9.12 — Mandatory special necessities

November 2025

Summary of legislation

The costs of the following items can be covered for members of the benefit unit as Mandatory Special Necessities (MSN) if the member meets the criteria for them and the cost is not otherwise reimbursed or subject to reimbursement from any other source:

• diabetic supplies
• surgical supplies and dressings
• transportation reasonably required for medical treatment, if the cost of that transportation in the month is $15 or more

The costs may be covered by:

1. using pay direct, whereby the recipient receives the items or services from a third party and the third-party invoices ODSP for the amount for the items or services
2. adding the amount for the items to the monthly income support payment

Legislative authority

Sections 21(2)3 of the Ontario Disability Support Program Act, 1997

Section 44(1)1.iii and iii.1 of the Ontario Disability Support Program Regulation 222/98

Summary of directive

The MSN benefit helps cover the costs of eligible medically necessary supplies, items and devices required as a direct result of a surgical, radiological or medical procedure or disease as outlined in the MSN Schedule of benefits (“the Schedule”). The benefit also provides coverage for transportation reasonably required for medical treatment which is $15 or more in a month.

The cost of the item or service must not be otherwise reimbursed or subject to reimbursement from any other source, including government programs (e.g., Ontario Health atHome, Assistive Devices Program, Ministry of Health) or private programs such as private health insurance.

Intent of policy

To assist ODSP recipients with the costs of eligible medically necessary supplies, items, and devices required as a direct result of a surgical, radiological or medical procedure or disease, and transportation reasonably required for medical treatment, where they are not reimbursed or subject to reimbursement from any other source. Approval will only be granted for entry-level devices or core models that provide basic functionality. Approval of medical supplies and medical transportation is based on the most economical costs.

Application of policy

Eligibility

The MSN benefit is available to all members of the ODSP benefit unit, including dependent adults, where an approved health care professional has verified that an applicant requires medical supplies, items, and devices listed in the MSN Schedule of benefits (“the Schedule”) as a direct result of a surgical, radiological or medical procedure or disease.

Coverage is provided when requested by an ODSP recipient and the ministry approves the need for items. The ministry will not cover the costs of “order releases” by vendors that have not been ministry approved and requested by a recipient.

Transportation costs to and from medical treatment are paid when the costs are $15 or more per benefit unit in a month, and the travel meets the eligibility criteria. Local and regional public transit and paratransit services are the default modes of travel eligible for coverage.

The ministry may request supporting information to determine initial and ongoing eligibility at any time (i.e., estimates/quotes for items/devices being requested, new form, verification of travel or attendance, or other supporting documentation).

The cost of supplies, items, devices or medical travel must not be otherwise reimbursed or subject to reimbursement from any other source, including other government programs (i.e., Ontario Health atHome, Assistive Devices Program, Ministry of Health) or private programs such as private health insurance.

MSN benefit application form

The Mandatory Special Necessities benefit application (ON00646E/F) (the “application”) is used to request funding for eligible supplies, items, devices, and transportation costs, covered under the MSN benefit.

The application should be provided to applicants requesting MSN for the first time and at the time of any subsequent renewal. There may be cases where an application is not required (see Section: When the MSN Benefit application is not required).

The application captures information to support eligibility determination for the MSN benefit and is to be used with the Schedule.

The application is only considered complete if the declaration and consent for release of information section has been completed and signed by the applicant, and the application has been completed and signed by an approved health care professional.

The following approved health care professionals licensed to practice in Ontario can complete the application:

• Physicians
• Nurse Practitioners
• Registered Nurses
• Occupational Therapists
• Physiotherapists
• Physician Assistants
• Psychologists^{footnote 1[1]}

The MSN benefit is paid commencing the date that the completed application is received by the ODSP office, except for emergency travel.

Coverage

MSN Schedule of benefits (“the Schedule”)

The MSN benefit covers the cost of eligible medically necessary supplies, items, and devices, captured under the following categories within the Schedule:

• diabetic supplies
• incontinence supplies
• respiratory supplies
• monitoring and medical devices
• wound care and surgical supplies
• self care
• braces, casts, and splints
• pressure devices
• prosthetic supplies

Each category outlines specific eligibility criteria, exclusions, comprehensive list of eligible supplies, items, and devices, and the recommended replacement periods that pertain to that category.

