Letter: Follow Up to Expanding Health Card Renewal Services to Persons with Disabilities
February 14, 2022
Sent via email to: renu.kulendran@ontario.ca; Dafna.Carr@ontario.ca; Joanne.Anderson3@ontario.ca; pauline.ryan@ontario.ca; Catherine.Zahn@ontario.ca; patrick.dicerni@ontario.ca
Renu Kulendran, Deputy Minister of Government and Consumer Services
College Park 5th Flr,
777 Bay St, Toronto, ON M7A 2J3
Dafna Carr, Associate Deputy Minister of Government and Consumer Services
College Park 15th Flr,
777 Bay St, Toronto, ON M7A 2J3
Joanne Anderson, Assistant Deputy Minister of Government and Consumer Services
College Park 15th Flr,
777 Bay St, Toronto, ON M5G 2E5
Pauline Ryan, Director, Ontario Health Insurance Plan, Pharmaceuticals and Devices Division, Ministry of Health
Macdonald-Cartier Bldg 5th Flr,
49 Place d’Armes, Kingston, ON K7L 5J3
Catherine Zahn, Deputy Minister of Health
College Park 5th Flr,
777 Bay St, Toronto, ON M7A 2J3
Patrick DiCerni, Assistant Deputy Minister of Health, Executive Officer & General Manager,
Ontario Health Insurance Plan, Pharmaceuticals and Devices Division 10,
438 University Ave, Toronto, ON M7A 1N3
To our leaders in government,
Re: Expanding Health Card Renewal Services to Persons with Disabilities
ARCH Disability Law Centre is an Ontario-based specialty legal clinic that is dedicated to defending and advancing the equality rights of persons with disabilities.
We welcome the Government of Ontario’s recent announcement[1] extending the deadline to renew health cards in light of the exigencies of the pandemic, and allowing those with Ontario Photo Cards the same opportunity to renew online as those with a driver’s license in the coming months.
This is an important remedy for persons with disabilities. However, it does not remedy the discrimination of persons with disabilities without a driver’s license or an Ontario Photo Card.
ARCH has raised these concerns in a letter to Ministers Elliott, Romano and Mulroney on January 26, 2022. We enclose a copy of that letter for your convenience.
The Barriers at Issue
It is estimated that approximately 750,000 Ontarians over 16 years of age do not have a driver’s license or an Ontario Photo Card. Among this group are vulnerable and high risk persons with disabilities who cannot attend ServiceOntario to renew their health cards without risk to their health or, reframed, should not have to go to ServiceOntario, risking their health in ways that others have managed to avoid.[1] Equitable access to health renewal services for persons with disabilities is a human rights issue. For persons with disabilities in this position, inequitable access to health card renewal services remains unchallenged and unchanged. The announcement does nothing to address their urgent need for continuity and certainty in accessing vital healthcare services past September 30, 2022, without the burden of exposure that those who have a driver’s license or an Ontario Photo Card avoid.
The work, in other words, is not yet done.
Persons with Disabilities may be more Vulnerable and High Risk
The disproportionate and adverse impacts of exposure are not borne equally.
Persons with disabilities are a “vulnerable”[1] and a “potential high-risk”[2] group.
A research study published one month ago in CMAJ found that patients in Ontario with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. [3] It also referenced prior research indicating “people with disabilities share high rates of risk factors for acquiring COVID-19, including poverty, residence in congregate care and being members of racialized communities.” [4] The OHRC confirms that the human-rights impacts of the COVID-19 pandemic may render “[p]eople with multiple intersecting identities… particularly vulnerable.”[5]
The OHRC identified human rights “impacts” of COVID-19 on vulnerable groups to include: “higher risk of contracting COVID-19 due to social conditions” and “restricted access to medical or other support services.”[6] A human rights-based approach to managing the COVID-19 pandemic includes taking steps to protect vulnerable groups in the following ways:
“Anticipate, assess and address the disproportionate impact of COVID-19 and related restrictions on vulnerable groups that already disproportionately experience human rights violations.
Make sure vulnerable groups have equitable access to health care and other measures to address COVID-19, including financial and other assistance.
Make decisions with input from vulnerable groups and the most affected communities.
…
Ensure that public health and emergency measures consider accessibility and other needs of people with disabilities who face heightened susceptibility to contracting COVID-19 and may face extra challenges to obtaining services and supplies, and accessing food and other basic needs because of restrictive measures.” [7] [Emphasis added].
Examples of Barriers to Renewing Health Cards – A Non-Exhaustive List
Persons with disabilities may not be able to renew their health card online or in person for a variety of reasons, including not having or being able to access an Ontario Photo Card, internet or mail services and not being able to use other forms of identity documents online that would otherwise be accepted at the ServiceOntario counter. [1]
In these situations, persons with disabilities must attend in person at ServiceOntario to renew their health card. While a medical exemption form is available, this may not be an option for persons with disabilities who have limited access to a health care provider or to a proxy who is “legally authorized to act for another person”[2] and can do so without regard to health and safety. The medical exemption form does not alleviate these barriers which the pandemic has only exacerbated.
