Manitoba
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Employment and Income Assistance Administrative Manual

Section 22 - Health Needs

22.1.1 HEALTH SERVICES PROGRAM

Health Services provides coverage for essential drug, dental and optical supplies and services for eligible participants and children-in-care. Outlined below is a summary of benefits:

Drugs

Dental

Optical

Participants may receive drug benefits from enrolment. To receive benefits, participants must have a prescription from a physician. They can take the prescription to a pharmacy and indicate that they are receiving income assistance. Pharmacists will access the Drug Product Information Network (DPIN), which will confirm participant and product eligibility. If pharmacists cannot confirm eligibility, they will contact DPIN Help Desk staff directly at 786-8000 or 1-800-663-7774 for authorization. DPIN Help Desk staff will consult with field staff as required to determine eligibility.

Participants may receive dental services after three months of enrolment, except general assistance adults who must wait 6 months. Emergencies can be met during the waiting period. To receive benefits, participants see a dentist, or denturist, indicate they are receiving income assistance and present their Health Services card if they have one. Agreements with the Manitoba Dental Association and the Manitoba Denturists Association lists services covered and fees. All dentists and denturists have a copy of the applicable agreement. If dentists or denturists need additional authorization, they will contact Health Services staff directly at 945-8767.

Participants may receive optical supplies and services after three months of enrolment, except general assistance adults who must wait six months. Emergencies can be met during the waiting period. To receive benefits, participants see a service provider, indicate they are receiving income assistance and present their Health Services card if they have one. Service providers are aware of the services covered and fees, and the Department has an agreement with the Opticians of Manitoba. If they need additional authorization, they will contact Health Services staff directly at 945-3051.

Field staff should not authorize drug purchases.

Field staff should not authorize dental treatment.

Field staff should not authorize optical benefits.

22.1.2 HEALTH SERVICES

Health Services cards provide pre-authorization for certain dental and optical supplies and services as indicated in the agreements with dental and optical service providers. Cards are issued to most participants, except general assistance, after a three-month waiting period. The waiting period is based on the case effective date. During the waiting period, drug benefits and emergency dental and optical benefits may be covered. Requests for emergency benefits should be directed to Health Services for authorization.

A current Health Services card should be recovered from the participant when a holder is found ineligible for all income assistance, enters a care institution in which coverage is not required, or is found to be misusing the card. The card should be returned, within two weeks of cancellation to Health Services.

22.1.3 TEST OF NEED

The actual cost of essential drugs, dental and optical needs may be included in the test of need. However, when calculating an applicant's needs, staff should deduct any amounts received through other programs, such as Pharmacare. Only the net cost to the participant should be included in the test of need.

22.1.4 GENERAL ASSISTANCE PARTICIPANTS

General assistance participants are eligible for Health Services, but do not receive Health Services cards. Drug benefits and emergency dental and optical benefits may be approved from enrolment. After a six-month waiting period for adults and a three-month period for children, basic dental and optical needs may be met in accordance with the approved services and fees. To access service, participants should see an appropriate service provider who will call Health Services for authorization. Field staff should not authorize Health Services benefits.

22.1.5 PARTICIPANTS WITH ALTERNATIVE HEALTH COVERAGE

Participants who have health services coverage from an alternate source are expected to access health services from that source. Typically, the alternate source would be either a private health plan or coverage through the federal government for First Nations and Inuit peoples. Health Services cards are not issued in these cases. If a service is covered by Health Services, but not by the alternate health coverage, Health Services staff will review the request and approve as appropriate.

[SAMIN Procedure: The SAHS field in SAMIN should be coded to N and the SAHS expiry date should be left blank.]

22.1.6 HEALTH CARD ONLY

Where the applicant's resources are sufficient to meet all basic living costs, other than health care, eligibility for Health Services only may be considered. If the applicant's actual health care costs, or an allowance for health expenses of $10.00 per adult per month, exceeds the household's available resources, enrolment for Health Services may be granted. The $10.00 allowance used in the Health Services test of eligibility is never to be included in calculating of cash grants. Applicants must not be enrolled for a Health Services card unless they are eligible on a long-term basis. Health costs must be verified and averaged to reflect the ongoing need, and must be recorded on file as confirmation of eligibility.

Participants receiving SAHS or HEX benefits are also eligible to receive SAFER, SAFFR, CRISP, and 55Plus.

22.1.7 SINGLE GRANT

Where an applicant has sufficient resources to meet his or her basic monthly living costs but claims to be unable to meet the cost of an immediate health need, the participant may be eligible for a single grant. Single grants may be issued for drug, dental and optical needs, as well as medical equipment. Eligibility is determined by comparing the applicant's surplus financial resources over a six-month period to the health cost in question. If the applicant will have insufficient resources to meet the total cost of the health need, a single grant by voucher or special cheque may be issued by field staff, after consulting with Health Services staff. When calculating an applicant's needs, staff should deduct any amounts received through other programs, such as the Manitoba Health Eyeglasses Program for persons 65 years of age and over.

Single grants are not intended to cover the cost of an applicant's Pharmacare deductible. The Pharmacare program requires that all applicants pay for, without exception, a minimum annual deductible of $100.00. Although the basic deductible amount cannot be waived, should the applicant experience an annual income reduction of at least ten per cent, the applicant may contact the Pharmacare program and request a deductible recalculation using his or her current, year-to-date income level. The Pharmacare program may be reached at (204) 788-2506 (English) or (204) 788-2520 (French).

22.1.8 HEALTH SERVICES ONLY - GRANDPARENTED PARTICIPANTS

In reviewing continuing eligibility for Health Services only status, those who were enrolled in that status as of September 1, 1980, are subject to special treatment. Specifically, the eligibility of such cases for Health Services only status must not be terminated as a result of the increase and expansion of Manitoba Supplement for Pensioners (MSP) benefits which took place on September 1, 1980, and July 1, 1986, at which time the program was renamed 55 PLUS - A Manitoba Income Supplement.