Coverage is provided only for eligible items listed under the Schedule when an approved health care professional confirms that the applicant has been diagnosed with a medical condition and specifies the expected duration of need for the required supplies, items, and devices. For some categories, the application form requires an approved health care professional to specify the supplies, items, and devices being requested, including supporting documentation when required (e.g., occupational therapy assessment and vendor quotes).

Recommended replacement guidelines indicate the quantity and frequency at which approved supplies, items, and devices are eligible for coverage. ODSP staff have the authority to ask for additional verification if recipients request eligible items above the recommended quantity and frequency outlined in the Schedule to assess reasonableness of requests.

Approval will only be granted for entry-level devices or core models that provide basic functionality. Approval is based on the most economical costs. Actual costs will be paid based on receipts.

Exclusions

The following items are not eligible under the MSN benefit, including but not limited to:

• items specifically for sports, for school, or are work-related
• clothing, including footwear
• items for cosmetic purposes
• experimental equipment and/or experimental therapy
• cost of therapy treatment (e.g., occupational therapy, physiotherapy, speech therapy, chiropractic, massage therapy, etc.)
• exercise equipment, including gym memberships (e.g., treadmills, exercise balls, etc.)
• medical supplies or items used by a health care professional providing treatment/services (e.g., suture kits, injections)
• household items/products (e.g., cleaning supplies, furniture, security systems, internet, etc.)
• dental items/supplies (e.g., retainers, mouth guards, dental products, etc.)
• home renovations (e.g., ramps, rails, stair lifts, etc.)
• medical treatment (e.g., surgery, laboratory fees for uninsured services under the Ontario Health Insurance Act)
• medications (e.g., over the counter or not covered through the Ontario Drug benefit, MOH)
• repair of items under warranty
• environmental controls (e.g. air conditioning, filtration systems)
• all mobility devices (e.g., boomer buggies, scooters, e-bikes and wheelchairs) including modifications to Assistive Devices Program approved mobility devices

When the MSN application is not required

In some cases, supplies and items may be requested without completing the application form. The applicant must attest to being diagnosed with a medical condition by an approved health care professional requiring specific supplies or items outlined under the following Schedule categories:

The applicant’s attestation must be documented on file. ODSP staff have the discretion to require an application form to be completed if verification by an approved health care professional is needed. ODSP staff have the authority to ask for additional verification if recipients request eligible items above the recommended quantity and frequency outlined in the Schedule to assess reasonableness of requests.

Medical travel and transportation

Travel and transportation costs are paid when the costs are $15 or more per benefit unit in a given month, and the travel meets the criteria of one of the three components outlined below. To receive transportation costs (except in emergencies) an MSN benefit application must be completed.

Approved costs should be based on the most economical mode of transportation that the approved health professional indicates a person’s condition enables them to use. Local and regional public transit and paratransit services are the default modes of travel eligible for coverage.

The MSN Benefit covers travel to:

1. Professionals designated under the Regulated Health Professions Act, 1991 (RHPA)

The MSN travel and transportation benefit is available to recipients who incur transportation costs to or from any therapy or treatment provided by a professional designated under the RHPA.

The following is the list of regulated health care professionals:

• audiologists
• chiropodists
• chiropractors
• dental hygienists
• dental technologists
• dentists
• denturists
• dietitians
• homeopaths
• kinesiologists
• massage therapist
• medical laboratory technologists
• medical radiation technologists and sonographers
• midwives
• naturopaths
• nurses
• occupational therapists
• opticians
• optometrists
• pharmacists
• pharmacy technicians
• physicians
• physician assistants
• physiotherapists
• podiatrists
• psychologists
• psychotherapists
• respiratory therapists
• speech-language pathologists
• traditional Chinese medicine practitioners

2. Alcohol and drug recovery groups

The costs of transportation to attend drug and alcohol recovery groups (e.g., Alcoholics Anonymous, Narcotics Anonymous) are covered, provided the recipient’s physician or psychologist has prescribed it, and the program is available locally. If the meetings are not held locally, then coverage cannot be provided.

