The important numbers in the FAO report, and what they mean
It’s easy to get lost in the sea of information included in the recent Financial Accountability Officer’s report on the autism program.
I’m going to breakdown some of the important numbers, and what they represent, looking at 3 main categories:
- The waitlist
- Number of kids in the program
- The 2019/2020 Budget
1. The waitlist
27,600
This is a number that showed up a lot in the media coverage of the report.
It actually represents the average number of kids waiting for needs-based therapy during the last fiscal year (April 1, 2019 – March 31st, 2020).
Despite the launch of the Childhood Budget program in spring 2019, and interim one-time funding starting in early 2020, only 8,100 kids received a cheque of some kind during the fiscal year … but even these kids are still waiting for needs-based therapy.
The language in the FAO report is clear: they consider the families who were given a cheque to still be on the waitlist, even the childhood budget kids. I applaud the FAO for taking this stance. A cheque is not even close to the same as receiving medically-recommended therapy, guided by professionals.
It’s important to note that an average number doesn’t really tell the whole story either. The number of kids in service under the old program was steadily decreasing throughout the fiscal year, and new registrations to the program were being added each month, further adding to the waitlist.
So it the waitlist for needs-based therapy was ~25,000 at the start of the year, but 30,000+ at the end of the year, the average waitlist number doesn’t fully represent the situation.
24,900
The average waitlist for the 2018/19 fiscal year.
The waitlist length hadn’t changed that much from the previous year (2017/18), so the average value they used here wouldn’t be that different from the actual waitlist at the end of the fiscal year in question.
Remember that this was the unconscionable waitlist Lisa MacLeod said they’d clear in 18 months, but failed to even make a dent in it, despite having a $600 million budget available
Every child deserves to receive therapy according to their individual needs.
Even the kids still in the old OAP are only getting needs-based ABA. The autism program will “soon” have access to other core therapies like SLP and OT where appropriate, to more fully meet their range of needs.
We might as well just say that roughly 42,000 kids are still waiting for more complete needs-based therapy.
2. Number of kids in the program
At the end of the fiscal year there were about 39,600 kids registered in the Ontario autism program, broken down as follows:
6,400
- Still in the old version of the program (sometimes referred to as the “legacy kids”), getting needs-based ABA
8,100
- Received either a childhood budget (CB) or interim one-time funding (IOTF) cheque
19,200
- Sent a letter inviting them to apply for a CB or IOTF, but had not yet received any money
5,900
- Not yet sent an invitation letter, even though the Ministry had promised all letters would be out before the end of the fiscal year
It was helpful to get confirmation of the number of legacy kids, because after the ministry decided to change their monthly numbers format earlier in the year, there was no way to calculate this anymore, and we could only guess.
The number of legacy kids at the beginning of the fiscal year was 10,365.
After Minister Todd Smith admitted last summer that they “didn’t get the redesign right,” and that they were going to move AWAY from childhood budgets, they did the exact opposite of that over the last year– They moved kids OUT of needs-based therapy and INTO childhood budgets. THOUSANDS of them.
I definitely encourage you to watch the clip in the link above to hear how Todd Smith spoke about the autism program last summer. He certainly hasn’t followed through on his promises there.
3. The 2019/2020 Budget
$608 million
- The apparent total OAP budget for the 2019/2020 fiscal year.
I say apparent, because they didn’t spend it all, but are claiming they still will … eventually.
Let’s break it down:
$271 million
- Spent on needs-based therapy.
There were over 10,000 kids being served at the beginning of the year, but only ~6,400 by the end of the year.
For reference, the total amount spent during the previous fiscal year in this category was $317 million (out of the total $361 million spend).
$97 million
- Spent on a combination of childhood budget and one-time funding cheques (8,100 kids, or ~$12,000/cheque)
We know from previous ministry data that over 5,000 kids had received childhood budget cheques by the end of January 2020. This means that very little money was spent on interim one-time funding before the end of March, as maybe only ~2,500 families received money by that format.
$67 million
- “other” expenses, not specified
This would include spending on things like diagnostics, administration, family/school supports, etc.
$174 million “accrued”
- The money the ministry claims they will spend later, but didn’t get around to it during the actual funding period.
This is one of the most important numbers from the 2019/2020 budget, so let’s dive into it a bit more.
This amount is said to be earmarked for 19,200 CB/IOTF invites they sent out (but didn’t pay out), as well as 5,900 kids who were registered for the program before the end of the fiscal year, but didn’t get an invitation to apply for funding yet (25,100 kids altogether, or ~$7,000/cheque).
By the end of the fiscal year the ministry had sent out 10,434 invites to apply for childhood budgets, and 16,877 invites for one-time funding. Only 8,100 of those invitations were converted to actual funding, leaving 19,200 still waiting for money.
From the FAO report:
The ministry has recorded unaudited autism services spending of $608 million in 2019–20, which includes an accrued expense of $174 million for 25,100 children who did not receive any payments in the 2019–20 fiscal year. Given the unique circumstances in this case, MPPs should confirm with the Auditor General of Ontario that the Province can record the full accrued expense of $174 million as spending in 2019–20.
If you think about who those 19,200 kids are, probably~5,000 of them were sent a childhood budget invite, but never received any payment. What happened there?
The uptake rate for the whole childhood budget “program” was low right from the beginning. Were families worried they’d miss out on needs-based therapy if they accepted a cheque instead of holding out? Did the ministry follow-up with these families?
It’s also important to know that invites for this kind of funding basically stopped at the end of 2019 (once interim-one-time funding was announced as the stopgap measure to replace it). If all those CB invites weren’t converted to funding back in 2019, I’m not sure how the government can claim they’ll be spending money on those kids in the current fiscal year unless there’s a plan to track each and every one of them down … which i doubt.
The FAO also spent a big section of their report discussing different funding/waitlist scenarios. It can basically be summed up like this:
- The new $600 million budget can accommodate a lot more kids than the previous $321 budget could, but if everyone were to receive the same average funding as the previous legacy program, there will still be a lot of kids on the waitlist.
- If you want nobody on the waitlist, but were to keep the same $600 million budget, there’s would need to be a big drop in the amount of support each kid would get. This was one of the major problems with the childhood budget model, because it doesn’t allow needs to be fully met, especially those with high needs.
- If you want nobody on the waitlist, but want the same equivalent service level as the legacy program, you’d basically need to double the budget again to get there.
With a crumbling service capacity issue, even if there was enough money in the program to fully meet the needs of every single child at the same time, there wouldn’t be enough service providers to serve that need all at once. Capacity building will take time, especially in already under-served areas like the north, and that rebuild needs to start immediately.
As long as the wait is reasonable, and what you’re waiting for is worth it, completely eliminating the waitlist isn’t possible or even necessary. A needs-based program that has a reasonable wait, and the proper controls, is the goal. This can be done with $600 million, but the budget will need to be re-evaluated on a yearly basis to account for things like inflation and changing registration numbers.
We’ve known for a long time that the Ford government has been under-spending on the autism program.
This isn’t even the first time the FAO has gotten involved:
Without a real program to properly channel the available budget, the spending during the current fiscal year will likely be questionable as well.
The Advisory Panel report has been available to the ministry for almost 9 months at this point, with very little to show for it.
The sooner they get the new program up and running, especially core services, the sooner we can start climbing out of this big mess.
