The NWT government says it has finalized a new approach to health benefits for some people that was heavily criticized when it first emerged as a draft proposal.
The Extended Health Benefits policy, which covers thousands of people who can’t access health coverage through work or other forms of government insurance, will now be transformed from April next year.
According to the territorial government, the revised policy will introduce a means-testing process for everyone accessing the policy except seniors.
Income testing will determine how people are helped to pay for prescription drugs, eyewear, dental treatment, medical equipment and some medical travel – things basic NWT health coverage does not cover.
From September 2022: What’s going on with the GNWT proposal to change health benefits?
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“This ensures that benefits are allocated based on individual income levels, promoting fairness and equitable access,” the territory stated in a Thursday news release.
Another major change removes the requirement that a person must have one of a specific set of diseases or conditions to access benefits.
Earlier this year, critics said that change would take benefits away from some people with serious existing conditions.
The Specified Disease Conditions program, some people argued, guaranteed coverage if you had a serious or chronic condition on the program’s list and could not cover the costs through another form of insurance. The proposed new system, they said, would require people to take out health insurance – which can be expensive if you have an existing condition – and pay premiums and co-payments to help meet the cost of some treatments, rather than having those costs fully covered.
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More than 70 percent of respondents to a GNWT survey disagreed with the suggestion that people who earned more than the program’s low-income threshold (projected at the time to start at $32,601, then rise according to family size) should have to purchase private insurance – and exhaust $3,000 of that insurance program’s drug benefits annually – before being eligible for NWT government drug benefits.
On Thursday, the GNWT said it had relented on that front.
The finalized program includes “removal of the requirement for residents to purchase third-party insurance and exhaust its drug benefits before being eligible” for drug benefits under the policy, the territory stated on its website.
The GNWT said the final policy also allows “access to medical supplies and equipment benefits through a cost-sharing model, along with reasonable family maximums.”
“The new policy offers a range of benefits, each with its own eligibility criteria and levels of coverage. This approach provides flexibility and accommodates diverse healthcare needs, allowing individuals to access the specific benefits that are most relevant to their circumstances,” the territory asserted.
Thresholds and cost-sharing
Defending the proposed policy last year, health minister Julie Green said the territory’s finances could only stretch so far.
“Our health system has a $190-million deficit that is increasing by about 20 percent a year. At some point we have to stop giving things away to people who can afford them, and this is that moment,” the minister said, explaining why income testing would be important.
A Q&A on the GNWT’s website – accompanying Thursday’s launch of the new policy, which doesn’t kick in until April 1, 2024 – attempted to explain some of the financial nuances.
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Income testing will be required for each “benefit period” lasting July 1 to June 30. (What happens between April 1 and July 1 in 2024 wasn’t immediately clear. “Work is under way to ensure a smooth transition,” the territory stated.)
The policy’s initial income threshold, below which residents not covered through other insurance can access support at no cost, has not yet been published.
The territory says it will use the Northern Market Basket Measure, a Statistics Canada product used to estimate poverty in the NWT, as a guide when setting thresholds for health benefits under the new policy. The thresholds will be updated annually.
“If your income is below the low-income threshold, you won’t have to pay anything for dental, vision, prescription drugs and medical supplies and equipment benefits. These benefits are available to you without any cost. Adjustments will be made to this threshold to account for family size,” the territory stated.
Cost-sharing payments for people over the income threshold involve paying a deductible first, then paying 30 percent of any drug costs above the deductible until you hit an annual cap, after which the GNWT covers everything. Again, the dollar value of that cap – known as an “annual family maximum” – was not immediately set out. A similar system will exist for costs of other medical supplies and equipment.
The Extended Health Benefits policy applies only to people with a valid NWT healthcare card who aren’t eligible for the Métis Health Benefits or Non-Insured Health Benefits programs. You’ll also be told to ask your employer to cover things before you rely on Extended Health Benefits.