3. Mental health therapy and mental health counselling

The costs of travel to mental health therapy/mental health counselling is covered when the treatment has been prescribed by a psychiatrist, other physician, or psychologist, and the program is provided under the supervision of a psychiatrist, other physician, or psychologist.

To "prescribe" a program means that the psychiatrist, other physician, or psychologist has provided a clear indication that the program is part of the client’s medical treatment or therapy.

The program or activity must be under the supervision of a psychiatrist, other physician or psychologist, and

1. the activity or program is administered and adapted to individual participants by qualified mental health caseworkers and
2. the mental health caseworkers are supervised by the psychiatrist, other physician or psychologist

Mode of transportation

In all cases of approved travel, the most economical mode of transportation that a recipient can use, must be used. Public and paratransit services are the default mode of travel where clients meet eligibility criteria.

The MSN benefit application asks the approved health care professional completing the form to confirm whether a recipient has a medical condition that prevents them from using public transit and paratransit options where they are available, or if a recipient requires medical patient transfer services. If the health care professional confirms the recipient can use public transit, and travel is serviceable by public local/regional transit options (i.e., bus, subway, trains), ODSP staff must issue public transit as the default mode of transportation.

ODSP staff must assess the following to determine reasonableness of taxi coverage:

1. the travel is not serviceable by local/regional transit;
2. recipients have explored public paratransit services (e.g., Wheel-Trans);
3. travel by private vehicle is not available;
4. community-based options are not available or not more economical (e.g., services provided by hospitals); and
5. a health care professional has indicated that a client has a medical condition that prevents them from using public services.

The following chart outlines the amounts that ODSP will pay for different modes of transportation:

* Waiting for customer during appointment. In regions where distances are great (e.g., the north or rural areas), it may be less expensive for a taxi to wait rather than to make a return trip. In this case, the waiting fee should be paid. In areas where distances are short (e.g., cities and towns), it is generally less expensive for a recipient to order a taxi for a return trip.

Where a private vehicle is used for medical transportation, the recipient should provide an estimate of the mileage for a return trip to the identified appointment. ODSP staff can assist the recipient in estimating the mileage. Where other means of transportation are required (e.g., taxi, ambulance), the recipient should submit a written estimate for the cost of return trips.

Emergency travel

ODSP recipients who require emergency medical treatment may request reimbursement for transportation costs that were not approved in advance. Emergency costs can be covered based on receipts. A note from the recipient requesting reimbursement and specifying the destination and the mileage incurred is also acceptable; however, receipts (e.g., parking receipt) should also be included if available. Where the recipient is requesting reimbursement, they should be asked if they will require regular appointments. If so, an MSN benefit application Form should be completed by the approved health professional and upfront verification would apply as in all other cases.

Out of town travel, out of country travel, meals, and attendants

Out of town travel

The MSN benefit helps cover the cost of the most economical travel that is reasonably required to attend medical treatment. Out of town travel may be approved when necessary to receive treatment or therapy provided by a professional designated under the RHPA (e.g., to receive specialized care, existing relationship with health care professional, referral by a health care professional, avoiding long wait times). This may include overnight stays en route for long trips or during treatment that lasts for more than one day. Where appropriate, travel across a provincial border may be covered. (i.e., Manitoba and Quebec).

The most economical accommodation should be used when overnight stays are required for a person to receive necessary medical services. The following chart is a guide for caseworkers to help determine reasonable costs for out-of-town travel. In all cases, approval is based on the most economical accommodation and actual costs.

Hospitals may have partnerships with local hotels/motels that offer patients accommodations at reduced rates (e.g., compassionate or medical accommodation rates). If such partnerships or reduced accommodation rates are available, ODSP does not cover alternative accommodations.

Out of country travel

If out of country travel is necessary for medical treatment or therapy outside of Canada, travel and transportation costs can only be covered when Ontario Health Insurance Plan (OHIP) is covering the costs of the treatment. A letter from the Ministry of Health verifying that the applicant is approved for the insured service under OHIP is required.

