WHAT HAPPENED?
Our office received a complaint from a senior who was denied assistance to fund a dental procedure. At the time, he was receiving benefits through a program called the Dental Assistance for Seniors Program, or DASP. The individual, who was familiar with the Ombudsman’s office, believed the denial was unfair because he was not given an explanation for the denial of benefits, he was not offered alternative dental care suggestions, and he was not able to appeal the decision.
WHAT DID THE OMBUDSMAN’S OFFICE DO?
The investigator learned that the decision was made and written by the Alberta Dental Service Corporation (ADSC), but that it is Alberta Health which administers DASP. She first engaged in an early resolution investigation, which resulted in Alberta Health working with ADSC to modify its denial letters. Eventually, we determined that a full investigation was necessary. The Ombudsman recommended Alberta Health create an appeal mechanism for seniors who apply for dental procedures through DASP. The Ombudsman also asked Alberta Health to ensure its public information is more transparent and that the delegation of its decision-making power to ADSC complies with legislation.
WHAT WAS THE OUTCOME?
Alberta Health acknowledged the Ombudsman’s recommendations and agreed to review both its appeal mechanism and legislative authority. It agreed to update its denial and approval template letters to seniors, use plain language, and provide more transparent information about the program to the public. Our office is satisfied that the letters are much clearer, and Alberta Health has updated its public information. The Ministry acknowledged the importance of an appeal process and making decisions within its legislative authority; it is working on implementing the recommendations made by the Ombudsman.
WHY DOES IT MATTER?
Albertans 64 years old or younger who are denied assistance with dental costs through programs like Income Support and Assured Income for the Severely Handicapped have the right to appeal. Once an individual turns 65, they lose the right to appeal. This is inconsistent and unfair to seniors across the province. Alberta Health acknowledges this and is working towards rectifying this unfairness. The program has demonstrated its commitment to a fairer process, with better letters and public information that is easier to understand. Our office is monitoring developments and looking forward to seeing the changes the Ministry will make to ensure age is not a barrier to an administratively fair appeal process.
