December 2016

9.1: Reviewing Eligibility

Legislative Authority

Sections 7(3) and 39(2) of the Act.

Section 14, 23, 30, and 33 - 35 of Regulation 134/98.

Section 4 of Regulation 135/98.

Audit Requirements

Financial and participation reviews are completed in accordance with provincial standards.

Documentation is on file to support decisions made.

Files clearly indicate current circumstances of the individual/case with respect to eligibility requirements such as the budgetary needs and available assets or income of the recipient, spouse and dependents in the benefit unit.

Third party verification of eligibility related information (e.g., income and assets) provided by the applicant is completed and documented.

All Participation Agreements (PAs) are complete and current for participants with active or deferred participation requirements (i.e., all PAs have bring forward dates and no date has passed without a review occurring).

The participation activities of recipients reflect current requirements.

A signed copy of the Rights and Responsibilities form is retained on file and a copy provided to the recipient.

Application of Policy

Staff are responsible for reviewing a recipient’s circumstances to ensure that the recipient is meeting his/her requirements for eligibility. This includes a financial eligibility review and participation review. Reviews should be completed in accordance with established timelines and processes.

In addition, staff should regularly monitor eligibility to ensure any changes in a recipient’s circumstances that affect eligibility are identified in the month that they occur. Every effort should be made to ensure that the recipient receives the correct amount of assistance and that overpayments are avoided (see Directive 9.3: Recovery of Overpayments for more information).

A process must be in place for recipients to report changes in their circumstances. The delivery agent is encouraged to reinforce the responsibility of the recipient for reporting changes that may impact on eligibility for assistance. Decisions regarding eligibility for financial assistance are communicated in a format and manner approved by the Director within five days following notification of the change.

The income reporting period for eligible Ontario Works recipients has been determined by the Director to be the 16th of one month to the 15th of the following month when calculating monthly entitlement.

Decisions about compliance with participation requirements should be fair and consistently applied.

Financial Eligibility Reviews

Eligibility Verification Process

The Eligibility Verification Process uses a risk-based approach to reviewing Ontario Works recipients’ ongoing eligibility for financial assistance.

The Eligibility Verification Model (EVM) will identify cases in which there is a high likelihood that there has been a change in the recipient’s financial eligibility, which has not been reflected in the amount of assistance issued. Each month, a percentage of the cases (3%) identified as high risk will be assigned to staff for review.

In the review, staff must critically analyze and interpret third party consumer credit and EVM output information to determine if the recipient continues to meet eligibility requirements and whether a change in the amount of assistance issued is required.

Application for Assistance (Part 1) Updates

Updates to Part 1 of the Application for Assistance must be completed on all cases at a minimum of once every 24 months to determine whether a recipient continues to be eligible for assistance. More frequent updates may be appropriate where there is reason to believe that the information in the Part 1 is inaccurate or out of date.

Updating Part 1 of the Application for Assistance involves reconfirming the recipient’s circumstances, including living arrangements, financial information and other eligibility related information. Updates may involve third party verification of information provided by the recipient.

Note. For cases being referred to the ODSP, staff are required to update Part 1 of the Application for Assistance where an update has not occurred within 3 months of the date of referral (see Directive 2.4: Referrals to the Ontario Disability Support Program).

Third Party Verification

Eligibility reviews include third party checks, which are completed to verify eligibility related information provided by a recipient.

Third party checks include requests from the following:

  • Ministry of Transportation. where there has been a history of vehicle ownership or changes in address
  • Equifax Canada. asset verification
  • Family Responsibility Office. child and/or spousal support payment information
  • Canada Revenue Agency. income verification and other eligibility related information
  • Employment Insurance. where there has been a history of employment and potential eligibility for Employment Insurance benefits

Additional requests may be made, as required, to obtain or verify eligibility related information on behalf of the applicant or any other member of the benefit unit.

Participation Reviews

Participation reviews are conducted on a regular basis to ensure recipients are meeting their eligibility requirements and are making progress toward preparing for, finding and maintaining employment.

Participation reviews should be conducted:

  • At least once every three months for Ontario Works recipients, including recipients with a temporary deferral of participation requirements;
  • At least once every four months for recipients with a temporary deferral of participation requirements who voluntarily choose to participate; and
  • At least once every six months for those recipients with a temporary deferral of participation requirements who are sole-support parents with a dependent child or a child in temporary care for whom publicly-funded schooling is not available, or are 65 years of age or older.