If the Ministry of Health does not approve all costs for treatment or services out of country, ODSP will not cover those costs. The recipient is responsible for any remaining costs.

Refer to ODSP Directive 2.4 Absent from Ontario for health-related travel requests.

Meals and travelling with a support person

Based on a recipient’s circumstances, costs for meals while travelling may be covered. Meal allowances should not exceed $5.00 for breakfast, $8.00 for lunch and $15.00 for dinner (daily total $28.00). Alcoholic beverages are not covered.

Many transportation providers offer free travel or discounted rates for a support person to accompany individuals with disabilities while travelling. ODSP recipients that may need a support person to accompany them while travelling to approved medical treatment must inquire with their travel provider about available coverage, such as:

• One Person, One Fare: contact an airline to inquire about free coverage for adjacent seating for a support person to assist a person with a disability
• VIA Rail: allows free travel for a support person in the same class of service (e.g., adjacent seat, same cabin)
• GO Transit (GO Transit is the regional public transit service for the Greater Golden Horseshoe): support person rides for free when accompanying a person with a disability
• Inquiring about coverage for a support person with local transit and paratransit agencies

ODSP does not cover additional costs for professional medical attendant services while the recipient is traveling to approved medical treatment.

If free or discounted travel for a non-medical support person is not available, and an ODSP recipient requires a non-medical attendant (e.g., a family member or friend) to accompany them (e.g., such as for assistance with meals, medication, disembarking, orientation, or communication) the attendant’s travel costs may be covered. Coverage is available when an approved health care professional confirms that attendant is necessary. Attendants are required to share accommodation on overnight stays.

Northern Ontario residents

Northern Ontario residents must apply for the Ministry of Health Northern Health Travel Grant (NHTG) Program for health-related travel expenses. Prior to travel, the traveller will need to have the referring health care professional complete the required sections of the NHTG application form and return the application to the ODSP office.

After the trip is completed, the NHTG application form, completed in full by the medical specialist or the health care facility service provider, along with the original receipts for the travel costs incurred, must be submitted to the ODSP office. If the NHTG application form and original receipts are not returned to the local office, an overpayment may be applied.

Other sources of funding

ODSP recipients are expected to access all other sources of funding before accessing the MSN benefit, where applicable. The following are other sources of funding for certain medical supplies:

Home care services

If an ODSP recipient is receiving home and community care services that include professional services (e.g., nursing services, physiotherapy, or certain other non-physician professional services) for treatment or intervention (e.g., wound care, ostomy care, or catheter care) from a publicly funded health service provider (e.g., Ontario Health atHome, a hospital), that organization is responsible for providing the supplies the person requires in connection with the professional services they are receiving.

Information about Ontario Health atHome is available at 310-2222 (no area code required).

Diabetic supplies

Insulin

Insulin is covered under the Ontario Drug Benefit (ODB).

Insulin needles and syringes

The Assistive Devices Program (ADP) provides an annual grant of $170 for insulin needles and syringes for persons 65 and older. All clients aged 65 or older should be referred to ADP (1-800-268-6021) for this grant.

Test strips and lancets

Test strips are covered under the ODB.

Diabetes Canada (1-800-361-0796) provides reimbursement for 75% of the cost of lancets (up to an annual limit of $920), only for Ontario residents with a valid health card who use insulin or have gestational diabetes). The balance of the cost is an approvable MSN item.

Blood glucose monitors

The three types of blood glucose monitors (device used for monitoring blood sugar levels) is as follows:

• traditional blood-glucose monitors
• intermittently scanned Continuous Glucose Monitors (isCGMs) — formerly referred to as Flash Glucose Monitors (FGMs)
• real-time Continuous Glucose Monitors (rtCGMs)

Diabetes Canada (1-800-361-0796), Ontario Division’s “Monitoring for Health” program can provide funding for traditional blood glucose monitors on a reimbursement basis for Ontario residents with a valid health card who use insulin or have gestational diabetes. If eligible, Diabetes Canada will provide the lesser of 75% of the value or $75, once every five years. The balance of the cost of a traditional blood glucose monitor is an approvable MSN item if not covered by another source.

