Feb. 22 Update: What we know and what we don’t about the new Ontario Autism Program.

There’s only 38 days until the new program goes into effect. We really didn’t learn anything yesterday from the government other than what the office of PC MPP Amy Fee told one parent. However, we did get this bombshell from City TV’s Cynthia Mulligan (who’s coverage of this has been fantastic):

Given how long my son has been on the waiting list, there is a very good chance that he would be receiving treatment right now had the government not cancelled all new treatment. I didn’t think this issue could get more personal for my family. I was wrong.

The government’s claim is that they only did this because there’s “no more money”, not that they were trying to inflate the size of the waiting list to better motivate their reforms. My three responses:

First, we have no real way of knowing what the government has been spending, due to their lack of transparency, and their explanations in Question Period don’t make any sense. This is a direct quote, from Hansard, by Lisa MacLeod.

That’s why we have increased our budget for this program from $256 million to $321 million. That is why we went in for an emergency $100 million from Treasury Board to ensure that we could keep this program alive.

The most obvious problem with this is that $256 million + $100 million is $356 million, not $321 million. What happened to the remaining $35 million? As well, the actual expenditure on the program last year was $317 million. So where are these numbers coming from? It’d be helpful if the government broke them down somewhere we could analyze them, not just repeat them in QP.

Second issue is that there’s always more money. The government has spent an awful lot of new money on other priorities between October and now.

Finally, let’s take the government at their word. Let’s suppose they are being 100% honest here. Then why not tell parents this back in October? We could have come up with some form of alternative arrangement for our kids. Instead, we’re waiting by our phones for a call that’s never going to come. My wife called CHEO every single week, to find out where Mats was on the wait list. Why make her go through all that? Why give people false hope?

On to the post, which I’ve updated with what we learned from yesterday.

New Program

Issue 1: Maximum Per Year Funding

What we know

• The maximum funding is $20,000/yr for kids aged 2–5 (4 years) and $5,000 for kids 6–17 (12 years).

What we don’t know

• What services and supports families will be able to purchase. We are told this will be released sometime in April 2019, which is after the new program is live!
• How families pay for services (do they pay out of pocket, then submit receipts? A receipts model would be highly problematic, as it would require families to have significant up-front cash. Does the money go direct to providers?) Sarah Jones was able to get some information on this from Amy Fee, but we don’t know if this is official government policy.
• What happens the first year a child is diagnosed. If a child is diagnosed at age 3.5, do they have to wait until their next birthday to receive funding? Do they get the full amount for a 3-year-old? Is the funding pro-rated? (So they’d receive half the amount they would for a full year?)
• Can families roll-over unused budget into following years, or is it “use it or lose it”?

Issue 2: Means-Testing

What we know

• Almost nothing. We thought we knew when the clawbacks start (at an income level of $55,000/yr), but yesterday in Question Period, it was indicated that families earning $55,000/yr would not receive the full amount. Details here, along with a best guess on how the funding might work. (Again, noting that the cost of ABA is around $80,000/yr and that $55,000/yr is less than some dual-earner minimum-wage families earn).
• We know the government is defining income, for means-testing purposes, as Line 236 on your tax return (which is standard for these types of programs), which is income after Line 207 through 235 deductions (including child care expenses and RSP contributions) have been applied. So this is “pre-tax” income, but net of some deductions.

What we don’t know

• Anything about means-testing, including the formula.
• We also still don’t know if the funding works differently for single-earner vs. dual-earner families, or if the program has some built in “marriage penalty”. (Or put differently, will this program pay families to get divorced).
• How the funding and means-testing works for families with multiple children on the spectrum. My interpretation of what the government has released is that it is not affected by number of children. That is, if you have one 11-year-old with a “Childhood Budget” of $2750, each child would receive a budget of $2750 if you instead had 11-year-old twins on the spectrum. It would be helpful to have this confirmed, though.

Issue 3: Going from Diagnosis to Funding

We know next to nothing about how children will transition from being diagnosed to receiving funding when the new program is fully implemented.

What we don’t know

• How long will it take for families to receive funding after a child is diagnosed? Will it be immediate? Will they have to wait a certain amount of time (say 6 weeks)? Or wait until a certain date (say April 1?)
• How does funding “renew”. Let’s suppose a 5-year old child starts to receive funding on October 13, 2021. She turns 6 on November 27, 2021. Does her initial pot of funding extend to her birthday (November 27, 2021)? end of the year (December 31, 2021)?, end of fiscal year (March 31, 2022)?, a full year (October 12, 2022?)? How does the fact she is going from a 5-year old (younger child) to a 6-year old (older child) during that year affect funding?

Issue 4: Data Needed to Forecast Costs

Outside analysts (like yours truly) would like to be able to estimate how much the government will be spending on this new program. In order to do that, we need to know how the means-testing works. There’s also a number of other important pieces of information.

What we don’t know

• Forecasted utilization rates for spending.
• How many kids are projected to use the program, along with their ages.

Issue 5: Government’s Forecasts of Costs

Based on the little information we have, it looks like the government is cutting yearly funding in the range of $50–100M , but honestly, who knows? We would like the government to tell taxpayers and parents what this new program costs, and whether it is less than what the old program would have cost.

What we know

• Between fiscal years 2011–12 and 2015–16, the government spent $180–190M each year. (Data here).
• In fiscal year 2016–17 they spent $254,633,529
• In fiscal year 2017–18 they spent $317,801,400
• The number $321 million, which the government has repeated both in Question Period and on Twitter. What we don’t know is what fiscal year this represents. Note that this would be a slight nominal increase from 2017–18, it would be a real (after inflation) decrease in expenditure, no matter which fiscal year it is for. (A brief editorial: For as long as I can remember on the autism file, parties have always been talking about “more” funding, and throwing around numbers… $32 million.. $65 million… $100 million, without telling us what this is more than. “More” is a comparative word, so it only makes sense if it is referencing (either implicitly or explicitly) some other value. What are you using as your baseline? Why can’t you say, “we’re going to spend $X more in 2019 than was initially budgeted for, for a total spend of $Y in 2019” or whatever. Why must voters be left in the dark? And all the parties are guilty of it.)

What we don’t know

• What the government will spend in fiscal year 2018–19 (Which ends Mar. 31, 2019)
• What the government would have spent in fiscal years 2019–20, 2020–21 and 2021–22 had there been no changes to the program.
• What the government will spend in fiscal years 2019–20, 2020–21 and 2021–22 under this new program.

Transition from Old Program to New One

Here’s what we know and what we don’t about the transition from the old program to the new one.

What we know

• The transition starts April 1, 2019
• The transition is expected to last 18 months (that is, until Sept. 30, 2020)

What we don’t know

• What changes were made to the OAP in fiscal year 2018–19, by this government (or the previous one), to prepare for this transition. There were rumours going around the community for some time that the Ontario government was not allowing service providers to start treating kids on the waiting list. Those rumours turned out to be true. What else has the government done to the program?
• For children currently receiving funding, how much funding will they receive upon renewal? Will it be the existing amount? The amount from the new funding formula? Something else? Nothing?
• For children currently on the waiting list, how long will it take them to receive funding? What does the process look like? Will they all have to wait until October 1, 2020?
• For children diagnosed during this period, will they receive their funding before October 1, 2020? On Oct. 1? Or will they have to wait a full 18 months? (So a child diagnosed on February 20, 2020 would need to wait until August 20, 2021)
• Will the government continue to spend the same amount of money on services during this period? Or will they be saving money by reducing funding to kids currently receiving treatment while not extending new funding to kids on the waiting list? (as asked earlier)

Let’s see if we learn anything today!