In our January 26, 2022 letter, we highlighted several potential barriers associated with obtaining an Ontario Photo Card:
“Persons with disabilities who do not have a driver’s license and Ontario Photo Card are especially vulnerable and marginalized. There are barriers associated in obtaining an Ontario Photo Card, including the ability to provide a signature and/or access to a guarantor.[3] Applying for an Ontario Photo Card is equally problematic for persons with disabilities who cannot, for medical reasons, attend ServiceOntario to have their picture taken.”
The requirements are potentially onerous for persons with disabilities who may experience barriers in securing a guarantor who can attest to their signature or are limited in doing so because of pandemic restrictions. Newly arrived Ontarians or those precariously housed may experience barriers in securing a guarantor they have known for at least two years and is a Canadian citizen.
We are aware of disability-related barriers in the use of mail services, delays in processing and the risks associated with the loss of original identity documents when using this method. These examples of barriers to equality of opportunity to safely renew is by no means exhaustive[4] nor are they experienced as barriers to all. Persons with disabilities are diverse. What is experienced as a barrier for one individual may not be for another.
We renew the call made to the Ontario Government in our January 26, 2022 letter “to allow for a flexible approach to determining continued eligibility through a number of ways and by a variety of different means in a manner that accommodates for the needs of persons with disabilities and actively removes these barriers to accessing service.”
We ask that you consider the following recommendations.
Recommendation #1: Consider how persons with disabilities can use and benefit from health card renewal services equally, in a manner that is responsive to and inclusive of all persons with disabilities. This includes taking into account that persons with disabilities are diverse and have multiple and intersecting identities that may expose them as particularly vulnerable; this includes Indigenous (First Nations, Inuit, Métis) and identities such as race, gender, and factors such geographic location, poverty and low-income, and (digital) literacy.
Recommendation #2: Consult and engage with a diverse range of persons with disabilities and disability-focused organizations to identify the barriers preventing persons with disabilities from renewing their health cards safely.
Recommendation #3: Review the Ontario Government’s policies on health card renewals, photo requirements, medical exemptions, mail-in services, Ontario Photo Card and Guarantor requirements for barriers that exist to persons with disabilities who, as a result, cannot renew online or through any other means.
Recommendation #4: Remove the requirement to attend ServiceOntario for the purposes of being photographed as a condition of eligibility for individuals who cannot attend for medical reasons.
Recommendation #5: Expand online renewal services by including the provision of in-person virtual appointments through Zoom and other videoconferencing platforms.
Recommendation #6: Provide flexible and varied methods of communication and document delivery including telephone, video conferencing, email, courier, mail, TTY, fax, etc. at no additional cost to the applicant.
Recommendation #7: Remove barriers associated with the “digital divide” for those who have limited or no access to the internet due to poverty, geographic location, social location and/or other factors. Implement systemic solutions while respecting the need to provide individualized ones when required taking into account Recommendations #6, #11 and #12.
The Government’s Prior Awareness of the Barriers
Our January 26, 2022 letter is not the first time you became aware of this problem. As of December 16, 2022 at least if not earlier, at a meeting some of you attended with David Lepofsky, you were put on notice that renewal barriers would continue to exist. In his Affidavit, Mr. Lepofsky states:
“I also explained at that virtual meeting that there should be some sort of route for people with no driver’s license and no Ontario Photo ID Card to renew their Health Card virtually, without having to go to ServiceOntario. I explained that this all raises serious human rights/equality disability concerns.”[1] [Emphasis added].
On January 19, 2022, Mr. Lepofsky wrote an email to Alison Drummond, Acting Assistant Deputy Minister for Seniors and Accessibility canvassing potential solutions for those who don’t have a driver’s license or an Ontario Photo Card.
“To reiterate, what is needed to fix this problem includes the following:
…
3. For the benefit of people with no Ontario driver’s license and the Ontario Photo ID Card, establishing a way to renew their Health Card remotely, e.g. by creating something like a virtual ServiceOntario Office, with its own Zoom room or like facility. This should accommodate people who do not have computer access.”[2] [Emphasis added].
Following the January 19, 2022 meeting, at a further meeting attended by some of you on January 25, 2022, Mr. Lepofsky again raised this issue.
“On January 25, 2022, I asked what plans, if any, the Government has to establish a means, such as a virtual ServiceOntario office accessible by Zoom, for a member of the public to renew an expired Health Card, in circumstances where that person has no driver’s license and no Ontario Photo ID Card. I noted that before the pandemic, none of us would have known to get an Ontario Photo ID Card in order to be able to renew our Health Card online during a pandemic or otherwise.
I was told that this idea is on the Government’s radar, and that it is being looked into longer term, as the Government explores other digital options. However there was no specific information to share with me about it at this meeting.”[3] [Emphasis added].