For people ineligible for the Monitoring for Health program or coverage through another source, the full cost of a traditional blood glucose monitor is an approvable item under the MSN benefit, subject to a limit of $54.

Only models of blood glucose monitors’ whose test strips are covered under the ODB will be approved under the MSN benefit. Vendors can verify which test strips are covered by the ODB.

The ODB provides funding for isCGMs and the Ministry of Health’s (MOH) ADP provides funding for real-time Continuous Glucose Monitors (rtCGMs) and its related supplies (i.e., sensors and transmitters).

Ostomy supplies

ODSP recipients requesting assistance for ostomy supplies must provide verification that they have applied for the yearly grant of $1,300 from ADP, payable in two instalments. Funding for costs greater than $1,300 is allowable. Information about the ostomy grant is available at Enteral feeding and ostomy

Incontinence supplies

The Easter Seals Society Ontario delivers an incontinence supply program for families of children with severe disabilities where the disability results in chronic incontinence.

Under the Easter Seals program, children (aged 3-5) are eligible for $400 and children (aged 6-17) are eligible for $900 in incontinence supplies, in two semi-annual instalments. Applicants should contact Easter Seals at 1-888-377-5437.

Dependent children are eligible through the MSN incontinence category for the amount above that which is provided by the Easter Seals program.

Supplies for Positive Airway Pressure Devices

ADP provides coverage for respiratory equipment and supplies. ADP coverage for Positive Airway Pressure devices (i.e., CPAP/APAP/BPAP) includes the device; heated humidifier; basic mask and headgear; carrying case; 6 ft tubing; necessary caps/filters required for setup; and user instruction manual.

Eligible supplies for CPAP/APAP/BPAP devices can be replaced based on the recommended replacement guidelines under the MSN benefit Schedule. Upgraded masks and headgear may be covered on a case-by-case basis, as basic supplies covered by ADP meet users’ general needs.

Covering the costs of approved items or services

Pay direct

Pay direct arrangements with vendors is the recommended approach; however, there may be circumstances where payment to the client is appropriate.

A decision to use a pay direct approach is not appealable to the Social Benefits Tribunal.

Approval periods and review dates

Approval periods and reviews are to be conducted as circumstances warrant. Staff are to use the identified duration on the MSN form and Schedule to determine whether a review is required and when a new MSN form should be issued. Staff must consider the item or service being requested. This may include changes in the individual’s medical circumstances, mode of travel, frequency of appointments, or availability of and changes in medical services. In some cases, a review or new form may not be necessary at the end of identified duration benefit period. For example, this applies to individuals approved for one time purchase items (e.g./abbr>, bathing, toileting and transfer aids, bed aids, braces and casts).

For medical items, supplies, and devices, where an approved health care professional specifies an indefinite duration, it is recommended that staff reassess the client’s eligibility within reasonable timeframes (e.g./abbr>, 6 months, 2 years), as the client’s medical condition and circumstances may change over time.

Recipients transferring from Ontario Works

Some Ontario Works recipients will be granted ODSP while receiving Ontario Works Mandatory benefits for medical transportation, diabetic supplies, and surgical supplies/dressings. Eligible costs should continue to be paid without interruption until the Ontario Works benefit expiration date if:

• There is proper documentation on file, and
• The item is eligible under the Schedule

Where requests are approved or not approved

A notice of decision approving or not approving the MSN request must be issued to the applicant. The notice must include information about the applicant’s internal review and appeal rights to the Social benefits Tribunal.

Retroactive payments based on reconciliation of costs

With the exception of meal allowances, MSN pays for the approved cost of the travel/transportation and items on the Schedule. In some cases, actual costs may exceed the amounts originally approved. In these cases, a reconciliation should take place based on verification of the actual expenses incurred. Payment for the difference in costs can be made retroactive to the date the completed application form was received by the ODSP office.

Related directives

2.4 — Absent from Ontario

9.6 — Assistive devices

9.10 — Extended Health benefit

Related materials

MSN Schedule of benefits