Alberta's low-income health benefit programs face systemic problems: provincial ombudsman

Benefits intended to help low-income adults and children in Alberta with their health-care needs are bogged down by challenges that are administratively unfair, according to the provincial ombudsman.

A public report released Wednesday states an investigation was opened after the ombudsman's office received several complaints.

"[The complaints revolved around] delays in issuing eligibility decisions, staff providing incorrect information and providing poor customer service, and multiple complaints about the family program losing clients' applications and other documentation," the report reads.

The Alberta Adult Health Benefit and Alberta Child Health Benefit provide support to low-income Albertans who require dental care, eye exams and access to prescription drugs, among other needs. 

Both are tied to the same maximum income guidelines. A couple with four children can qualify for the benefit with a maximum net household income of $46,932, while a couple with two kids can qualify should they make less than $36,634 per year. 

The Adult Health Benefit specifically covers benefits for residents with lower income who may be pregnant or have high ongoing prescription drug needs.

The report states the programs are the most generous of their type in the country, offering a wider range of benefits than similar programs, many of which pay only for prescription drugs.

Two ministries, Alberta Health and Seniors, Community and Social Services (SCSS), run the programs.

"We did several interviews with the department and frontline staff, who were extremely accommodating. They're working extremely hard," Alberta ombudsman Kevin Brezinski told CBC News.

"But they do have a lot of process issues that they need to rectify."

Early complaints

In the report, the Alberta Ombudsman's Office states it received a complaint in July 2021 from a man trying to access the adult program. The man, whom the report identifies as Ahmed, had applied for benefits for his family on three occasions but hadn't received a decision of any of them, dating back to October 2020.

Ahmed said his two children, along with he and his wife, have serious health issues, with over $5,500 in ongoing prescription expenses on a yearly basis. Without assistance, the family is not able to live, the report states.

At the end of June 2021, Ahmed phoned the health benefit contact centre. A supervisor told him they had sent him a letter requesting more information, the report reads.

"Ahmed told the supervisor he had not received any mail. The supervisor told him to take the problem up with Canada Post. The supervisor then explained the program was waiting for Ahmed to send in proof of ongoing medical expenses," the report reads.

"Ahmed told the supervisor he had submitted the required medical expenses three times, by fax, as the program requested. The supervisor told him to send them in again."

Instead, Ahmed reached out to the ombudsman's office, which contacted the benefit contact centre. 

"The program approved Ahmed for benefits on July 29, 2021, but it did not tell him. By Aug. 10, 2021, Ahmed contacted us again. He was frantic after hearing nothing from the program," the report reads.

"We again contacted the program and asked if someone would call Ahmed to tell him the good news. They agreed to."

Investigation opened into 'systemic issues'

The report states that an investigation was opened into systemic issues in February 2022 after several complaints were received.

"From the start, this investigation unfolded in unexpected ways. From our first interaction to almost our final interviews with the programs' staff, we learned of more administrative problems," the report reads.

According to the report, every year, the programs fail to serve people because of technical glitches. The report states that 7,394 files were accidentally closed for several days in August 2022 due to computer glitches.

"The programs use old technology that does not work properly. There is no online version of the programs. People cannot email the programs. The programs suffer from a lack [of] accountability for effective operations," the report reads.

Staff at the main call centre can't change information in the main system, such as an address change, the report states.

"They can only make note of it, causing administrative nightmares. Additionally, the programs don't keep copies of letters they send, leading to further administrative issues. Assessors can't transfer calls to other assessors or supervisors," the report reads.

Among several other findings, the report also states that the family program does not give adequate reasons for denying benefits and does not adequately explain reassessments. The programs also deny reimbursements, which is contrary to policy, the report reads.

The final report makes 28 recommendations and five observations, which were provided to Alberta Health and SCSS. Both responded, writing that the recommendations would be considered. 

"Alberta Health is reviewing the draft report and will consider the recommendations that relate to health policy," wrote Andre Tremblay, deputy minister of Alberta Health, in a letter included in the report.

"Work to address some of the report recommendations is planned, such as updates to the policy, training manuals and public websites."

Tremblay wrote that further updates on the progress of the work would be provided in December 2024.

Brezinski said his office is seeking to collaborate with government departments to ensure the programs are improved.

"In this case, [around] 101,000 Albertans utilize both the adult program and the child program," he said. 

"These are vulnerable people that have medication issues or health issues that they need these supplies. We hope that they don't find barriers in the future when trying to access these programs."