22.1.9 HOSPITAL PATIENTS

Participants who are residents of general, mental health or extended treatment hospitals may be provided only, on an item-by-item basis, health services with such things as: dentures, emergency dental work outside of hospital, glasses, prosthetic/orthotic devices and emergency ambulance service. These health costs are not covered by Manitoba Health, Insured Benefits. Chiropody, physiotherapy and podiatry services provided to participants in such hospitals are the responsibility of the hospital.

22.1.10 PERSONAL CARE HOME RESIDENTS

Before authorizing health costs not covered by Manitoba Health for persons residing in personal care homes, the participant's personal account must be checked and any excess resources applied to the essential health need.

(See Section 18.3.3 Residential Care Facilities, Chronic Care Facilities, Community Residences And Personal Care Homes for EIA policy for status aboriginal persons off-reserve).

22.1.11 EXTENDED HEALTH SERVICES ASSISTANCE

Single parents and persons with disabilities who have found employment may be eligible for up to 12 months of extended Health Services. The Employment and Income Assistance Regulation provides for a monthly allowance for Health Services costs, calculated as the greater of:

  • $50.00 per person to a maximum of $150.00 per family; or
  • the average Health Services costs for the three months in which these costs were the highest during the past 12-month period.

To be eligible for this extended assistance, participants must:

  1. have employment income as defined by the program, (i.e., income that is subject to earnings exemption), this would exclude such income as training allowances, employment insurance benefits and CPP benefits;
  2. continue to be categorically eligible as a single parent or an individual with disabilities; and
  3. continue to be financially eligible when assistance for these Health Services needs is included in the monthly budgets.

Participants who choose to receive extended assistance will remain enrolled and be subject to the rules and regulations governing the program. Participants should be advised of these rules and regulations so that they can determine whether it is in their best interests to remain in the program to receive extended assistance. Eligibility for the extended assistance will cease before the end of the 12 month period if the participant's categorical eligibility ceases or gross monthly income is in excess of the monthly budget (including an allowance for health needs) for three consecutive months. Participants have an obligation to report any changes in their family or financial circumstances that would affect their eligibility for extended assistance.

Participants receiving HEX or SAHS only benefits are also eligible to receive SAFER, SAFFR, CRISP, and 55Plus.

22.1.12 DRUG PURCHASES - BY CASH

To prevent claims to the provincial pharmacare program, it is necessary for an EIA office to obtain the official pharmacare receipt before reimbursing any income assistance participant for a cash purchase of prescription drugs. Field staff must call DPIN Help Desk staff at 786-8000 or 1-800-663-7774 to receive approval to provide a cash reimbursement to a participant.

22.1.13 PRESCRIPTION DRUGS - CONTROL PROCEDURES

The Health Services Program provides basic coverage for essential prescription drugs. Prescription drug abuse occurs when a participant receives drugs without a legitimate medical reason. Abuse also occurs where a participant obtains unnecessary or duplicate prescriptions. If this action is deliberate it may constitute an offence under the Criminal Code, Food and Drugs Act or the Narcotic Control Act.

When a case of suspected abuse is identified, it is handled as follows:

  1. Employment and Income Assistance (EIA) is notified of suspected abuse by the Provincial Drug Program; or

    EIA staff notify the Provincial Drug Program that they suspect the participant of abuse and request that a review is completed by the Provincial Drug Programs to verify the suspicion.

  2. EIA staff interview the participant and present the Department's information and advise the participant of the implications of defrauding the EIA program. The Manager of Investigations may assist with the interview process.
  3. The participant's explanation is obtained and documented in Case Notes on the EIA file.
  4. If the explanation is satisfactory, no other steps need to be taken other than notification of the explanation to the Provincial Drug Program. If the explanation is not satisfactory, the EIA Director or designate may suspend automatic prescription drug authorization by the DPIN system.
  5. The following procedures must be completed by EIA staff when suspending automatic prescription drug authorization:
    1. The Provincial Drug Program is notified of the decision.
    2. The participant is notified of the decision in writing.
    3. The participant is advised they must select one general practitioner and one pharmacy for further drug purchases.
    4. The Social Allowances Management Information Network (SAMIN) is updated so that future Health Services cards will not be automatically issued to the participant.
    5. EIA will complete a bring-forward for one year to review the case to determine if automatic coverage should be reinstated.
    6. The EIA Director or designate and the Manager of Investigations may decide to pursue prosecution following the review.

22.1.14 CHIROPRACTIC TREATMENT

Assistance may be granted for chiropractic services above the maximum annual amount payable by the Department of Health. Requests for treatment must be approved by the Chiropractic Review Panel. Chiropractors are supplied with forms which they send directly to the Chiropractic Review Panel at 201-114 Garry Street. The program may provide coverage at the applicable Manitoba Health rates and the Manitoba Health authorized range of services apply. Chiropractic x-rays are not covered by the program.

22.2.1 PHYSICIANS' FEES

Medical assessments or reports

Manitoba Health's Insured Benefits Branch does not insure the cost of medical assessments or reports required by a third party. Such costs may be paid by EIA where:

  1. the medical examination is required to determine or review eligibility for income assistance under the disability category or,
  2. a participant requires a driver's licence for medical or employment reasons, and must provide the Motor Vehicle Branch with a medical report to prove driving capability.

The Insured Benefits Branch establishes the payment rates according to the physician's area of specialty. In addition to the established payment rates, EIA may provide an additional $45.00, over and above this payment rate, to the physician for completing the EIA Disability Assessment Report. Rates may be obtained from the Supervisor, Physicians' Registry, Manitoba Health, at 786-7101. Nurse Practitioners, if in private practice, may be eligible to receive the additional amount of $45.00 payment for the completion of EIA Disability Assessment Reports.

