10 thoughts on the FAO’s financial review of autism services and program design considerations for the new Ontario Autism Program

FAO Autism Report published July 21, 2020

Ontario’s Financial Accountability Office (FAO) has published their financial review on autism services. You can read the whole report here. Here are my 10 initial thoughts when reading the report:

1. $608M wasn’t actually spent on services in FY19/20, more like $337M plus $97M in liabilities for the money doled out as childhood budgets (CBs). The $97M in CBs received does not mean the money was spent on services last FY as you have one year to spend the money or return it. The ministry has $174M tagged as carry forward to this current FY for childhood budgets, but that’s only if the Auditor General okays the accrued expense.
2. If the OAG okays the carry-forward budget expense, will the government spend $774M this year ($600M budget plus the $174M carry-forward)? I’ll believe it when I see it.
3. The $174M unspent last fiscal is trending higher than the $192M underspend I estimated over the two fiscals before the new program will be up and running sometime in 2021. This angers me as the government could have reinstated the existing OAP as the interim plan, got more kids in service and stopped the service capacity decline.
4. The FAO report highlights the dilemma facing the implementation working group has in developing a sustainable needs-based program. A status quo budget won’t do when considering inflation and population growth. In the last year 6,409 kids registered into the OAP.
5. The report doesn’t say what the “Other” $67M was spent on. It’s $27M less than the $94M spent in the FY18/19 “Other” category. Back then the “Other” was made up of non-therapy costs such as Admin, Family Supports, Diagnostic Services, School Supports, and Respite, others.
6. Will the government grow the budget based on increased demand? If not, either waitlists will grow, or the “Care Coordinators” will be coordinating you out of the OAP like the old AIP program. Churn decided by someone other than your child’s behavioral services team and not needs based.
7. The number of legacy children by the end of March 2020 was at 6,400. This is interesting because the ministry stopped transparency in January 2020 when we derived the legacy kids to be down to 8,050. We don’t know what the July 2020 numbers are, but it’s likely the legacy kids are down 50% despite Minister Smith saying there would be no disruption in service.

Legacy kids decreased from 10,365 to 6,400 over the course of FY19/20

8. The average childhood budget of $8,100 shows what a raw deal the MacLeod plan was in comparison to the average $29,900 in services under the needs-based ABA program. Yes, waiting for years on end was also a raw deal, but at least there was hope at the end that your child would receive the therapy they needed.

9. On the other hand, it would cost $1.35 billion to have a needs-based service that will “Clear the waitlist”. I don’t think clearing the waitlist is realistic anytime soon due to capacity shortages to accommodate this kind of demand. Also in Canada we’re used to waiting a reasonable amount of time to get a health care service that’s worth waiting for (say 6 months to a year). Still, what would it take to have a reasonable wait time? $900 million, $1 billion? Where’s the gap going to come from?

10. The FAO report estimates that a cumulative total of 1,600 kids will be added to the OAP by 2025–26, yet there were 6,409 kids registered last year. It would be good to know how many of the 6,409 were newly diagnosed versus kids that were just simply not registered before or are coming back after receiving services in the past.