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

Note: As of January 1, 2020, the income test policy for life threatening health needs coverage changed. This was due to the elimination of MSP premiums and premium assistance programs.  There was no impact to applicants as the actual amount of the income threshold did not change.

Policy

Effective:  January 1, 2020

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 must have an annual adjusted net income of $42,000 or less.  This is the same income threshold used to determine eligibility for Medical Services Plan (MSP) supplementary benefits
  •  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: January 1, 2020

To be eligible for coverage under the life-threatening health needs (LTHN) supplement, the person must meet the applicable income test.  To qualify, the person’s family unit must have an annual adjusted net income (ANI) of $42,000 or less.   The calculation used to establish the ANI is the formula used to determine eligibility for Medical Services Plan (MSP) supplementary benefits. It’s based on the person’s annual net income from the previous year as confirmed by the Canada Revenue Agency (CRA) (or combined net income for them and their spouse), less deductions for:

  • age (and the age of spouse);
  • family size;
  • disability; and
  • any income from the Universal Child Care Benefit and Registered Disability Savings Plan.

The amount left is called “adjusted net income.” If it is less than $42,000, the person’s family unit may qualify for a supplement under LTHN.  [For more information on the income test used and MSP supplementary benefits, see Contacts].

Verification of financial eligibility must be completed each time a person requests an item under the life-threatening health needs coverage.

Effective:  April 1, 2010

By regulation, the ministry requires that 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.

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:  January 1, 2020

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

EAW

1. Ensure that the person 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 persons's life
  • which supplement (within medical equipment, medical supplies, or medical transportation) is required to meet the person's need
  • how would this supplement prevent the direct and imminent threat to their life

2. Complete a financial assessment detailing the current income and assets available to the person. 

  • If the applicant is an existing recpient, a re-application can be done to  note details; however, this step is not necessary if eligibility for monthly benefits has already been established.
  • If the person is not receiving assistance (non-client), complete an Application for Assistance and note details [see Related Links - BCEA Application - Stage 1 and 2].  

3. Determine if the non-client meets the income test - annual adjusted net (ANI) family income does not exceed $42,000 (the income test for MSP supplementary benefits).  To confirm financial eligibility for non-clients:

  • use MSP Supplementary Benefits Application - Eligibility Calculator to determine ANI [see Additional Resources]
  • use information provided by the person to complete eligibility calculator (i.e.: last year’s Notice of Assessment from Canada Revenue Agency)

4. Determine if the applicant or recipient 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.

5. Individuals who are not ministry recipients 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.

6. If the applicant or recipient is eligible, forward medical information to Health Assistance.

Health Assistance

7. Determine if the person meets the eligibility criteria for the item(s) requested. Follow the procedures outlined for the specific health supplement that has been requested:

Related Links – Medical Equipment – Breathing Devices

Related Links – Medical Equipment & Devices

Related Links – Medical Equipment – Hearing Instruments

Related Links – Medical Equipment - Orthoses

Related Links – Medical Supplies

Related Links – Medical Transportation

8. Complete the appropriate decision.

Effective:  January 1, 2020

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 meets the income test;
  • 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 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

Effective: January 1, 2020

Health Supplements for Persons With a Life-Threatening Health Need

EAW

  • Verifying that the person’s annual adjusted net family income does not exceed $42,000 (the income test for MSP supplementary benefits)  
  • Verifying that there are no other resources available to the person to meet that need
  • Providing a denial decision if the person does not meet the financial criteria
  • 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. 

Health Assistance 

  • 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.
  • Determining what constitutes a direct and imminent life-threatening health need.
  • Assessing eligibility for medical equipment
  • Assessing eligibility for medical supplies
  • Assessing eligibility for medical transportation

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