Transfer of Medical Files

According to the Manitoba Medical Association (MMA), the charge for copying a patient medical records or file is at the discretion of the physician. As is the case with all uninsured services, financial hardship and ability to pay must be taken into account in the determination of what if any fee is to be charged, and is not provided for by EIA.

Tray Fees (also known as Uninsured Disposable Supplies)

Most diagnostic tests or minor procedures can be performed in a hospital facility or hospital clinic where the cost of the disposable supplies is covered through the hospital operating budget.

While the Employment and Income Assistance (EIA) Program will not compel participants who require tests or procedures of an elective nature to access these services through hospitals, staff are to encourage participants to have diagnostic tests and minor procedures performed at these facilities where neither the participant nor the EIA Program incurs costs.

If the participant still chooses that such tests or minor procedures be provided in a physician’s office, staff may approve tray fees (which are the supplies) up to the following rates: $18.00 for minor or $45.60 for major diagnostic tests or procedures.

Manitoba Health Insured Services provides the physician with payment for the examination and the cost of any diagnostic test or procedure performed during an office visit. According to the Manitoba Medical Association (MMA) the physician has the discretion to set the amount charged for disposable items and the only stipulation is that the disposable items must bear a direct relation to actual costs incurred. Patients can request a breakdown of the invoice to determine what service and/or supply would constitute the payment of the tray fee.

There may be circumstances that require special consideration which should be brought forward to the Program Specialists for review and/or approval.

22.2.2 OUT-OF-PROVINCE MEDICAL COSTS

Employment and Income Assistance funds are not to be applied to any out-of-province medical costs. All such claims will be processed directly by the Out-of-Province Claim Department of Manitoba Health, Insured Benefits Branch.

22.2.3 EXTRA BILLINGS FROM PHYSICIANS

Where a participant attends a physician who chooses to practice outside of the insured provincial program and charges fees in excess of the Manitoba Health, Insured Benefits negotiated schedule, no assistance shall be granted for resulting extra billings.

22.2.4 OUT-OF-PROVINCE MEDICAL PREMIUMS FOR NEW ARRIVALS TO MANITOBA

Insured health benefits provided by Manitoba Health are available to new residents of the province after a 90-day waiting period. To assist new participants within the 90-day waiting period, the following procedures are applicable:

  1. At intake, the applicant should be advised to register under the Manitoba Health, Insured Benefits plan, and the health plan registration number from the province of origin should be recorded.
  2. A written statement of the premium status of the new arrival should be obtained from the province of origin.
  3. Upon receipt of confirmation of coverage or notice of premium due, any costs may be granted to ensure that the applicant maintains province of origin health insurance benefits to completion of the 90-day waiting period.

22.3.1 TRANSPORTATION - HEALTH REASONS

Where participants require transportation to a medical centre, the following methods of transportation should be used in the order listed:

  1. Public transportation (bus, train, or airplane) or participants own vehicle chargeable at the equivalent rate of the cheapest available public transportation;
  2. If method 1 is not available, participant's own vehicle at:

    North of 53rd parallel:

    22 cents per km.

    South of 53rd parallel:

    20 cents per km.

  3. If methods 1 and 2 are not available, a licensed carrier (taxicab) at approved prevailing rates.
  4. If methods 1, 2 and 3 are not available, a privately-owned vehicle at the rates indicated above under point 2.

NOTE:

  1. Privately-owned vehicles cannot be legally hired when a licensed carrier is available in the area.
  2. The participant must hire and pay the owner of the privately-owned vehicle and submit receipts in order to be reimbursed by the EIA office. At no time should an EIA worker hire or pay the owner of the privately-owned vehicle directly.

The above priority list of methods of transportation may be altered at the discretion of the EIA director or designate in the following situations:

  1. when the physical or mental condition of the participant makes it impossible to use public transportation (e.g., a person using a wheelchair, etc.);
  2. when related expenses (those other than actual fares) such as meals, hotel, babysitting costs, etc., may result in higher total costs than incurred in using another form of transportation;
  3. in emergency situations;
  4. when groups of participants might be able to use taxis, private vehicles, etc., more economically than by individually using public transportation; and\or
  5. when rural participants are not able to use an urban bus system.

Under normal circumstances, payment will be made to provide transportation only to the nearest centre where appropriate treatment facilities are available. Under exceptional circumstances, this provision may be waived at the discretion of the EIA director or designate (e.g., when the participant has a long-standing contact with a doctor other than one who is in practice at the nearest centre or when the participant has been referred to another doctor by a doctor who is in practice at the nearest centre). NOTE: When participants choose to attend a more distant medical centre where transportation costs are higher, they may do so and claim the lesser amount.

Control of Possible Abuse

No account is to be forwarded for payment unless the participant has signed the account or the H Form to verify services provided. Periodically, random samples should be selected from the total caseload or from particular communities where there are high transportation costs and these samples should be reviewed for possible abuse.

Personal Care Home Residents

The cost of an escort required to accompany a resident on a trip or to an appointment away from the personal care home is the responsibility of the participant and therefore may be provided as a health need. However, costs for escorts accompanying participants for a trip to a hospital and return within 24 hours are the responsibility of the personal care home.

22.3.2 WHEELCHAIR TRANSPORTATION - MEDICAL AND RELATED ACTIVITIES

Medical Appointments and Related Activities

EIA participants who require special wheelchair transportation for medical appointments and related activities (including hospital admissions and discharges, physiotherapy, occupational therapy, swimming lessons for therapeutic purposes, Alcoholics Anonymous meetings and group activities organized by the Society for Manitobans with Disabilities), should use the following methods of transportation in the order listed:

  1. Public transportation (e.g., Handi-Transit)

    If Handi-Transit is available but the participant chooses to use his or her own vehicle or have a friend or a relative provide the transportation, reimbursement may be made, upon request, at the equivalent rate of the least costly available public transportation.