We are compelled to ask: what are the current plans to address the barriers? Without a clear plan in place before September 30, 2022 to address these and other systemic barriers, persons with disabilities must choose, still, to risk losing access to vital health care services or risk exposure.
Persons with disabilities in this situation, with no means of renewal, need you to collectively decide to make this a priority and take clear, definitive action now.
We ask that you consider the following recommendations.
Recommendation #8: Publicly commit to addressing the needs of those without a driver’s license or Ontario Photo Card prior to the deadline of September 30, 2022, so that no one is denied access to health card renewal services because of their disability. Publicly extend the deadline if necessary in order to achieve this.
Recommendation #9: Reveal what plans are now being considered to establish a means to safely renew for those who do not have a driver’s license or Ontario Health Card and the timelines for their implementation.
Human Rights Obligations
We thank the Government of Ontario for publicly acknowledging that it is “committed to ensuring all Ontarians have the opportunity to renew while continuing to access the care they need, when they need it.”[1] [Emphasis added].
To be clear, expanding health card renewal services to include those who are excluded because of their disability is not about making it “easier and more convenient,”[2] though that is a by-product. The changes we and others are calling on you to make are not “nice-to-haves.” They are “must-haves” because they are legal obligations.
On December 20, 2021, the Ontario Human Rights Commission’s Chief Commissioner put the Ontario Government on notice of these legal obligations as they pertain to the inclusion of persons with disabilities possessing Ontario Photo Cards:
“The Human Rights Code requires proactive planning to prevent or remove barriers to people with disabilities and older adults in services. I am writing to encourage you to make sure people with disabilities and older adults will have the same opportunity as others to obtain the health card renewal online.” [3] [Emphasis added].
We believe that the Chief Commissioner’s letter remains relevant vis a vis those who do not have an Ontario Photo Card (or a driver’s license).
Persons with disabilities have the right to renew their health card in a manner that takes into account their disability – whether they have a driver’s license or a Photo Card. Ontarians have the right to equal treatment to access health card renewal services without discrimination based on disability in accordance with s. 1 of the Ontario Human Rights Code. Where there is a disability-related barrier that is “baked” systemically into a policy, the Ontario government has a duty to accommodate to the point of undue hardship.
In this crucial moment of (digital) redesign, the voices and perspectives of persons with disabilities are central in barrier removal and prevention. We repeat and adopt below the recommendation made by the Ontario Human Rights Chief Commissioner.
Recommendation #10: “[T]o consider whether a policy or procedure may be needed to ensure the needs of people with disabilities and older adults are considered and addressed in future service offerings.” [1]
Accessibility Commitments
The Ontario Government has made a commitment, in its “Ontario Public Service (OPS) Accessible Customer Service Policy” to “support the full inclusion of persons with disabilities in its laws, policies, programs and services. These obligations are spelled out clearly in the Ontario Human Rights Code, the Ontarians with Disabilities Act (ODA), 2001 and the Accessibility for Ontarians with Disabilities Act (AODA), 2005.”[2]
Articulated below are the guiding principles that the Ontario government has publicly committed to in the design and delivery of goods and services to persons with disabilities.
“Goods and services are provided in a manner that respects the dignity and independence of persons with disabilities.
Goods and services are provided to persons with disabilities with the same attention to quality and timeliness that are provided to others.
Goods and services to persons with disabilities are integrated with regular services, unless an alternate measure is necessary, to enable a person with a disability to obtain, use or benefit from the services.
Customers with disabilities are given equal opportunity to obtain, use and benefit from goods and services.
Whether a person’s disability is apparent or not, everyone should be treated with courtesy, made to feel welcome, and have their need for disability-related accommodation respected whenever they access a government service.”[3] [Emphasis added].
Recommendation #11: To design and deliver health card renewal services in a manner that respects the principles of accessible customer service.
The Need for Accessible Accommodation
Currently, there is no accessible, accountable and transparent process available for members of the public who require “alternative measures” to equally benefit from a service in a manner that respects a person’s need for individualized accommodation.
This despite a paragraph in the recent announcement to contact ServiceOntario, “to inquire about options for their specific situation” if an individual “faces difficulties in renewing their health card, for whatever reason.”[1]
While there are some whose needs may be met through the generic options that are suggested by the ServiceOntario representative, (medical exemption and mail-in), this falls below the standard imposed by the Human Rights Code to provide accessible and individualized accommodation that is responsive to the individual’s disability-related needs and circumstances.
Recommendation #12: Provide an accessible, accountable and transparent process for persons with disabilities to access meaningful and individualized accommodation.
There are human rights and health-related impacts that will stem from the policy decisions you choose to make or not make. We hope this letter compels you to take responsibility and responsive action. We look forward to meeting to discuss this issue with you further. We thank you for your consideration.
Sincerely yours,
ARCH Disability Law Centre
The original letter has a digital signature The original letter has a digital signature
Robert Lattanzio Hannah Lee
Executive Director Staff Lawyer
*Detailed Footnotes are in the original letter*