who left disability assistance due to employment income (exhausting their annual earnings exemption) should continue to submit monthly reports in order for the ministry to re-establish their eligibility for disability assistance.  MSO recipients may again be eligible for disability assistance at any time during the year if their financial circumstances change due to a loss of employment or a reduction in income, or at the beginning of the new exemption year, as they may be eligible for assistance with a new annual earnings exemption limit. [For more information, see Related Links - BCEA Application - Stage 1 – Prospecting - Medical Services Only Clients Requesting Assistance]. 

[For more information, see Related Links – Eligibility Review]

Effective:  January 1, 2020

To maintain an eligible  family unit’s access to  health supplements (for example, Medical Services Plan, PharmaCare, dental, and optical) when they are no longer receiving assistance, the  case must remain open as an MSO case. Family units may continue to be eligible for MSO depending on the reason they are no longer receiving assistance and as long as they meet the eligibility criteria and applicable income test.

To initiate a recipient’s MSO coverage, follow these steps:
 

1. Record the income amount and source on the system.
2. If recipient is eligible to continue receiving Transportation Supplement, ensure cheque production remains on [for more information, see Related Links – Transportation Supplement].
3. Mail the MSO Notification letter HR3317 or HR3317B [see Forms and Letters].
4. Update the case by adding the appropriate MSO reason code.
5. Set the MSO review date based on the applicable MSO review timelines (see Table 1). 
6. If the case includes a person in receipt of the Tube Feed supplement, select the appropriate corresponding value with “Tube Feed” in the title.
7. A family unit may have more than one source of income that makes them eligible for MSO. When this occurs, select the highest applicable MSO reason code according to the hierarchy in Table 1.
8. For One Year Transition cases, clients will retain eligibility for a 12-month period of transition. At the end of the 12-month period the MSO case will need to be reviewed to confirm that they are no longer eligible, and if so, the case closed. Every effort must be made to ensure the client is advised of this time frame.
9. Profile appropriate documentation to the client’s case.

Table 1
Value (LOV)	MSO Client Reason	MSO Review Date
Leaving Fed Benefits 65+	Persons with the PWD designation, PPMB, or persons receiving special care, who leave income assistance or disability assistance at age 65 or older	10 years
Tube Feed Fed Bens @ age 65+
PWD < 65 Leaving CPP Benefits	Persons with the PWD designation who are under age 65 who leave disability assistance for a pension or other payment under the Canada Pension Plan (CPP)	Review date should be equal to 10 years or when age reaches 65 years (whichever comes first) (then every 10 years after that)
Tube Feed PWD under 65 CPP
PWD < 65 Leaving Employment	Persons with the PWD designation who are under age 65 who leave disability assistance for employment and/or family maintenance income	12 months
Tube Feed under 65 Emp
Under 65 Crime Victims Asst	Persons with the PWD designation, PPMB, or persons receiving special care who are under age 65 who leave income assistance or disability assistance for Crime Victim Assistance	Review date should be equal to 10 years or when age reaches 65  years (whichever comes first) (then every 10 years after that)
Tube Feed Under 65 CVA
PWD Agmts with young adults	Persons with the PWD designation who leave disability assistance for the Ministry of Children and Family Development’s Agreements with Young Adults	Up to 12 months (depending on length of  agreement)
Tube Feed PWD agmt young adult
MSO transition from BCB	Persons who were designated MSO under BC Benefits (prior to BCEA 2002)	Review date should be equal to 10 years or when age reaches 65  years (whichever comes first) (then every 10 years after that)
One Year Transition	Ineligible for MSO – One year transition from the date they became ineligible for MSO as a result of not meeting income test Note: Not be used for new MSO cases.  Only to be used when case is switched from another MSO reason	12 months

Effective: January 1, 2020

To assess eligibility for a health supplement for persons with MSO coverage, follow these steps:

EAW	1.	Verify continued eligibility for MSO coverage by reviewing the eligibility criteria and update the case if necessary. Take the opportunity to update the address and record income amount and source on the system.
	2.	Verify family unit meets applicable income test [see Policy – Eligibility for Medical Services Only]. Example: MSO reason: A family unit in receipt of disability assistance (DA) that ceases to be eligible for disability assistance as a result of employment income Income test to determine ongoing eligibility for MSO coverage: If any person in the family unit is over age 65, family unit must be in receipt of a qualifying federal benefit Confirm family unit is receiving federal OAS/GIS or Allowance If any person in the family unit is under age 65, family unit’s annual adjusted net income must be less than $42,000 (equivalent to the income test for MSP supplementary benefits) Use MSP Supplementary Benefits Application - Eligibility Calculator to determine if they may be eligible [see Additional Resources]. Use information provided by the client (e.g., last year’s Notice of Assessment from Canada Revenue Agency) and/or tax data from the ministry’s systems to complete eligibility calculator. Note: Ministry staff are not making the determination of eligibility for Federal Benefits or MSP supplementary benefits. Staff should refer the clients to Service Canada or Health Insurance BC (HIBC) if they have questions related to those benefits.
	3.	If the family unit does not meet the applicable income test, then they would be eligible for transitional MSO coverage for 12 months from the date of this determination. [see table 1 above] Any time a health supplement is requested during the 12 month transitional MSO coverage period the income test should be completed to determine if any circumstances have changed which would make them eligible again for ongoing MSO coverage or if their period of transition coverage has ended.
Health Assistance Adjudicator	4.	If the client has MSO coverage, they must still meet the eligibility criteria for the specific health supplement that has been requested. To determine eligibility, follow the procedures outlined: Related Links – Medical Services Plan and Medical Coverage Related Links – Dental and Orthodontic Services  Related Links – Optical Services Related Links – Medical Equipment - Hearing Instruments Related Links - Medical Equipment & Devices Related Links – Medical Equipment – Breathing Devices Related Links - Medical Equipment - Orthoses Related Links - Medical Supplies Related Links – Medical Transportation Related Links - PharmaCare Related Links – Extended Medical Therapies Related Links – Nutritional Supplements (Infant Formula Supplement) Related Links – Tube Feed Supplement Related Links – Alternative Hearing Assistance Supplement

Answer   On June 30, 2002, CVA, governed by the CVA Act, replaced the CICA which had been administered by the Workers' Compensation Board. The change in legislation restructured benefits to be more responsive to the immediate and long-term needs of victims and other claimants. Based on a financial assistance model, the CVA helps victims, immediate family members and eligible witnesses with the costs associated with the victimization rather than providing compensation for pain and suffering. The CVA replaces the wage-loss benefit scheme in order to provide income support across a broader range of victims, including caregivers, children, students and others who for various reasons were not attached to the work force at the time of their injury.

Answer    Yes, if the spouse was the dependent spouse on the case, a new case with MSO status will need to be opened. If the surviving spouse does not meet the criteria for MSO, they would be eligible for one year of MSO coverage from the date that they became ineligible

Answer     Yes. The case would be switched to MSO and the appropriate reason code added.

Answer     No. Only cases that are eligible for  health supplements on the date they became eligible for MSO will qualify as an MSO client.

Answer     When verifying the MSO client’s financial circumstance, it is necessary that staff note the amount of income/assets and the source(s) of the income/assets on the system and scan and profile the supporting documentation to the system. Staff should use the opportunity to keep the case up to date by verifying the address, telephone number and dependant information.

Answer     No, the system will not recognise this change. Staff will review cases turning 65 and update the MSO reason code accordingly.