  2. If method 1 is not available, the participant's own vehicle or a friend or relative's vehicle at:

    North of 53rd parallel:

    22 cents per km

    South of 53rd parallel:

    20 cents per km
  3. If methods 1 and 2 are not available, commercial wheelchair transportation of the participant's choice at the prevailing rates.

    NOTE: To verify currently licensed Commercial Wheelchair Transport Operators and their rates, contact: Taxicab Board
    Transportation and Government Services
    206 - 301 Weston Street
    Winnipeg, Manitoba R3E 3H4
    Phone: 945-8919

Handi-Transit

For health related transportation, private wheelchair transportation should not be authorized unless the participant has first tried to book Handi-Transit.

Participants are required to maximize their use of Handi-Transit in the following ways:

  1. Handi-Transit should be booked at least 3 - 7 days in advance when participants have prior notice of an appointment or event.
  2. Participants should schedule medical appointments for times Handi-Transit is available.
  3. Private wheelchair transportation for medical appointments should be authorized one-way only if Handi-Transit is available for the remainder of the trip.

Standing orders with private wheelchair transportation companies may be issued to participants who have regular medical appointments at times when Handi-Transit is not likely to be available. These orders should be issued to the transportation firm in writing for specific days and destinations and should be reviewed at least every three months. Participants with standing orders are still expected to try to book Handi-Transit for these trips.

22.3.3 EMERGENCY HEALTH TRANSPORTATION

Emergencies may require that indigent persons be transported to health care facilities using special transportation.

Northern Manitoba

North of the 53rd parallel on the west side of Lake Winnipeg and north of the 51st parallel on the east side of Lake Winnipeg, such transportation may be subsidized by the Northern Patient Transportation Program (NPTP) of Manitoba Health, Emergency Services Branch.

Transportation may be categorized as elective, urgent or emergency. Transportation is provided by the most care-effective, cost-efficient mode as defined by medical authority.

Southern Manitoba

South of the noted northern boundaries of the NPTP, the following applies in determining financial responsibility for emergency health transportation:

  • A person unable to pay for emergency health transportation can seek assistance from the EIA office serving the area. Any person not deemed in need by the EIA authority must assume responsibility for the cost of emergency health transportation.

22.3.4 WHEELCHAIR TRANSPORTATION - SOCIAL ACTIVITIES

Persons using wheelchairs are eligible for up to 24 pre-authorized wheelchair transportation trips per year for social activities (e.g., shopping, religious services, sporting events, visiting). The director or designate may waive this maximum in exceptional circumstances. Beyond this provision, transportation costs for social activities are the responsibility of the participant. Participants should be advised to use the least expensive form of transportation possible.

Social Trips - Winnipeg and Brandon Only

Eligible participants residing in Winnipeg and Brandon should be provided with "chits" which will provide the pre-authorization for 24 social trips per year. As each return social trip requires two chits, 48 chits should be provided to cover the period between April 1 and March 31. Participants who are eligible for wheelchair transportation provisions and who enrol after April 1st of each year should be provided with a pro-rated number of chits based on two social trips per month until March 31st. Chits may be used only for transportation services provided by private licensed carriers within Winnipeg and Brandon.

Participants may also use public transportation (e.g., Handi-Transit) for social trips. EIA offices should forward the appropriate number of bus tickets to these participants to ensure they receive up to 24 social trips (48 tickets) per year.

Social Trips - Outside of Winnipeg and Brandon

Participants residing outside of Winnipeg and Brandon are eligible for up to 24 wheelchair transportation trips per year for social activities. Although no restrictions should be placed on when these trips can be used, participants are required to contact their EIA office for authorization prior to each social trip.

22.3.5 CITY OF WINNIPEG AMBULANCE DEPARTMENT

HS certificate holders may obtain direct service from the City of Winnipeg Ambulance Department without prior authorization from EIA office staff. The Ambulance Department submits block billings directly to HS for service provided.

In cases where a non-valid certificate, or no certificate, is produced by the participant, the Ambulance Department will send the bill directly to the participant who will be required to submit the bill to the EIA office for payment.

22.3.6 TRANSPORTATION TO EVALUATION TRAINING CENTRES

Vocational Rehabilitation Services assumes financial responsibility for all transportation costs associated with attendance at Evaluation Training Centres.

22.3.7 TRAVELING MEAL ALLOWANCES

Where approved as a health need, the maximum traveling meal allowance for rural participants seeking treatment away from their home communities is $17.20 per person per day in the south, and $18.90 per person per day in the north.

Where only one or two meals are required, the following allowances may be provided per person per meal:

 

South

North

Breakfast

$3.60

$4.00

Lunch

$5.30

$5.80

Dinner

$8.30

$9.10

When a participant is away from home and receiving a meal allowance for five days or more per month, the other budgeted food allowance would normally be decreased for all meals provided away from home. The EIA director and designate have discretion to modify or waive this requirement, if circumstances warrant. The budget will be adjusted if the participant is away for 30 days or more unless special circumstances warrant consideration. The EIA director or designate may vary this requirement and document the circumstances on file.

22.3.8 INTER-MUNICIPAL LIVERY RATES

Under authority of the Manitoba Motor Transport Board, Inter-Municipal Livery (ground travel) rates effective July 1, 2008 are as follows:

Round Trip

The toll for a round trip is $1.25 per kilometre ($2.00 per mile) from the point of commencement of the trip to its destination outside the City of Winnipeg and back to the point of commencement.

One-way Trip

The toll for a one-way trip is $2.11 per kilometre ($3.38 per mile) from the point of commencement of a trip to its destination outside the City of Winnipeg.

Waiting Time

The toll for waiting time shall not exceed $25.00 per hour and shall be chargeable at the rate of $6.25 for each period of 15 minutes or part thereof.

