Social Policy in Ontario

Submission to the Ontario Ministry of Health & Long-Term Care regarding proposed amendments related to OHIP+

When the OHIP+ change was first announced, the government indicated that OHIP+ would become a “second-payer” program – families with children who have private insurance plans would bill those plans first and the government would cover all remaining eligible costs of prescriptions through OHIP+.

However, the proposed regulations indicate that families with private prescription drug coverage will be required to pay out-of-pocket for any costs not covered by their plans. Although this may seem like a slight adjustment from the original announcement, we are concerned that the difference will have a burdensome impact on working families with low incomes.

Read the full submission (PDF)

The government’s proposed strategy is to use the Trillium Drug Program (TDP) as a stop-gap for those families who have health insurance and out-of-pocket drug costs. But unlike OHIP+, under TDP families first pay an annual deductible (typically 3 or 4 per cent of household income) before they receive any support.

Under the proposed regulations, a sole-support parent with household income of about $30,000 and some employer-sponsored health benefits would have to pay about $850 for medicines before receiving coverage from TDP.

In recognition of the cost burden that this could put on low- and modest-income families with partial coverage, Maytree recommends that the government preserve OHIP+ as the first and sole payer for prescription medicines for families with incomes below a particular threshold (for example, the threshold for the Low-Income Individuals and Families Tax Credit).

Improving OHIP+ for lower- and modest-income Ontarians