Amanda Fraser with her dog Baxter in her home in Edmonton on May 3.Kelsey McMillan/The Globe and Mail
Amanda Fraser was diagnosed with multiple sclerosis in 2015 at age 26, when she suddenly lost the ability to walk.
Through medication and physical therapy, she was able to regain her mobility, but to this day, she still has “relapses” where she is unable to walk without the assistance of her four-wheel walker.
These relapses can last anywhere from one day to four months, and she has no way of knowing when they will happen.
In 2020, Ms. Fraser, who lives in Edmonton with her husband and dog, had to quit her job as a registered nurse because of her disability. When she is able, she volunteers as an MS advocate.
To offset some of the costs that people with disabilities incur, the federal government is poised to roll out a new Canada Disability Benefit in June − a $200 monthly payment. But despite her health challenges, Ms. Fraser doesn’t meet the criteria to receive it because the main symptoms of her disability are not constant.
Advocates are increasingly concerned that many people with disabilities will struggle to access the new benefit, worth up to $2,400 a year.
The key issue is that qualification for the program depends on whether applicants have initially been approved for the federal Disability Tax Credit (DTC).
“It’s really difficult for people living with MS to try and fall under these very stringent guidelines that the Disability Tax Credit requires because it’s just not what our lives look like,” Ms. Fraser said.
The DTC has long faced criticism for its exclusive criteria and complex application process, including a requirement for a physician to complete an extensive medical form. As a result, some people receiving monthly support from federal or provincial disability programs still don’t qualify for the DTC.
“It’s not an easy process to complete,” said Daniel Corvino, manager of government relations at MS Canada, ”and that is something that we’ve been advocating for for a really long time. We need to have a simple process.”
According to Statistics Canada, the poverty rate in 2020 for working-age adults with severe disabilities was more than double that of working-age adults with either milder or no disabilities.
The DTC is a non-refundable tax credit, so it only benefits people who pay taxes. However, it is a gateway to other forms of assistance that help people regardless of income − including the new Canada Disability Benefit.
According to a 2023 Disability Advisory Committee report by the Canada Revenue Agency, only 25 per cent of people surveyed by Statistics Canada in 2017 who identified as having a severe or very severe disability applied for a DTC certificate. Only 11 per cent of people with disabilities completed the full process, meaning they applied, were approved, filed a tax return, and eventually claimed the credit.
To apply for the tax credit, a person must submit two forms: one that they fill out themselves, and one completed by their doctor. There is no legal maximum on what a Canadian doctor can charge to fill out a form, and patients are typically paying anywhere from $30 to $300 to request a form that is not guaranteed to be approved by the CRA.
The criteria on the medical form require a person to have significant difficulty performing at least one activity of daily living, which includes feeding, walking, dressing, eliminating, mental functions, hearing and speaking.
By this definition, they either cannot perform the activity, it takes at least three times longer to do so than someone of a similar age without the impairment, or they need assistance to complete the activity. This limitation must apply at least 90 per cent of the time, and must have lasted or be expected to last for at least a year.
The 90-per-cent requirement can make it challenging for people with episodic disabilities to qualify. This type of disability is characterized by unpredictable and fluctuating symptoms and includes conditions such as epilepsy, fibromyalgia, lupus and, in Ms. Fraser’s case, MS.
“Just last year, I had a really bad relapse where I lost use of my entire left body so I couldn’t even sit up straight because I didn’t have enough strength in my torso to hold myself up,” Ms. Fraser said.
“My left arm was completely numb and weak, so was my left leg, and I even got a face droop on the left side of my face. I had to go to the hospital for the month of August three times a week to receive treatment.”
Outside of these erratic relapses, however, Ms. Fraser can walk without assistance. So when she saw that the form stipulated that a person is unable to walk 90 per cent of the time, and that it didn’t factor in how her chronic pain and fatigue impact her life, she knew she didn’t fit the criteria and decided not to apply.
“I might have given it a shot if it wasn’t so long, time-consuming, confusing, and associated with a cost. Because I’d also have to go and ask a health care provider to fill out a part of it, too.”
“So I’m asking my very busy neurologist or my very busy family doctor to fill out very long forms, which are probably going to cost me money.”
John Oakey, vice-president of taxation at Chartered Professional Accountants Canada, said another challenge in navigating the application is the “complicated legislative wording that makes it difficult for people to actually access the Disability Tax Credit.”
Section 118.3 of the Income Tax Act, for example, describes the eligibility requirements as having “one or more severe and prolonged impairments in physical or mental functions,” or the ability to perform at least one basic activity of daily living must be “markedly restricted.”
“I don’t know if there’s a single person that could tell you what “markedly restricted” even means,” Mr. Oakey said. “I don’t even know if there’s tax people that can tell you what ”markedly restricted” means without going to look it up. And even then, it’s not defined in the act. You have to look at the courts to try to get a determination of what that actually means.”
Even if people meet the Disability Tax Credit‘s medical criteria, there are other barriers.
“Probably one of the biggest hurdles that most people have is that they don’t have access to the medical practitioner to complete the form,” said Mr. Oakey.
Kory Earle-Morrow lives with an intellectual disability characterized by challenges with learning and communication. He spent years working for as little as $10 a week doing a range of jobs from washing windows to working in bookstores as part of sheltered workshops, and lived on the Ontario Disability Support Program.
During the height of COVID-19, he was able to get a job at an assisted living facility − his first job that paid a living wage − where he eventually trained for his current job as a personal support worker. He lives with his husband in Carleton Place, Ont.
Kory Earle-Morrow at his home in Carleton Place, Ont., on April 23.Justin Tang/The Globe and Mail
Mr. Earle-Morrow tried to apply for the tax credit with the assistance of a friend at People First of Canada, a national organization representing people with intellectual and developmental disabilities, but he was unable to find a doctor to complete his medical form.
“Then I pretty much just gave up, right?” Mr. Earle-Morrow said. “Because it was frustrating, it was becoming overwhelming. It felt like the system set me up to be a failure on that aspect. It was way too much.”
Kathleen Ross, a family physician and past president of the Canadian Medical Association, said there are a “large number” of Canadians living with disabilities who don’t meet the DTC criteria.
Dr. Ross added that the “long and onerous” medical forms are taking a toll on physicians as well as patients, and burdening the already overwhelmed health care system.
“It can take, depending on how much you put into that piece of paper, up to 45 minutes to complete that form,” Dr. Ross said. “In 2023, there were 280,070 Disability Tax Credit forms processed in Canada. If you kind of back that up by the number of minutes that it takes to complete the form, that’s 600,000 lost patient visits.”
While Dr. Ross said there are ways the form could be simplified, she also said the government could alternatively allow applicants to self-declare their disability to receive the credit, and rely on spot checks and audits for verification.
“My experience after 30 years of dealing with patients with disability is that they know when their life is being significantly impacted, and I think that we can provide patients with the dignity to acknowledge when something is significantly altering their life,” Dr. Ross said.
“It’s not just about decreasing the paperwork. These are real people in real need of support.”