These rates include all taxes and apply to all inter-municipal livery operators in Manitoba who are licensed under The Taxicab Act and/or The Highway Traffic Act and shall not be exceeded by EIA payment.

22.3.9 TELEPHONES FOR HEALTH AND SAFETY REASONS

Schedule A, section 7(1)(g) of the EIA Regulation provides the authority to approve the costs associated with maintaining a telephone for health reasons.

Approval must be based either on the acceptable written recommendation of a health professional (e.g., a doctor, public health nurse, community mental health worker, etc.) or on the written approval of the EIA director or designate. In the case of the former, the recommendation must support the need for a telephone by clearly indicating that the participant or applicant will be at risk without a telephone.

The EIA director or designate may provide approval where:

  1. the need is sufficiently obvious as not to require a health professional's recommendation as there are compelling reasons to indicate a phone is necessary for the applicant's or participant's health and safety;
  2. the health professional's recommendation is not sufficiently clear on the need for a phone but additional knowledge of the case supports the need; or
  3. the health professional does not recommend the phone but knowledge of the case provides compelling reasons (related to health) to support the need.

22.4.1 MEDICAL SUPPLIES AND EQUIPMENT

In Manitoba, the Regional Health Authorities (RHA) have operational responsibility for the Home Care Program including planning, delivery and ongoing management of the services. Home Care services may include personal care assistance, home support, health care, family relief, respite care, medical supplies and equipment, and adult day programs. These services are provided by the RHA's, other contracted health care professionals such as the Victorian Order of Nurses, Community Therapy Services and other service providers.

The Home Care Program provides a base list of medical supplies and equipment available across the province. In Winnipeg, additions to this list would include electric beds, electric Hoyer lifts and ceiling track systems (up to 12 feet). The Home Care Program is responsible for providing the medical equipment and supplies to individuals who have an open Home Care file. For new medical equipment and supply requests, confirmation of eligibility may be determined by contacting the appropriate RHA.

With respect to equipment and supplies, please note the following:

  1. RHA staff will assess equipment and supplies needs for EIA participants who are receiving services from the Home Care Program and arrange for their provision.
  2. Where the equipment is not covered by the Home Care Program, i.e. walkers, raised toilet seats, bath bars, urinals and bedpans, EIA staff may approve the purchase of such items based on the recommendation of a medical professional.
  3. For EIA participants who are not receiving services from the Home Care Program, EIA staff would reference the standard base Home Care list as a guide to approve the purchase of medical supplies or equipment.
  4. EIA staff should, whenever possible, order all medical equipment and supplies from the Materials Distribution Agency (MDA), a special operating agency of Manitoba Government Services. All orders should be made using the EIA - Order Form in the Medical Equipment and Supplies Catalogue provided by MDA. All items should be ordered directly from:

    Materials Distribution Agency (MDA)
    7 - 1715 St. James Street
    Winnipeg, Manitoba R3H 1H3
    Main Phone: 204 - 945-8605
    Customer Service: 1 - 800 - 561-8313
    Equipment Returns: 1 - 877 - 632-7867
    Fax: 945-5077
  5. Medical supplies and equipment not available through the MDA can be obtained from local suppliers or pharmacies. Three separate quotes are required in these circumstances.
  6. Where EIA is approached by Home Care, a participant or advocate to share the cost of a major health related expenditure, the request must be forwarded to the Program Specialist in Service Delivery Support for approval, regardless of the cost of the item to be purchased.
  7. Hospital discharges must not be delayed when the MDA is unable to fill the order for the necessary equipment and supplies required at the time of discharge or if adequate discharge planning time is not available. The requirement for three separate quotes from vendors for the health equipment or supplies can be waived in this circumstance.

Specialized Supplies and Equipment

Ostomy Supplies

The Winnipeg Regional Health Authority (WRHA) administers the Manitoba Ostomy Program for all Manitobans. Retroactive to April 1, 2004, there will no longer be a co-payment for the participants who use the program. The management and delivery of these ostomy supplies is the responsibility of the WRHA.

Wheelchairs, Wheelchair Repairs

Wheelchair requests for EIA participants must include an assessment by an occupational therapist and/or a doctor. EIA should provide approval for wheelchairs that meet the basic needs of the participant.

Manitoba Health loans wheelchairs without charge to all eligible Manitobans through the Manitoba Community Wheelchair Program. Eligible Manitobans include persons living in the community and does not include persons living in an institution, such as a personal care home. The Manitoba Community Wheelchair Program must be the first source for obtaining wheelchairs for Employment and Income Assistance participants (EIA) who live in the community.

Persons residing in personal care homes or other institutions are responsible for obtaining their own wheelchair, unless they have been loaned a wheelchair from the Manitoba Community Wheelchair Program at least six months prior to entering the institution. If they meet the latter condition, they may keep the wheelchair and continue to have it serviced by the Program. In those situations where the individual is responsible for the cost of a wheelchair and is an EIA participant, the EIA program will provide the wheelchair. These requests must be sent through to SMD to check the EIA volunteer equipment pool for a wheelchair. If there is no suitable wheelchair, SMD will provide EIA with a recommendation of an appropriate supplier.

The Society for Manitobans with Disabilities (SMD) is contracted by Manitoba Health to distribute and repair wheelchairs. As the provider of the Province's generic wheelchair program, SMD should be utilized as the primary supplier of standard manual and motorized wheelchairs for EIA participants. Wheelchairs can be obtained from:

Wheelchair Services
Society for Manitobans with Disabilities
1111 Winnipeg Avenue
Winnipeg, Manitoba R3E 0S2
Toll Free: 1-800-836-5551
Fax: 975-3240

Temporary Mobility Equipment

If participants have a temporary medical condition (three-months or less) and their physician prescribes mobility equipment, the Manitoba Division of the Canadian Red Cross Society, Mobility Equipment Loan Program is to be accessed for the loan of the equipment. There is no cost to the participant and this program operates throughout the province with many equipment depots. Mobility equipment available for temporary loan includes manual wheelchairs (electric wheelchairs not supplied), walkers, crutches, and canes may be available through the Manitoba Red Cross Society.

