Ontario Autism Program FAQ

Here’s my attempt at answering the most common questions I hear about the Ontario government’s revised Ontario Autism Program. I’ll be focusing on their “new” OAP, not the previous version of the program, but naturally it’s hard to discuss the revisions without occasionally discussing the previous program.

For a more in-depth analysis of the Ontario Autism Program, I recommend reading Dr. Janet McLaughlin’s piece The Ontario PC Autism Plan: The Truth behind the Talking Points.

It’s important to note that there are two different versions of a “new” OAP: One released on February 6, and an “enhanced” version released on March 22. I will reference both in this document. I will try to be clear if I mean Feb 6 OAP or Mar 22 OAP, or both.

The views expressed in this document are those of one parent. I have no affiliation with any advocacy group or service provider.

Q. Why have the changes to the OAP been so unpopular with parents?

A: I can only speak to the views of this parent, but here goes.

This is always going to be a difficult file to get right. Treatment is expensive and governments don’t have unlimited dollars to allocate to an OAP. Because of these cost pressures, it’s vital that governments spend every dollar in the program as efficiently as possible.

These changes did the opposite – they’re exceptionally wasteful.

The reason is that resources are allocated based on a single variable: the age a child enters the program. This is a poor proxy for a child’s actual needs. So some children were allocated way more resources than they can possibly use, while others can’t access the intensive therapy they require. It’d be like giving every person that shows up to the emergency room the same treatment, regardless of their issue. It makes no sense.

Or as I said put it in Ten tweet-length reasons why the new OAP needs to be scrapped:

It’s a colossal waste of money because the money isn’t targeted. Some kids get way more money than they need, to go out and buy a spare iPad. Others don’t get enough to pay for even 10% of the therapy they need.

Fortunately, in the March 22 announcement, the government indicated that they would add a “needs” component to the program, but we still don’t know what that will look like.

One big complaint parents’ have had was how little information the government has been providing about the program, both in the Feb 6 and March 22 variants.

Parents have many other complaints of the Feb 6 proposal, some of which were addressed on March 22, which saw the elimination of income testing and an expanded list of services. While the government deserves all the criticism they have received for the incredibly wasteful Feb 6 proposal, they also do deserve credit for fixing some of these issues in the March 22 announcement.

Q: What is a Childhood Budget?

A: For most of Canadian healthcare and education, you have a need — need a cast for a broken arm, need to enroll your child in school, etc., you go to the service provider, it gets done, and most (if not all) the financial transactions are invisible to the end user. If you break your arm, you don’t really have to concern yourself with how much the hospital is billing the government.

The (Feb 6 and Mar 22) Ontario Autism Program works differently. Children are assigned a budget, that lasts them until the age of 18, which they can use to purchase eligible services from eligible service providers.

The Childhood Budget approach has benefits — it gives parents flexibility on the services they choose, potentially creates competition between providers, driving innovation and lowering costs. It also has drawbacks — parents are forced to navigate a complex system, they may not have the information they need to make the best choices. But the biggest drawback of all: the size of the Budget may not cover the therapy their child needs.

Q: How large is a Childhood Budget?

The lifetime Childhood Budget is a function of the age a child enters the program. The formula is children get allocated $20,000 for every year from ages 2-5 and $5,000 for every year from ages 6-17. So a child entering on their 5th birthday would receive a Childhood Budget of $80,000 (12 years @ $5,000 + 1 year @ $20,000).

Note that these $5,000 and $20,000 values do not necessarily represent how much the child can spend for each year — that is governed by a separate set of rules.

The Mar 22 OAP suggested that “need” may enter into this formula, but the government has given no indication on how they will do so.

The Feb 6 OAP had a provision that some or all of this money would be clawed (aka taxed) back based on a family’s income. Those income-testing rules were eliminated in the Mar 22 edition.

It is still unclear on how age is determined in the calculation (age of diagnosis? Age at time OAP paperwork is completed?) In particular, we don’t know how age will be treated for children who were diagnosed and/or received treatment under the previous OAP. Finally, we do not know how partial years will be calculated (what happens if a child’s clock starts at age 3 years, 8 months).

What is an ‘Age Cap’?

The term “age cap” is a holdover from previous attempted Liberal reforms, where kids would “age out” of therapy. In the context of the Feb 6 and Mar 22 OAP, it refers to the fact that years 6-17 are worth less than ages 2-5 in calculating the Childhood Budget. This is highly unpopular with many parents since a child’s needs typically do not experience a 75% drop-off between the ages 5 and 6.

Q. How much of the Childhood Budget can a family spend each year?

A: Short answer: we don’t know.

When the plan was first released, parents had assumed that the amounts that entered the Childhood Budget for each year of a child’s age was the amount that could be spent that year. So if $20,000 flowed into the CB for the child at age 5, and $5,000 for age 6, then the family could spend $20,000 when the child was 5 and $5,000 when the child was 6.

Turns out, that’s not necessarily the case. Buried within the Ontario Autism Program website was this line:

Families will have options in how they receive their budgets. This includes being able to access 20 percent of their remaining childhood budget each year.

The government has not yet provided the list of options, so parents (and service providers) still do not know how the spending rules will work.

