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."

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.