Section 22 - Health Needs
Policy
Infant Formula Program for HIV Mothers and Infants (PDF 117 KB)
22.1.1 Health Services Program
Policies
Form
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
Policy
22.1.3 Test of Need
22.1.4 General Assistance Participants
22.1.5 Participants with Alternative Health Coverage
22.1.6 Health Card Only
22.1.7 Single Grant
22.1.8 (deleted)
22.1.9 Hospital Patients
22.1.10 Personal Care Home Residents
22.1.11 Rewarding Work Health Plan
Policy
Rewarding Work Health Plan (PDF 152 KB)
All EIA participants who have found employment and no longer require or are eligible for income assistance, may be eligible for up to 24 months of EIA prescription drug, dental and optical coverage under the Rewarding Work Health Plan (RWHP). The Provincial Services Branch of Family Services is responsible for the administration of eligible health benefits to individuals receiving the RWHP.
To be eligible for the RWHP, participants must
- have employment income as defined by the program (i.e., income that is subject to earnings exemption) at the time the income assistance case closes. This would not include income like training allowances, employment insurance benefits and CPP benefits;
- Have been enrolled on income assistance for three consecutive months under the single parent or persons with disabilities categories in order to receive this benefit for the first time.
- Have been enrolled on income assistance for six consecutive months under the General Assistance case category in order to receive this benefit for the first time.
- If these participant groups return to EIA and then secure other employment, there is no monthly income assistance enrolment prerequisite and these participants may immediately receive the RWHP upon EIA case closure.
The RWHP is not available to participants leaving EIA to employment who are eligible for First Nations Non-Insured Health Benefits (FNIHB). However, if some members of the household are not eligible for health coverage under FNIHB, the RWHP may be considered for eligible household members where other RWHP enrolment conditions have been met.
Eligibility for the RWHP is based on participants leaving income assistance due to/with employment earnings. There is no ongoing income test required while participants are receiving this benefit.
RWHP participants who move out of Manitoba must advise the Provincial Services Branch and they will no longer be eligible for prescription drug, dental or optical coverage.
Participants who become eligible for alternate supplementary health benefit coverage must also advise the Provincial Services Branch. These participants will be expected to use their new health benefit coverage first, but may be eligible for a supplement from RWHP up to coverage levels allowed by EIA.
RWHP coverage will end when participants have received the benefit for 24 consecutive months. Provincial Services will forward an advance letter to participants notifying of the pending RWHP expiry.
Participants receiving the RWHP are also eligible to receive Rent Assist, Manitoba Child Benefit, and 55Plus income supplements.
22.1.12 Drug Purchases - By Cash
22.1.13 Prescription Drugs - Control Procedures
- 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. - 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.
- The participant's explanation is obtained and documented in Case Notes on the EIA file.
- 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.
- The following procedures must be completed by EIA staff when suspending automatic prescription drug authorization:
- The Provincial Drug Program is notified of the decision.
- The participant is notified of the decision in writing.
- The participant is advised they must select one general practitioner and one pharmacy for further drug purchases.
- The Income Supplement Management Information Network (SAMIN) is updated so that future Health Services cards will not be automatically issued to the participant.
- EIA will complete a bring-forward for one year to review the case to determine if automatic coverage should be reinstated.
- The EIA Director or designate and the Manager of Investigations may decide to pursue prosecution following the review.
22.1.14 Chiropractic Treatment
Forms
22.2.1 Physicians' Fees
Medical assessments or reports
- the medical examination is required to determine or review eligibility for income assistance under the disability category or,
- 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.
Transfer of Medical Files
Tray Fees (also known as Uninsured Disposable Supplies)
22.2.2 Out - of - Province Medical Costs
Policy
22.2.3 Extra Billings from Physicians
22.2.4 Out-Of-Province Medical Premiums for New Arrivals to Manitoba
- 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.
- A written statement of the premium status of the new arrival should be obtained from the province of origin.