In some cases, a review and update to participation requirements occurs when a participant completes an employment assistance activity. This includes a review following the date of completion of any of the following:

  • A basic education or job-specific skills training course;
  • Literacy screening questionnaire, assessment and/or training program;
  • Structured job search;
  • A community placement; and
  • Referral to Employment Placement services where a participant is not able to find employment through the above activities.

When a participant’s circumstances have not changed (e.g. no change to employment assistance activities) the caseworker may update his or her PA over the phone and set a review date for three, four or six months as appropriate based on the participant’s circumstances. For example, where a participant’s employment assistance activity is scheduled to end on the 1st day of the month following the regular three month review date, the caseworker may update the PA with the participant over the phone and set a review date for the 1st of the following month when the employment assistance activity is scheduled to end.

Participation Agreement (PA)

The PA is the review tool by which participation requirements are monitored to determine a recipient’s eligibility. All Ontario Works applicants, their spouses and any dependent adults included in the benefit unit must complete and sign a PA. This includes persons whose participation requirements have been deferred. An adult who is solely in receipt of Temporary Care Assistance on behalf of a child does not have participation requirements.

The PA is an evolving document and it will change as recipients engage in and complete employment assistance activities. It should also respond to temporary or changed circumstances in a recipient’s life such as illness or injury, or lack of appropriate child care or attendant care for dependent family members.

The PA should be reviewed in order to:

  • Note the time frames for meeting a requirement and/or changing the requirement;
  • Identify where and why participation requirements and time frames are not being met;
  • Explore opportunities to adjust requirements based on new activities;
  • Ensure the recipient’s abilities, skills and circumstances are properly documented;
  • Determine if the participation requirements are reasonable and appropriate for the recipient’s needs, skills, circumstances and interests; and
  • Review the recipient’s progress and experiences at job interviews and/or placements and document new skills acquired and next steps.

Review Outcomes

There are six possible outcomes from a review:

  • there is to be no change in the amount of financial assistance or benefits issued to the recipient;
  • there is no change to participation requirements;
  • participation activities are amended to reflect activities that best fit the recipient’s skills and abilities;
  • financial assistance and/or benefits are varied or suspended due to reported changes in circumstances or non-compliance;
  • there is a determination of an overpayment; or
  • the recipient is found to be ineligible and financial assistance is cancelled or reduced.

Where there are changes to be made to financial assistance, it is required that the recipient be sent notification regarding this decision and informed that they can request an internal review if they disagree with the decision in a format and manner approved by the Director.

Recipients with Deferrals Who Choose to Participate

Participation monitoring of recipients with deferrals should be completed in the same way as reviews/monitoring for mandatory participants. Information gathered through monitoring of these recipients is only assessed to determine whether their efforts support their continued participation in employment assistance activities.

Recipients with deferrals cannot have their financial assistance reduced or cancelled for refusing or failing to make reasonable efforts to participate in employment assistance activities.

Events that Prompt Immediate Review

An immediate review should be carried out if the recipient:

  • is unable to prove that they have been engaging in an independent job search;
  • does not participate in agreed upon structured job search activities;
  • misses two referrals to any of the following without a reasonable cause: community placement agencies, job interviews, a job placement agency, a self-employment development agency, a program for the treatment of substance abuse, basic education, job-specific skills training, or literacy assessment and/or training;
  • refuses an offer of paid employment;
  • fails to attend basic education, job-specific skills training, literacy assessment and/or training, a job placement agency, a self-employment development agency, a program for the treatment of substance addiction or community placement for more than three days (or more than three times, if applicable) without authorized absence;
  • is reported to attend community placement or employment placement agency but does not participate in assigned activities;
  • attends basic education or job-specific skills training or literacy assessment and/or training but does not meet the requirements set by the program; or
  • is not meeting self-employment development goals while with a self-employment placement agency.

After reviewing the PA with the recipient, it may be necessary to change the participation requirements or determine that the recipient is ineligible for assistance.

