Ontario government promises help for families falling through the cracks due to OHIP+ changes
Thestar.com
May 6, 2019
Rob Ferguson
Families falling through the cracks after recent changes to OHIP+, including parents stuck paying hundreds of dollars monthly for specialized infant formula, can expect help from the government, says Health Minister Christine Elliott.
“We don’t want people to be in a worse situation,” Elliott said Thursday of the April 1 changes, which made private insurance plans the “first payer” for all claims to save an estimated $250 million a year.
Ontario Health Minister Christine Elliott announces the Government of Ontario's plan for long-term health care system at Bridgepoint Active Healthcare in Toronto on Feb. 26, 2019. On May 2, Elliott said help is coming for families falling through the cracks after recent changes to OHIP+.
“We’re going to resolve it, absolutely,” she promised, acknowledging that the formula issue is one of the main snags with the change from the previous Liberal government’s OHIP+ plan that provided universal coverage.
A fix can’t come soon enough, said a Niagara Falls mother whose 7-month-old son requires $700 a month in specialized nutritional formula free of milk proteins.
“There are a lot of families out there like ours,” said Kelsey Vettor, whose boy Ryker vomits if fed normal milk-based formula because of a severe dairy allergy.
His formula, Puramino A+, costs $67 per can for a total cost of about $700 monthly which Vettor and her fiancé are paying since OHIP+ no longer covers it.
“It’s a lot of unexpected money,” Vettor told the Star in a telephone interview. She first learned of the extra cost when her fiancé went to a hospital pharmacy to get the formula in early April and was told he would have to pay upfront.
New Democrat MPP France Gelinas, her party’s health critic, said specialized formulas used to be covered under a separate government program that was then rolled into OHIP+.
The April 1 change has left families in a “bureaucratic nightmare” for formula and other prescriptions because parents must now prove to the government which medications their private plans don’t cover, added Gelinas (Nickel Belt).
“These changes to OHIP+ are way bigger than just the infant formula,” she said.
“It is becoming so difficult that it’s bringing in huge delays so the parents are paying up front because they can’t stand to see their kids sick. If you do this, then OHIP+ doesn’t pay you back for all of those months that you have been paying while trying to fight the government.”
Gelinas also said families who reach spending limits under their private drug plans are now also “on the hook” for prescription costs once the cap is reached.
The health ministry is working with insurance companies and other players to iron out snags in the new system, Elliott said.
“We’re following up to understand exactly what the problem is,” she added, not providing a time line for remedies. “This will be the government that will fix it.”
Green Leader Mike Schreiner said his office in Guelph has also heard from families experiencing problems getting the medications they need.
“I’ve had constituents reach out with concerns they were covered before and now they’re not being covered. It seems people are falling through the cracks and it’s something the ministry needs to address.”
The changes to OHIP+ were quietly announced on the Canada Day weekend after Premier Doug Ford’s Progressive Conservative government was sworn in following its landslide defeat of Kathleen Wynne’s Liberals in last June’s provincial election.
At the time, Elliott said in a press release that “Premier Ford promised the people he would find efficiencies without compromising service or jobs.”
The idea was to focus benefits “on those who need them the most,” the government added in an online posting this January as efforts were underway tp create the revised OHIP+ with insurers and pharmacies in time for the April 1 implementation.