- 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
Form
- physicians,
- registered dieticians,
- psychologists,
- registered physician assistants,
- registered nurse practitioners,
- registered psychiatric nurses,
- licensed practical nurses,
- registered nurses,
- midwives,
- registered Social Worker,
- registered occupational therapist, and
- mental health worker (non-regulated, must be directly involved in client care).
- appointment card,
- list of scheduled treatments, or
- medical lab requisition form
- Public transportation (bus, train, or airplane) or participants own vehicle chargeable at the equivalent rate of the cheapest available public transportation;
- 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. - If methods 1 and 2 are not available, a licensed carrier (taxicab) at approved prevailing rates.
- If methods 1, 2 and 3 are not available, a privately-owned vehicle at the rates indicated above under point 2.
- Privately-owned vehicles cannot be legally hired when a licensed carrier is available in the area.
- 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.
- when the physical or mental condition of the participant makes it impossible to use public transportation (e.g., a person using a wheelchair, etc.);
- 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;
- in emergency situations;
- when groups of participants might be able to use taxis, private vehicles, etc., more economically than by individually using public transportation; and\or
- when rural participants are not able to use an urban bus system.
Approval of Costs for Medical Escorts
Wherever possible, participants should seek out family or friends to act in this escort role. Where the assistance of family or friends is not an option and participants are required to access medical escort services provided by community-based health care providers, EIA will consider costs associated with the escorts’ transportation and meal-related costs/needs only. Hourly rates charged by medical escorts for their time will not be covered by EIA. Participants are responsible for these costs and may consider paying for them using their monthly Income Assistance for Persons with Disabilities (IAPD) benefit or other exempted sources of income.
The department may consider costs for medical escort meals (see Section 22.3.7) and accommodations for MHSAL-approved out-of-province medical treatment where a medical escort is also assessed as required to support participant needs. MHSAL is responsible for the to-and-from transportation costs of the medical escort in these instances.
Personal Care Home Residents
EIA may consider costs for health-related transportation and meals (where required) for both EIA personal care home residents and their medical escorts to attend essential health/medical appointments outside of the personal care home that are not paid for by MHSAL. These costs may be approved as a health need following standing EIA health transportation and travel meal guidelines and rates (see Section 22.3.1 and 22.3.7). However, hourly rates charged by medical escorts for their time will not be covered by EIA and are the responsibility of each participant.
Costs for medical escorts accompanying participants for trips to attend medical appointments occurring in hospitals are the responsibility of the personal care home as an insured health service providing residents are expected to return from these appointments to the personal care home within 24 hours.
Control of Possible Abuse
22.3.2 Wheelchair Transportation - Medical and Related Activities
Policy
Paying Taxi Invoices - Wheelchair Transportation (PDF 130 KB)
Form
Taxi Invoice (PDF 140 KB)
Medical Appointments and Related Activities
- 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. - 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 - 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: 204-945-8919
Handi-Transit
- Handi-Transit should be booked at least 3 - 7 days in advance when participants have prior notice of an appointment or event.
- Participants should schedule medical appointments for times Handi-Transit is available.
- Private wheelchair transportation for medical appointments should be authorized one-way only if Handi-Transit is available for the remainder of the trip.
22.3.3 Emergency Health Transportation
Northern Manitoba
Southern Manitoba
- 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
Social Trips - Winnipeg and Brandon Only
Social Trips - Outside of Winnipeg and Brandon
22.3.5 City of Winnipeg Ambulance Department
22.3.6 Transportation to Evaluation Training Centres
22.3.7 Traveling Meal Allowances
Breakfast | $3.60 | $4.00 |
---|---|---|
Lunch | $5.30 | $5.80 |
Dinner | $8.30 | $9.10 |
22.3.8 Inter-Municipal Livery Rates
Round Trip
One-way Trip
Waiting Time
22.3.9 Telephones for Health and Safety Reasons
- physicians,
- registered dieticians,
- psychologists,
- registered physician assistants,
- registered nurse practitioners,
- registered psychiatric nurses,
- licensed practical nurses,
- registered nurses,
- midwives,
- registered Social Worker,
- registered occupational therapist, and
- mental health worker (non-regulated, must be directly involved in client care), or
- on the written approval of the EIA director or designate.