When a participant has a temporary medical condition and does not qualify for a wheelchair through the Manitoba Wheelchair Program, or if there is a wait list at the Manitoba Red Cross Mobility Equipment Loan Program, the cost of rental may be approved as a health need. These situations are assessed on a case by case basis. Three quotes must be obtained for the rental of a manual or electric wheelchair prior to authorizing and the rental should not exceed three months.

Prior to authorizing a temporary rental, it is important for staff to establish that:

  • the medical condition is temporary and will not exceed three months and;
  • there is no ongoing need for the mobility aid, as a medical recovery is expected;
  • there is no eligibility for the Manitoba Wheelchair Program and;
  • the Manitoba Red Cross manual wheelchair is not available or not appropriate.

The Manitoba Community Wheelchair Program does not provide some mobility equipment, such as special seating or specialized wheelchairs. When it has been determined that the equipment required to meet a participant's basic needs is not available from the Manitoba Community Wheelchair Program or the EIA volunteer equipment pool, three quotes from suppliers must be obtained. The only exception is for customized seating where the need for quotes is not required. When costs exceed $3,000.00, a request for equipment should be referred to the Minister's designate for approval.

All scooter requests regardless of cost must receive approval through the Minister's designate. Requests are to be considered on a case by case basis.

Wheelchair Elevators, Lifts and Ramps

If the cost is greater than $3,000.00, requests for the elevators, lifts and ramps should be referred to the Minister's designate in the Central Office, for an assessment of the participant's home regarding cost and suitability for installation, before a requisition is made. The assessment will be considered a major repair.

Manitoba Health does not supply these items:

Manitoba Home Oxygen Therapy Program

Participants must meet eligibility criteria for acceptance in the program as assessed by a provincially designated physician. Oxygen concentrators and accessories are provided through the Home Care Program.

The standard for ongoing provision of equipment necessitates blood gas testing after three months and yearly thereafter. Testing can be arranged through a physician who forwards the results to the Home Care Coordinator.

Portable Oxygen Cylinders and Carts

Although not covered by the Home Care Program, small portable oxygen cylinders and carts are available for rental or purchase through oxygen suppliers. The oxygen portion of this cost can be claimed through Pharmacare.

Prosthetic and Orthotic Devices

Devices of this nature are normally covered as an insured service under The Health Services Insurance Act and its Regulations, and are not available through the Materials Distribution Agency.

Breast Prostheses, Elastic Stockings, Hearing Aids and Shoe Adjustments

EIA offices will deal directly with the appropriate supplier.

Request Procedure for Emergencies

The usual Medical Authorization is a prerequisite. Following the receipt of the usual Medical Authorization, the EIA director or designate will determine if an emergency exists. Where an emergency is deemed to exist, the EIA office may purchase item(s) directly from the supplier.

Eligibility

Eligibility under EIA should be determined, prior to ordering.

22.4.2 SUPPLIES AND SERVICES - PERSONAL CARE HOME RESIDENTS

It is the responsibility of personal care homes to provide the following supplies and services to residents:

  1. Mending of clothes (e.g., seam repairs, replacing buttons, etc.)
  2. Supplies required for personal hygiene and routine skin care (e.g., soap, toothpaste, denture cleaners, mouth wash, oral hygiene products, shampoo, body powder and lotion)
  3. Non-prescription biologics and related preparations such as skin care powders, lotions, creams, ointments, jells and cleansers, throat lozenges and non-prescription eye drops as approved under the personal care home drug program by the personal care home drug utilization committee (Note: it is best to contact the personal care home to address specific requests from participants/residents for non-prescription items)
  4. Diabetic supplies
  5. Medical nursing supplies (e.g., wound management supplies and dressings, catheters, needles, syringes, diagnostic and testing materials, ostomy supplies and tube feeding supplies)
  6. Disinfectant and antiseptic preparations
  7. Sheepskins
  8. Dietetic supplies and nutritional aids or supplements
  9. Overhead trapeze bars
  10. Mechanical lifts
  11. Mechanical slings for occasional use
  12. Therapeutic and pressure-reducing mattresses
  13. Raised toilet seats
  14. Commodes
  15. Restraint devices
  16. Humidifiers
  17. Wheelchairs for occasional transportation
  18. Oxygen and oxygen concentrators
  19. Incontinent care aids

Needs not provided by personal care homes include:

  1. Major repairs and alterations to clothing
  2. Purchasing and labelling of clothing
  3. Dry cleaning of clothing and other privately-owned items such as rugs, drapes, bedspreads and blankets
  4. Alcoholic beverages and tobacco products
  5. Cosmetics and deodorants
  6. Hairdressing and haircuts
  7. Support hose
  8. Hearing aids and batteries
  9. Dentures and denture adhesives
  10. Services performed by a chiropodist or podiatrist
  11. Services performed by a chiropractor that are not covered by Manitoba Health Services
  12. Acupuncture
  13. Television and radio services
  14. Eyeglasses
  15. Insurance for personal belongings
  16. Transportation costs when not covered as an insured benefit
  17. Escort costs when not covered as an insured benefit
  18. Incontinent care aids when the resident prefers a brand that is different from those care aids provided by the personal care home
  19. Non-prescription biologics and related preparations such as skin care powders, lotions, creams, ointments, jells, cleansers, throat lozenges and non-prescription eye drops when the resident prefers a brand that is different than that provided by the personal care home
  20. The following items when they are purchased solely for one resident's use and remain the property of that resident (in some cases personal care homes have limited numbers of these items for sharing among residents who do not require exclusive/constant use of the item): canes; walkers; crutches; wheelchairs and wheelchair repairs; pressure cushions; slings for mechanical lifts; specialized seating; and, transfer poles.

