The least expensive, appropriate medical or surgical supplies may be provided to eligible clients in order to avoid an imminent and substantial danger to health.
Medical supplies are available under the Employment and Assistance Regulation and Employment and Assistance for Persons with Disabilities Regulation.
Effective: August 28, 2018
Medical or surgical supplies are provided only to clients who are eligible for general health supplements. [see Related Links - Health Supplement Summary]
Medical or surgical supplies may be provided to eligible clients when the ministry is satisfied that all of the following requirements are met:
Clients are responsible for providing required documentation. The ministry is not responsible for any fees associated with documentation.
Medical supplies may be approved for the period of time indicated on the prescription as long as eligibility criteria are met. Unless changes are needed to their list of supplies or there is a change to their eligibility, the supplies renew each year on their birthday and the recipient can continue to place their order through the Product Distribution Centre (service provider for most medical supplies).
If the client is requesting a new item or there is a significant quantity change for an existing approved item, an updated prescription which includes medical justification for an increase or new item will need to be provided.
[For information on medical supplies required for clients in receipt of the tube feed supplement (for example tubes or bags) see Related Links – Tube Feed Supplement.]
No Other Resources
Effective: April 1, 2010
By regulation, the ministry requires that all other available resources must first be considered before requesting funding. For income assistance and disability assistance clients, other resources include (but are not limited to) accessing medical supplies or funding through:
If there are other resources available, the individual is not eligible for medical supplies from the ministry.
Co-funding may be considered when other resources cannot pay the entire cost. For example, if an insurance company will pay $500 for an item that costs $1,000, the ministry may consider funding the remaining $500 if all other eligibility criteria are met.
Note: When assessing medical supplies eligibility for income or disability assistance clients, exempt assets are not considered. When assessing other resources for persons with a life-threatening health need or persons who are medical services only, see Related Links – Life Threatening Health Need and Medical Services Only.
Effective: October 1, 2012
The following medical or surgical supplies may be considered when all eligibility criteria are met. This is a general guide and is NOT all-inclusive.
Note: Rubber gloves may be provided to either the client or a non-employed care provider when required as part of the care of the client.
Effective: April 1, 2010
The ministry does not provide medical or surgical supplies that do not meet the eligibility criteria above, including the following:
[For more information, see Related Links - Monthly Nutritional Supplement, Nutritional Supplements, or Diet Supplements.]
Effective: August 28, 2018
All requests for Medical Supplies are assessed by Health Assistance (HA).
The following procedures are to be used to determine eligibility for Medical Supplies.
Confirm that the applicant is eligible for general health supplements or assess for eligibility under life-threatening health needs [see Related Links – Life-Threatening Health Needs].
|Verify that there are no other resources available [see Policy].
Ensure that the client has provided a written prescription and diagnosis, with detailed medical justification, from a medical practitioner or nurse practitioner, including the quantities required and expected duration of the need. The Information Required - Medical letter (HR3237) may be used to request documentation from clients [see Forms and Letters].
Ensure the service request has all required documentation and is ready for adjudication, and forward to HA.
No price quotes are required.
Assess application to ensure eligibility criteria are met.
If application is approved, an approval letter will be issued to the client and Product Distribution Centre (PDC) or Service Provider. If denied, a denial letter and decision summary outlining reasons for the decision will be sent to the client.
Note: It is the client’s responsibility to contact PDC or other Service Provider to place their order.
Note details. Details include substantive reasons explaining what is requested and why the eligibility criteria are met (or not met). If the medical supplies are approved, include the cost of the medical supplies and the name of the service provider.
Medical Supplies Transition for 17-Year-Old At Home Medical Benefits Program Recipients Applying for the Persons with Disabilities Designation
When applying for the Persons with Disabilities (PWD) designation and disability assistance, youth who are aging out of the Ministry of Children and Family Development’s (MCFD) At Home Medical Benefits Program may also authorize MCFD to disclose information to Health Assistance (HA) allowing HA to assess their eligibility for ongoing medical supplies.
Consent to disclosure of information is provided when the Persons with Disabilities Designation Application – Prescribed Class (HR3642) form is completed as part of the application process for the PWD designation and disability assistance [see Forms and Letters].
Upon receipt of the HR3642 form, HA will contact MCFD to obtain a complete list of medical supplies that have been provided to the applicant as part of their coverage under the At Home Medical Benefits Program.
HA reviews this list of supplies and will provide the recipient with a letter outlining the supplies that will now be covered through the Ministry of Social Development and Poverty Reduction (SDPR). As SDPR may not cover all items previously provided by MCFD, the recipient will be advised which items cannot be approved. The recipient would then have the right to reconsideration of any items denied by SDPR.
As long as all needed documentation is received prior to the applicant aging out from the At Home Medical Benefits Program, SDPR makes every attempt to provide the applicant with a copy of their PWD Designation approval and their Medical Supplies approval letter prior to their benefits stopping with MCFD.
Product Distribution Centre would continue to be the provider of these medical supplies.
[For more information on the application process for PWD designation, see Related Links – Designation Application.]