- 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;
- 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
- 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
Policies
Form
- 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.
- Where the equipment is not covered by the Home Care Program, i.e. walkers, raised toilet seats, bath bars, urinals and bedpans, Disability and Health Supports Unit may approve the purchase of such items based on the recommendation of a medical professional.
- For EIA participants who are not receiving services from the Home Care Program, Disability and Health Supports Unit would reference the standard base Home Care list as a guide to approve the purchase of medical supplies or equipment.
- Disability and Health Supports Unit, are to forward all approved orders for medical equipment and supplies to the Materials Distribution Agency (MDA), a special operating agency of Manitoba Government Services. All orders should be made using the appropriate and approved administrative forms and sent to:
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: 204-945-5077 - Medical supplies and equipment not immediately available will be secured by MDA through agreements with relevant health equipment/supply vendors.
- 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 Manager - Disability and Health Supports Unit for approval, regardless of the cost of the item to be purchased.
- Hospital discharges must not be delayed when the necessary equipment and supplies required at the time of discharge are not in stock at MDA, or if adequate discharge planning time is not available. In these instances, MDA will secure the required equipment and supplies from the first available vendor for the immediate use of the participant being discharged.
Specialized Supplies and Equipment
All Manitobans living in personal care homes or other institutions are responsible for obtaining their own wheelchair, unless they have been loaned a wheelchair from the MWPat least six months before entering the institution. If individuals were loaned a wheelchair prior to entering the institution, they may continue to use and have it serviced by the MWP. In situations where EIA participants living in personal care homes or institutions require a wheelchair, the EIA program may consider funding the basic and essential wheelchair equipment through the MWP.
The MWP manages the equipment pool of wheelchairs provided by either MWP or purchased by the Department for eligible EIA participants. When participants no longer require their wheelchair, they, or EIA staff are to contact MWP at the below to co-ordinate the return of the wheelchair to the MWP equipment pool.
TTY: 1:800-856-7934; TTY: (204) 975-3239
- The DHSU provides funding for one seating system per client
- Seating components may be replaced if:
a. changes in the client’s anatomical measurements support the size change
b. there are significant changes to the functional, postural or medical status of the client
c. there is significant wear of the current seating system that places the client at risk - Seating components will not be replaced:
a. if the current seating is assessed as continuing to meet client’s postural and functional need
b. to accommodate client’s preference
c. if the items are lost or stolen.
Wheelchair Elevators, Lifts and Ramps
Manitoba Health does not supply these items:
Prosthetic and Orthotic Devices
Request Procedure for Emergencies
Eligibility
Continuous Positive Airway Pressure (CPAP) Machines and Related Consumables/Supplies
The CPAP machine co-payment requirement is not waived for EIA participants and may be provided as a health need where eligibility criteria are met. Requests for single grants to meet the CPAP co-payment costs by Manitobans who are not financially eligible for income assistance are not to be considered.
The Disability and Health Supports Unit is responsible for the review and approval of CPAP prescription from the SDC for EIA participants as well as the administration of CPAP-related co-payment and ongoing consumable requirements for EIA participants found eligible for CPAP coverage.
22.4.2 Supplies and Services - Personal Care Home Residents
- Minor mending of clothes (e.g., seam repairs, replacing buttons, etc.)
- General laundering of clothing
- Prescribed drugs and over-the-counter preparations approved by Manitoba Health
- Food, including special and therapeutic diets, dietary supplies, thickeners and nutritional supplements.
- Supplies required for general personal hygiene (e.g., soap, perineal cleanser, barrier products, shampoo, denture cups, toothettes) excluding over-the-counter products approved by an alternate provincial drug program.