22.4.3 CHIROPODY, PODIATRY, or FOOT CARE SERVICES

Podiatry, chiropody or foot care services are not an insured health service by Manitoba Health. As permitted under Schedule A, section 7(1)(h) of the Regulation the parameters of the policy are as follows:

Approval of podiatry or chiropody and foot care services will only be authorized when:

  • Information from the physician or other health practitioner indicates that foot care service is essential in the management of the medical condition; or
  • Staff determine that information provided on the medical assessment form supports that foot care service is an essential health need in the management of the medical condition.

When one of the above criterion is met, staff can approve foot care services:

  • At a rate up to $32.00 each visit; and
  • To a maximum of nine visits per fiscal year.

Participants in hospitals are not covered through EIA for podiatry or chiropody services, as it is the responsibility of the facility to cover these costs as detailed in section 22.1.9. Individuals residing in Personal Care Homes, Chronic Care Facilities and Mental Health Centres are to access their personal resources available in their liquid assets first, before EIA would approve these services in accordance with section 22.1.10.

In exceptional circumstances where the participant cannot attend a medical clinic due to mobility restrictions, the director or designate may approve to a maximum of $40.00 for a home visit. All other requests for payment not described in this policy must be referred to the Program Specialist for review and consideration.

22.4.4 ACUPUNCTURE

EIA does not fund acupuncture services under any circumstances. This policy is consistent with advice from the Manitoba Health, Insured Benefits Branch which does not recognize acupuncture as a clearly understood or acceptable medical procedure.

22.4.5 RADIOISOTOPE MATERIAL FOR NUCLEAR MEDICINE EXAMINATIONS

Nuclear medicine examinations are paid for by Manitoba Health as an insured benefit. However, the radioisotope material used in the examination does not form part of the insured service, therefore, the cost of such materials must be borne by the patient. The payment of account due to materials used is in turn a claimable item under the Health Services program.

22.4.6 HEARING AIDS

For EIA participants of any age, the actual cost of hearing aids and related services will be paid according to the schedule of rates negotiated with the Hearing Aid Dealers Association of Manitoba listed below.

The type of hearing aid approved for payment should be consistent with the recommendation of the audiologist or otolaryngologist. For example, if the audiologist recommends that a participant receive a digital/programmable hearing aid, then the costs for this type of hearing aid should be covered to the maximums prescribed (see hearing aid rates payable for rate maximums).

Staff must not direct participants to any particular agency or dealer for the purchase of hearing aids. The choice of dealer must be left entirely to the participant with Family Services and Consumer Affairs meeting the cost in accordance with the negotiated agreement.

Hearing aid services to children under 18 years, not in receipt of income assistance are insured services through the Hearing Aid Program with Manitoba Health, to view the specifics of this program please view the Manitoba Health Internet site address:

www.gov.mb.ca/health/mhsip/hearingaid.html

Any person applying for "single grant" assistance from EIA because of the need for a child's hearing aid should be advised of the insured service, which should be considered when calculating any possible eligibility for such a single grant.

Hearing Aid Rates Payable

The maximum amounts to be paid for hearing aids are the usual and customary prices up to the amounts listed when provided by a licensed hearing aid dealer. (These rates, negotiated with the Hearing Aid Dealers Association of Manitoba, are effective April 1,1999):

  1. hearing aid: landed invoice cost to a maximum of $500.00 per hearing aid;  $1,800 per digital/programmable hearing aid
  2. dispensing fee: $250.00 (in the case of binaural hearing aids the dispensing fee for the second hearing aid is $150.00)
  3. taking ear impressions: $20.00
  4. ear mould: landed invoice cost to a maximum of $48.00 per ear mould (includes checking the fit and efficacy of the ear mould)
  5. hearing examination, if requested by an audiologist or otolaryngologist

    air and bone conduction audiogram:

    $ 7.45

    speech tests (including air and bone):

    $11.80

    supra threshold test:

    add $1.80

  6. impedance audiometry: $14.85
  7. hearing aid selection if requested by an audiologist or otolaryngologist (includes testing and recommendation for amplification, electroacoustical modification, etc.)

    monaural:

    $14.85

    binaural:

    $22.40

  8. hearing aid orientation visit (includes instructions on the proper use and maintenance of the hearing aid, adapting to amplification and the provision of informational brochures and other printed material): $14.85
  9. follow-up visits for fitting checks, etc. (up to two visits per hearing aid within 90 days of purchase of hearing aid): $7.45 per visit per hearing aid
  10. validation testing where appropriate sound field test equipment or other accepted means are available: $29.85
  11. electroacoustic test

    monaural:

    $14.85

    binaural:

    $28.75

Regular servicing and cleaning, instrument warranty, the provision of a suitable hearing aid while a hearing aid is away for repair, and CROS or by-CROS aids are included in the amounts set out above.

These rates are the same as those used by Manitoba Health in its subsidization of services provided by licensed hearing aid dealers to children under 18 years of age.

Replacement of Hearing Aid

One device is allowed per ear every four years, unless there is a medically diagnosed change in the participant's condition.

22.4.7 FAMILY SUPPORT PROGRAM

In Winnipeg, the Family Support Program operated by the Family Centre of Winnipeg, provides supports to families through child care, respite services, parental guidance, and household assistance to families that are in crisis, where special needs exist, or where a family member is ill or has a disability. For participants who may require family support services in Winnipeg, referrals should be made directly to the Family Support Program, which will assess the need for services and the length of service required. Approval for the provision of services is not required from the Department of Family Services and Consumer Affairs. The Family Centre of Winnipeg provides services through a service purchase agreement with Child and Family Services.

The Family Support Program may be contacted at 947-1401 (Fax 947-2128).

