N.W.T. gov't moving ahead with changes to extended health benefits despite pushback

While the N.W.T. government says its upcoming changes to the extended health benefits program will make it more equitable, critics say those same changes will do the opposite.

In its current form, the program helps cover costs of prescription drugs, medical supplies and equipment that aren't eligible for coverage through third-party insurance.

Two significant changes include an income assessment to determine eligibility for the program and doing away with the current specified disease conditions list. The list includes about 50 conditions that currently guarantee coverage under the program.

Denise McKee, executive director of the NWT Disabilities Council, agreed that the program needed change. The council also wanted the list removed and the program expanded to allow for more people to access it.

But the incoming changes, she says, have done the opposite.

"We are being marginalized more," McKee said.

Income threshold unclear

With the change, the territory will introduce a low-income threshold. If residents fall under that threshold then they qualify for coverage of drugs, dental, vision, and medical supplies and equipment.

If residents are over that threshold then they will need to pay a portion of the costs; they're also not eligible for dental or vision coverage. The territory has released a calculator for residents to get an idea how much it may cost them and a Q&A on the changes.

However, the territory has not yet said what that income threshold will be.

A discussion paper that went out for feedback put it at $32,602 annually, with an additional $9,451 per dependent.

Stacy Ridgely, director of policy, legislation, and intergovernmental relationsfor the Department of Health and Social Services,said those numbers will be adjusted in relation to the Northern Market Basket Measure.

"People shouldn't be married to those numbers, not that they'll change that much," said Ridgely.

Despite the "What We Heard" report noting that respondents thought the threshold was too low, Ridgely said the department is using the Northern Market Basket Measure to be in line with other government services that use that for income testing, including income assistance.

Eligibility will be based on someone's income statement from the previous year again, similar to income assistance. Ridgely said it will be possible for someone to be reassessed if someone's income changes significantly.

It's also not clear whether the threshold will be adjusted for each region.

"We want to do that, but it's really a matter of trying to figure out if we can do that easily," said Ridgely.

"The majority of people that would be accessing this program would be in the hubs."

However the threshold is set, McKee said it won't fully capture the additional costs that often come with living with a disability ranging from additional power costs and home modifications, to specialized child care and adaptive clothing.

The N.W.T. Pharmaceutical Association has called on the territorial government to give residents on the specified disease condition list one-year's notice of how the changes will affect them,"to allow time to adjust for the increase in health care costs."

Ridgely says the territory is "hoping to have it done a few months out so that people can make appropriate decisions and adjustments."

The new policy kicks in on April 1, 2024, followed by a transition period.

Equity, not cost-saving, says territory

Last year, Julie Green, outgoing minister of health and social services, told Cabin Radio the health department had a growing $190-million deficit.

"At some point we have to stop giving things away to people who can afford them, and this is that moment," she said at the time.

The territory's latest budget shows extended health benefits cost $13.3 million.

McKee said that view was "disconnected" from the reality of those living with a disability in the territory.

"We have people that are middle class that spend much of their resources on costs that are necessary because of their disability and none of that will be considered," she said.

Ridgely said the changes were not brought in as a way to save money.

"It's a public policy shift," she said. "We wanted to be able to provide residents of the Northwest Territories with an equitable array of extended health benefits so that we're on an even playing field."

She added that the changes may end up costing the territory more than the program's current iteration.

Through its engagement period, the territory received 729 responses on its proposed changes to the program. Just over half of respondants 51 per cent either disagreed or strongly disagreed with the proposed changes, 40 per cent either agreed or strongly agreed, and nine per cent were neutral.

With hundreds opposed, why is the territory still moving ahead with these changes?

"All the people that responded were the people that were on the specified disease list," said Ridgely.

"So we didn't get a lot of respondents from people who weren't on it, people that have been, you know, denied or didn't have access to this program before because they weren't on a very limited list."

She maintained that the new iteration of the policy will be more fair and equitable for residents.

By doing away with the list,McKee is concerned some residents who previously had their drugs and other supplies covered by the government may turn to third-party insurance which can often be expensive if you have a pre-existing condition.

Ridgely said there's no requirement for residents to get third-party insurance to be eligible for extended health benefits.

"It depends on what the drugs are that you're being covered for and then we sort of go from there," she said.

"The most that anyone would ever pay is about four per cent of their net income," she added.

Part of the problem, said McKee of the Disabilities Council, is that it's not clear how many people will be affected by the changes.

In its discussion paper, the territory stated about 2,200 residents don't have access to benefits through an employer or other government plans.

Ridgely said there were many factors that affect who is eligible under the program's incoming iteration.

"It's not easy to put a firm number on that," she said.

The changes will not affect those eligible for non-insured health benefits, Mtis health benefits, or extended health benefits for seniors.