Q. What was income testing (a.k.a. means-testing) and the autism tax?

A: Under the Feb 6 OAP, the Childhood Budget varied “based on the length of time a child is in the program and household income”. What this essentially meant was that money was clawed back (or taxed back) from the Childhood Budget, as a family’s income went up.

Although the government typically does not use income testing in health care or education, you could see the logic in what they were trying to do: dollars for autism therapy are scarce, so why not focus support on families least able to pay?

In practice, though, the income test was a convoluted mess, with all kinds of unintended consequences. It considered a family, living in downtown Toronto with 3 kids, where both parents had full-time minimum-wage jobs as being “too rich” to receive full support. The clawback was so steep that it essentially made it impossible for both parents in a couple to have jobs, and caused working Moms to have higher effective tax rates than millionaires.

Fortunately the government saw the error of their ways, and scrapped the income test (a.k.a. “autism tax”) in the Mar 22 OAP.

Q: How much has the government spent on the OAP in the past?

A: In fiscal year 2017–18, they spent $317.8 million. In 2018–19, the (previous) government had budgeted $321.5 million.

One distinction we need to make is between estimated spending at the beginning of the year, and how much was actually spent. Here’s estimated vs. actual for the last 5 fiscal years.

The “estimated spending” numbers come from expenditure estimates made at the beginning of the year. Here’s the Expenditure Estimates for the Ministry of Children and Youth Services (2018–19). The “actual spending” amounts are released a few months after the end of the fiscal year, in the Public Accounts.

Q: If the government spent $317.8 million in 2017–18 and planned on spending $321.5 million in 2018–19, where does the $256 million figure that Lisa MacLeod keeps citing come from?

That’s an ongoing mystery. She and other cabinet ministers have cited this $256 million figure over and over in Question Period:

• Mar. 26: “ Under the previous Liberal administration, they spent $256 million on autism.” [Lisa MacLeod]
• Mar. 25: “ Under the current program, we are extending the funding between $256 million up to $321 million.” [Lisa MacLeod]
• Mar. 7: “The previous government put $256 million in, Mr. Speaker.” [Doug Ford]
• Mar. 6: “ The numbers are available, and we’ve said it many times, that the previous Liberal government’s budget was $256 million.” [Peter Bethlenfalvy]
• Feb. 26: “ That’s why I went to the Treasury Board and secured an additional $102 million, so that we could have an annual spend this year of $361 million and a $321-million spend moving forward, up from the $256 million that the Liberals spent.” [Lisa MacLeod]
• Feb. 25: “When we opened up the file, the previous government had not only bankrupted this province, but they had bankrupted the autism file, to a tune of $256 million. We’re enhancing it by $100 million.” [Doug Ford]
• Feb. 21: “The budget used to be $256 million; I have increased it” [Lisa MacLeod]
• Feb. 20: “ They had funded it to $256 million. We had to run to the treasury for emergency funds of $100 million.” [Doug Ford]
• Feb. 19: “On the announcement day, I did make the commitment that this would be a $321-million investment into families with autism, which is much more than the $256 million the previous Liberal administration had offered.” [Lisa MacLeod]

Given that the pre-election Expenditure Estimates clearly show a value of $321 million, there is an obvious disconnect here.

The most likely explanation for this discrepancy comes from Liberal MPP Michael Coteau (Don Valley East) in an interview with iPolitics:

But Liberal MPP Michael Coteau — the former minister for community and social services — said the holdback is standard practice in government, and the money was supposed to roll out over the year.

“Anyone who’s trying to say that $256 million was the final number, just doesn’t understand how government processes work,” Coteau told reporters on Tuesday. “It’s a farce.”

This mystery still has not been fully resolved.

Q: Will the government spend the entire $321 million a year it has allocated towards the OAP?

When the Feb. 6 OAP was released, based on the information I was given, I was skeptical that the government would spend all $321 million. My estimates has the government spending roughly $100 million less than that, though that was just a rough estimate, since there were so many unknowns in the plan.

In the Mar. 22 OAP, the government eliminated income testing, which raises the cost of the program considerably. With that move, I believe $321 million in a plausible estimate of the program’s costs, particularly since there are still so many unknowns.

Q: Now the government is saying that they will double the yearly OAP budget, from $321 million to $600 million. How will that extra money be used, and where will it come from?

A: Nobody knows.

Q: Really, nobody knows what the government has in mind. In a recent update I speculate that the government many consolidate several existing programs. But that’s just speculation. The government has given no hints on what it will do, so everyone is just guessing.

Q: Where can I learn more?

Here is a list of Ontario government sources:

• Program details from the Ministry of Children, Community and Social Services.
• Transcripts from Question Period.
• Feb. 6 Press Release: Helping Families by Improving Access to Autism Services.
• Feb. 6 Press Release: Ontario Takes Decisive Action to Help More Families with Autism.
• Feb. 6 Press Release: Electronic Press Kit Now Available: Ontario Takes Decisive Action to Help More Families with Autism.
• Feb. 7 Press Release: New Ontario Autism Program Draws Support From Across the Province.
• Mar. 11 Press Release: Ontario Continues to Support Students with Autism.
• Mar. 22 Press Release: Ontario Enhancing Support for Children with Autism.