While doctors were up in arms over the federal budget’s changes to the capital gains tax, many overlooked an announcement with far more consequence for their low-income and socially marginalized patients – one that will place an immediate burden on our already stretched work lives.
The budget included $6.1 billion in funding over six years for the long-in-development Canada Disability Benefit (CDB), and the curtain was lifted on some specifics of how the program will work. For many in the disability rights community and their supporters, the reveal fell far short of the government’s promise of an inclusive “Nothing Without Us” approach to program design. It ignored almost every recommendation people with disabilities and experts had offered during years of consultation.
The amount being offered to some people with disabilities, $200 per month, is a drop in the bucket in a time of high inflation, rising rents and significant added costs to living with a disability. This meagre funding reveals a government uninterested in supporting people with disabilities to live with dignity and escape poverty.
Of even greater concern, however, is the choice of the Disability Tax Credit (DTC) as the gateway to the new benefit. Using the DTC will severely limit access to the program, especially for those who are low income and socially marginalized, and it will place an unnecessary and time-pressured burden on physicians. Doctors should join people with disabilities in protest.
The disability benefit will be available only to people with a valid DTC certificate, making it one of the most difficult government disability support programs to access. Disability Without Poverty, an advocacy group, estimates there are 1.6 million Canadians with disabilities living below the poverty line yet the budget itself says only 600,000 will qualify for the new benefit.
The program rests on a definition of disability that is predominantly medical and sets an unnecessarily high threshold. While contemporary understandings of disability increasingly focus on the social barriers to participating in society and their impact on day-to-day function (think a lack of ramps to enter buildings or inflexible or nonexistent workplace sick day policies), the DTC looks mainly to medical diagnoses and single organ system dysfunction. Furthermore, it demands a severe level of impairment at least 90 per cent of the time, which does not account for the many disabilities that fluctuate in severity or whose moderate impairments raise high barriers to social and workplace inclusion.
This definition will exclude many people from necessary income supports. The structure of the DTC, however, poses even more barriers to access. To date, it provides only a non-refundable tax credit, meaning it only benefits higher income people who pay taxes.
It provides only a non-refundable tax credit, meaning it only benefits higher income people who pay taxes.
It also requires a lengthy and complex form to be filled out by a physician or other health provider, without government payment for its completion. Many physicians charge for this service, once again making it unlikely that lower income people, let alone the millions of Canadians without a primary care provider, have applied.A huge catch-up in applications will be required – possibly on the order of several million – ideally to be completed in the next year, before CDB payments begin in July 2025. Given the complexity of this form, that could mean several hundreds of thousands of hours of physician time to support entry to this program. It is hard to understand why the government would choose to place this burden on an overstretched health system.
The irony is many of those who are most in need of this supplement have already been assessed by health providers and have been determined to have a disability by expert government assessors. Anyone who receives provincial disability social assistance or a federal disability support such as the Canada Pension Plan-Disability already has undergone an extensive process of assessment and approval for disability income supports. A federal government whose priority is to urgently provide support to people living with disabilities in highest need could easily offer this benefit to those already approved for these programs. That may not capture everyone who needs these funds, but it would go a long way toward immediately offering support to people with disabilities living in the deepest poverty.
Doctors and our national and provincial organizations should rise up in unison to push for a change to the structure and funding of the CDB. After years of consultation, the government is offering a program that is inadequate, inaccessible and inequitable while asking health providers to serve as its gatekeepers. This is unacceptable, unconscionable and will exacerbate health inequities.
While this advocacy takes place, however, we need to make sure we are doing everything we can to support our patients living with disabilities. This means assisting every one of them to apply for the DTC, lowering barriers by not charging for this form completion, and proactively reaching out to patients to encourage them to apply.
Even an inadequate $200 per month is essential to people living in deep poverty; we must provide urgent, direct support to these individuals with one hand while advocating for better with the other.
the problem in part is provinces already they little to no law to stop provinces from just clawing back those funds the DTC is they only way they can deliver the funds to people as it is. and BC for example this year i think is the 1st year you were not forced or threatened to applying for CPPD to be clawed back as it is the Federal Govermeent in a way is already paying 600+ to provinces pay for disabled people those that Clawback scam something that if you didnt apply to the provinces would make you reaply for disability benifits every year until you agree to apply for CPPD then they magicly decided to stop making you reaprove. Govemerments have a histroy a proven one of spiting on the diabled when it comes time BC spent millions going around asking what people needed then the proceded to ignore it all and do nothing for years.
I agree with the sentiments expressed by Dr. Bloch. The Ontario Medical Association should champion this issue more vocally. Poverty amongst the disabled was clearly an issue over two decades ago, obvious in my oncology practise. We have legislated poverty amongst the most vulnerable in Canada and have been much too quiet about it. It’s THE most important health issue among Canada’s disabled community. Eligibility for the Benefit should include all current recipients of provincial and territorial disability support programs.
I would like to share a few nuances of the Disability Tax Credit (DTC), as someone who has been disabled since 1998 and also a physician. The application has gone through a few iterations during this time. Most notably has been the addition of the cumulative effects of disability section and a more comprehensive mental health section. It recognizes that individuals may experience impairments in multiple systems/organs and not meet the high threshold requirement in any one criteria, yet still be disabled per federal criteria. This section also permits describing individuals with intermittent disability as in Multiple Sclerosis. The best approach for physicians, is to complete every section of the form for any degree of impairment (regardless of individual thresholds). The multiple impairments can be described fuller in the cumulative effects of disability section. This is the most important section in 2024. Finally, it can only help to include a narrative report about the patient’s disability and impact on function. Include as much relevant objective imaging, lab reports and specialist reports as possible.
The benefits to holding the DTC is beyond tax savings. Successful applicants can open a Registered Disability Savings Plan. The CRA normally provides a generous retroactive declaration of the DTC. For every year an individual is deemed eligible for the DTC, he/she is eligible for: 1) Tax Refund – The CRA will automatically recalculate filed returns and issue a refund cheque. This benefits anyone who was working prior to becoming disabled. Often, years have elapsed before an application has been made for the DTC. 2) Up to a $1000 retroactive Bond per year (eligibility to age 49; lifetime maximum of $20,000) and 3) Matching contribution grants up to $3500 per year (others can contribute on behalf of the RDSP holder; eligibility to age 49; lifetime maximum $70,000). The last two benefits may be carried forward to age 49. Some banks offer self directed plans (TD Webbroker and National Bank) while other banks restrict clients to investing in proprietary mutual funds with high management expense fees.
Finally, the Canada Disability Benefit legislation recently announced includes funding for physicians. There should be no need to charge patients to complete application. This was a most significant barrier for patients to even bring up the topic with their physicians. With that degree of poverty, even a hundred dollars seems like an insurmountable amount.
Thank you, Dr. Leighton, for your thorough clarification. Much appreciated.