Medical Supplies
- Diabetic supplies
- Medical nursing supplies (e.g., wound managements supplies and dressings, compression dressings, venous ulcer treatments, catheters, needles, syringes, diagnostic and testing materials, ostomy supplies and tube feeding supplies)
- Disinfectant and antiseptic preparations
- Incontinent care aids (as determined by individual resident PCH assessment)
Medical Equipment (note: for use by, or transferrable to, more than one resident)
- Overhead trapeze bars
- Mechanical lifts and slings sliders
- Transfer belts
- Basic walkers and crutches for short-term use
- Therapeutic and pressure-reducing mattresses
- Raised toilet seats
- Commodes
- Restraint devices
- Transport wheelchairs
- Oxygen, regulators and oxygen concentrators
- Fall mats
- Bed and chair alarm systems
Needs not provided by personal care homes and which are the responsibility of the individual include:
Personal Consumption Items
- Major repairs and alterations to clothing
- Purchasing and labelling of clothing
- Dry cleaning of clothing and other privately-owned items such as rugs, drapes, bedspreads and blankets
- Alcoholic beverages and tobacco products
- Cosmetics and deodorants
- Hairdressing and haircuts
Medical Equipment (for individual use)
- Support hose
- Hearing aids and batteries
- Dentures and denture adhesives
- Eyeglasses
- The following items when they are purchases solely for one resident's use and remain the property of that resident: canes; walkers; crutches; wheelchairs and wheelchair repairs; pressure cushions; slings for mechanical lifts; specialized seating; and, transfer poles.
- Repair and preventative maintenance cost associated with equipment owned by the individual
Medical Supplies (for individual use)
- Incontinent care aids when the resident prefers a brand that is different from those care aids provided by the personal care home
- Non-prescription biologics and related preparations such as skin care powders, lotions, creams, ointments, jells, cleansers, throat lozenges and non-prescription eye drops and when the resident prefers a biologic brand that is different than what is provided by the personal care home
- Portable oxygen for outings other than approved recreation programs.
Other Personal Health-Related Services
- Services performed by a chiropodist or podiatrist
- Services performed by a chiropractor that are not covered by Manitoba Health Services
- Acupuncture
- Television and radio services
- Insurance for personal belongings
- Transportation costs when not covered as an insured benefit
- Transportation and meal costs for medical escorts accompanying participants to essential medical appointments when not covered as an insured benefit by Manitoba Health, Seniors and Active Living.
22.4.3 Chiropody, Podiatry, Foot Care Services, Orthopaedic Footwear and Foot Orthotics
Policy
Orthopaedic Footwear and Foot Orthotics (PDF 294 KB)
Form
Orthotics Preauthorization / Claim (PDF 106 KB)
Podiatry, Chiropody or Foot Care Services
- 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.
- At a rate up to $32.00 each visit; and
- To a maximum of nine visits per fiscal year.
Orthopaedic Footwear and Foot Orthotics
22.4.4 (deleted)
22.4.5 Radioisotope Material for Nuclear Medicine Examinations
22.4.6 Hearing Aids
Form
Hearing Aid Rates Payable
- hearing aid: landed invoice cost to a maximum of $500.00 per hearing aid; $1,800 per digital/programmable hearing aid
- dispensing fee: $250.00 (in the case of binaural hearing aids the dispensing fee for the second hearing aid is $150.00)
- taking ear impressions: $20.00
- ear mould: landed invoice cost to a maximum of $48.00 per ear mould (includes checking the fit and efficacy of the ear mould)
- 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 - impedance audiometry: $14.85
- 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 - 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
- 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
- validation testing where appropriate sound field test equipment or other accepted means are available: $29.85
- electroacoustic test
monaural: | $14.85 |
binaural: | $28.75 |
Replacement of Hearing Aid
22.4.7 Family Support Program
22.4.8 Winter Boots
22.4.9 Supports for Participants Enrolled in an Approved Program to Address Addictions
Policy
Single Parents and Persons with Disabilities
- 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).
- 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.
- 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.
General Assistance Participants
- 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).
- 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.
- 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.
All Participant Groups
- treatment appropriate for an individual’s needs not available in local community;
- participant’s privacy is in jeopardy as a result of the location of the group;
- participants’ sponsor or other support unable to attend programming in the participant’s local area; and
- participant is experiencing a crisis that is impacting on the progress of his or her recovery.