Looking beyond the word

Authority Ministry of Social Development and Social Innovation
Details

Ingrid was in a crisis: She could not afford infant formula for her five-year-old son, Stephen, who had a serious medical condition and needed infant formula to survive. The formula, prescribed by Stephen’s pediatrician, cost more than $600 per month. It was not covered by the Ministry of Health.

Ingrid received disability assistance. Because her fixed income did not give her enough money to cover the extra cost of the prescribed infant formula, Ingrid called the ministry’s toll-free line and made a request for the infant formula. The ministry worker who answered Ingrid’s call declined the request because she felt Stephen was too old for “infant” formula. Ingrid called us.

We investigated whether the ministry followed a reasonable procedure. First, we looked at the ministry’s policy for health supplement requests. Ingrid’s request fell under the provisions of the ministry’s regulation, which meant that the ministry policy is to create a service request and follow certain steps to adjudicate the request. Staff should not have denied the request at intake.

The second issue we looked at was whether or not Stephen was eligible for infant formula. The ministry’s regulation did not specify an age limit for infant formula, yet the ministry had created an age restriction in practice that was not supported by written policy or regulation.

Following our proposal, the ministry agreed to pay for Stephen’s formula. The ministry followed up with Ingrid to inform her of its decision, and to expedite the process, they contacted Stephen’s pediatrician directly – obtaining the information to justify Stephen’s need for infant formula. Finally, the ministry agreed to take steps internally to improve its handling of future medical requests for infant formula.

In this case, a practice based on assumptions had developed into an informal policy that seemed arbitrary and unfair. Because of our investigation, the ministry was able to resolve the situation for Stephen and other B.C. children who may have similar needs.

Category Children and Youth
Type Case Summary
Fiscal Year 2014
Location The Interior