22.4.8 (deleted)

22.4.9 SUPPORTS FOR PARTICIPANTS ENROLLED IN AN APPROVED PROGRAM TO ADDRESS ADDICTIONS

The Employment and Income Assistance (EIA) program recognizes that addictions often negatively impact a person's life by infringing on the person's own well-being, and that of his/her family, and by limiting full participation in society, including, restricting a person's ability to obtain and retain employment. EIA supports and encourages a participant's desire and efforts to address or reduce the harm from an addiction.

Accordingly, the following policy outlines the supports available to EIA participants when the participant, a service provider, and EIA are in agreement with a rehabilitation plan to address concerns related to an addiction. The supports available are sensitive to the varying needs of differing participant groups, and the different types of programs available.

Single Parents and Persons with Disabilities

Residential Programs

When the participant is enrolled in, and is attending a residential program, the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 3 months:

  • shelter costs: - to maintain stable accommodations for the family. If the accommodations are a contributing factor to the addiction, and the participant expresses a desire to move, storage and moving costs would be provided instead of shelter costs. Both shelter and moving costs may be required where other members of the household remain in the community (children, and/or the spouse of a person with a disability) pending the return of the person from the residential program;
  • basic needs/residential fee: - where required, (and not otherwise covered) in accordance with EIA's established per diem for the service provider. The personal allowance is also payable to or on behalf of the participant in the residential facility. Basic needs are payable for family members remaining in the community;
  • child care costs: - where required, without the participant contributing the $1.00 per day. The approval should take into consideration the availability of family member(s)/friend(s), subsidized care and private care;
  • transportation: - where required, to enter and return from the residential program, and any transportation costs required while in attendance at the program, in accordance with the most reasonably priced and appropriate means of transportation. In some cases these costs may be covered by the service provider or another program or agency (for example Manitoba Health).

Day Programs

When the participant is enrolled in and is attending a day program (day programs are usually all day, daily sessions) the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 3 months:

  • child care costs: - where required, without the participant contributing the first $1.00 per day. The approval should take into consideration the availability of family member(s)/friend(s), subsidized care and private care;
  • transportation: - to and from the program, in accordance with the most reasonably priced and appropriate means of transportation.

Self-Help Groups

When the participant is participating in a self-help group or a community based program (not usually daily, or all day) the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 6 months:

  • child care costs: - where required, without the participant contributing the first $1.00 per day. The approval should take into consideration the availability of family member(s)/friend(s), subsidized care and private care;
  • transportation: - where it is not practical or feasible for the participant to attend a group within close proximity to his/her home, or where required for medical reasons, in accordance with the most reasonably priced and appropriate means of transportation.

A participant may require the supports from all three types of programs over the course of time.

No sanctions will apply for a single parent or a person with a disability if he/she chooses not to participate in a program respecting addictions.

General Assistance Participants

Residential Programs

When the participant is enrolled in, and is attending a residential program, the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 3 months:

  • shelter costs: - to maintain stable accommodations for a family with children, if the accommodations are not a contributing factor to the addiction, in which case moving costs may be approved. Shelter costs may also be approved for a childless couple and a single person, if the living arrangement is stable and not a contributing factor to the addiction;
  • basic needs/residential fee: - where required, (and not otherwise covered) in accordance with EIA's established per diem for the service provider. The personal allowance is also payable to or on behalf of the participant in the residential facility. Basic needs are payable for family members remaining in the community;
  • child care costs: - the spouse would normally provide child care, unless he/she is in treatment, employed or otherwise unable to provide the care, in which case costs may be approved without the participant contributing the $1.00 per day;
  • transportation: - where required, to enter and return from the residential program, and any transportation costs required while in attendance at the program, in accordance with the most reasonably priced and appropriate means of transportation. In some cases these costs may be covered by the service provider or another program or agency (for example Manitoba Health).

Day Programs

When the participant is enrolled in and is attending a day program (day programs are usually all day, daily sessions) the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 3 months:

  • child care costs: - the spouse would normally provide child care, unless he/she is in treatment, employed or otherwise unable to provide the care, in which case costs may be approved without the participant contributing the $1.00 per day;
  • transportation: - to and from the program, in accordance with the most reasonably priced and appropriate means of transportation.

Self-Help Groups

When the participant is participating in a self-help group or a community based program (not usually daily, or all day) the following may be approved by the Case Coordinator or Counsellor, as required by the participant's circumstances, for up to 6 months:

  • child care costs: - the spouse would normally provide child care, unless he/she is in treatment, employed or otherwise unable to provide the care, in which case costs may be approved without the participant contributing the $1.00 per day;
  • transportation: - where it is not practical or feasible for the participant to attend a group within close proximity of his/her home, in accordance with the most reasonably priced and appropriate means of transportation.

A participant may require the supports from all three types of programs over the course of time.

In some situations, the rehabilitation plan may be a step to independence as outlined in the action plan developed by the participant and the Case Coordinator or Counsellor. In these situations, where employment expectations apply, participation in the approved rehabilitation plan should be considered as meeting the expectation of the action plan. Should the participant fail to follow through with the program she/he is subject to the same sanctions as any other participant who fails to meet her/his employment expectations. When considering imposing sanctions to promote participation, consideration should be given to the reasons why the participant may have failed to meet her/his obligation. Staff should consult with the service provider, where possible, to ensure that the participant has been given every opportunity to comply. If sanctions are imposed, all policies relating to imposing sanctions apply, including denying benefits and reducing the budget.

All Participant Groups

Requests for funding for expenses other than those identified above, including extending the specified timeframes, must be reviewed with the Director, for his/her approval or that of his/her designate.

Approval should be based on confirmation of the participant's attendance. It is acknowledged that in some cases with self-help programs, such confirmation may not be available. All approved costs should be coded using the appropriate SAMIN health needs codes.

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