Ineligibility for Non-Compliance Reasons

There are four types of non-compliance with participation requirements:

  • refusal to accept employment and to make reasonable efforts to maintain employment;
  • refusal to accept a referral for participation in an employment assistance activity, including a community placement or employment placement, withou. a reasonable cause;
  • refusal to accept an offer of a placement without a reasonable excuse; and
  • failure to make reasonable efforts to meet participation requirements without reasonable excuse.

Applicants or participants who quit or are fired from their job are not subject to a period of ineligibility unless the applicant or participant fails to make reasonable efforts to accept and maintain full-time, part-time or casual employment or to participate in an employment assistance activity.

Where a delivery agent has been approved to deliver the Ontario Works Addiction Services Initiative (ASI), a recipient may be made ineligible if they refuse screening, assessment or treatment for substance addiction that is a barrier to participation or employment.

If an applicant or member of the applicant's benefit unit indicates that they will not accept employment or participate in employment assistance activities, assistance for the applicant can be refused or reduced for the benefit unit, until the applicant or member of the benefit unit agrees to participate.

If a recipient or other member of the recipient's benefit unit does not comply with or meet the participation requirements, assistance for the applicant or member of the benefit unit will be cancelled or reduced for one month for the first occurrence and three months for all subsequent occurrences. At the discretion of the Administrator, a recipient serving a period of ineligibility may be issued a drug card if the administrator is satisfied that the recipient requires prescription drugs to treat a serious illness or health condition.

Where the assistance is reduced because of non-compliance, the amount of the reduction is equal to the basic needs amount, shelter amount and benefits or the basic needs amount and benefits (in a board and lodging situation) for that individual. The non-compliant participant is required to attend all participation and financial reviews that are scheduled for the benefit unit.

Where the assistance amount for a benefit unit is reduced due to non-compliance, any assets belonging to the non-compliant individual are still included in the total assets for the benefit unit. In addition, any income received by the non-compliant individual is still included in the calculation of assistance for the benefit unit during the period of ineligibility. Earnings exemptions and child care deductions continue to apply.

If the recipient relocates to another Ontario Works delivery agent, the conditions of ineligibility remain applicable. Conditions of ineligibility are tied to the recipient, not the delivery agent.

An internal review can be requested by a recipient for decisions of ineligibility or reduction of assistance, and may be appealed to the Social Benefits Tribunal.

Reasonableness Test

The focus of the reasonableness test should be to determine if non-compliance was intentional or if it was the result of an employment barrier or factor affecting the employability outside the recipient's control.

A determination of reasonableness should be made in accordance with current business practices and should be based on the “best fit” between a recipient’s interest and/or skills and available opportunities.

Delivery agents are expected to use the reasonableness test identified in their approved business plans. The reasonableness test should have the flexibility to respond to the different expectations as required within the employability continuum.

Reasonable criteria could include:

  • temporary illness;
  • absence of appropriate child care;
  • court appearance or detainment;
  • change or shift in the recipient’s personal needs;
  • change or shift in the recipient’s individual circumstances;
  • inappropriate ”fit” for the participant;
  • program resources or services to support employability not available within the local community;
  • failure of transportation arrangements and no alternative; and/or
  • extreme inclement weather which affects mobility.

Reinstatement of Eligibility

Recipients whose assistance is cancelled or reduced for one or three months because of non-compliance with participation requirements need to reapply or request reinstatement after the expiration of the penalty time period, and must meet the participation requirements in order to re-qualify. At reinstatement, a new participation agreement is signed.

If an adult member of a benefit unit fails to comply with program requirements for an extended period (beyond the initial ineligibility period) the benefit unit continues to receive assistance less the pro-rated share of assistance attributable to the adult member in non-compliance. If that member chooses to comply with the requirements at the end of the ineligibility period, then the pro-rated share is restored for the benefit unit.

Closing a File

A case file should be closed if the recipient is no longer eligible for assistance or does not provide enough information to determine eligibility.

When closing a file, any assignments for support should be cancelled.

If a decision of ineligibility is made, the case file should be closed using the appropriate reason and documentation including:

  • reason for ineligibility;
  • effective date; and
  • notification date.

If a file is closed due to ineligibility, the participant should be notified of the decision and right to appeal in a format and manner approved by the Director.

When closing a file in the Social Assistance Management System (SAMS) or other technologies, appropriate reasons should be identified to ensure the statistical information gathered from the system is accurate.

If a case is closed due to death of recipient, the last month’s financial assistance goes to the estate of the deceased.