Eligibility requirements and disabilities
The Supplement for Handicapped Children Requiring Exceptional Care is governed by the Taxation Act 
, more specifically by the rules prescribed in the
Regulation respecting the Taxation Act .
Eligibility for the Supplement for Handicapped Children Requiring Exceptional Care is determined based on defined requirements. It is not based on diagnosis alone. The requirements take into account one or several of the following elements:
- the presence of severe and multiple disabilities;
- the severity of the child's disability (severity of the limitations in carrying out his or her life habits based on his or her age);
- the need for complex medical care.
Therefore, even if two children received the same diagnosis, the applications filed for them could result in different decisions due to differences in their disabilities, limitations and/or the complex medical care they require.
Analysis of eligibility : three different situations
Assessment period of eligibility for the Supplement for Handicapped Children Requiring Exceptional Care
A
Child with
very severe and multiple disabilities
B
Child requiring
complex medical care at home
C
Very young child with
severe, multiple and persistent disabilities
In situation A, since the eligibility requirements are different for the two determined age groups, a child may not be eligible for the Supplement for Handicapped Children Requiring Exceptional Care before age 4 but may be eligible after that age. Conversely, a child may be eligible before age 4, but no longer be eligible after that age. For the same reason, a child may be eligible for different tiers before and after age 4.
In situation B, under the Taxation Act, a child may be eligible at any age (between ages 0 and 18) as soon as care is administered at home. However, in situation A, eligibility is only possible as of age 2.
For the three situations, once the child is eligible for the Supplement for Handicapped Childre Requiring Exceptional Care, the child remains eligible until he or she turns 18 if his or her condition has not changed.
Regarding situation A and in certain cases for situation B, we must assess the severity of the limitations in carrying out the child's life habits to determine his or her eligibility. For more information on the assessment of the limitations, consult the Disabilities and severity of limitations section below.
Eligibility requirements depending on the situation
The child has physical impairments or a mental function disability causing very severe and multiple disabilities that prevent him or her from carrying out the life habits of a child of his or her age. The disabilities are expected to last for at least one year.
Child age 2 or over, but under age 4
With regard to carrying out the following 3 life habits:
- Nutrition
- Moving about
- Communication
Tier 1
Absolute limitation respecting 3 life habits
Tier 2
Absolute limitation respecting 1 life habit
Serious or absolute limitation respecting at least 1 other life habit
Child age 4 or over, but under age 18
With regard to carrying out all 7 life habits taken into consideration
Tier 1
Absolute limitation respecting 4 life habits
Serious or absolute limitation respecting at least 1 other life habit
OR
Absolute limitation respecting 3 life habits, including moving about
Serious or absolute limitation respecting at least 2 other life habits
Tier 2
Absolute limitation respecting 2 life habits
Serious or absolute limitation respecting at least 1 other life habit
OR
Absolute limitation respecting moving about
Serious or absolute limitation respecting at least 1 other life habit
The child's medical condition requires complex medical care at home for which parents have received training at a specialized centre in order to learn the specific techniques for using the required equipment. Care must be administered by the parents who must also be able to respond to any potentially life‑threatening change in their child's clinical condition. Parents are expected to administer the complex medical care to their child for at least one year.
Child under age 18
The child receives one of the following types of care:
Tier 1
- Respiratory care:
- tracheostomy with mechanical ventilation;
- for children under age 6 OR children aged 6 and over who have an absolute limitation in carrying out a life habit or a serious limitation in carrying out two life habits, excluding personal relationships:
- tracheostomy without mechanical ventilation;
- daily non-invasive mechanical bi-level positive airway pressure ventilation using BPAP.
- Nutritional care:
- parenteral nutrition at home (intravenous hyperalimentation).
- Cardiac care:
- intravenous inotropes;
- ventricular assist device (artificial cardiac pump).
- Renal care:
Tier 2
- Respiratory care:
- for children aged 6 or over who do not have limitations in carrying out their life habits:
- tracheostomy without mechanical ventilation;
- oxygen therapy or mechanical ventilation (CPAP, high-flow oxygen therapy systems) on a daily basis, 24 hours per day.
- Nutritional care:
- gastrojejunal or jejunal feeding tube.
- Other care:
- daily skin care for severe and generalized dermatologic conditions, at high risk of pressure wounds, webbing and contractures.
Child under age 2
All the elements listed under REQUIREMENT 1 or REQUIREMENT 2 describe the child's condition:
Tier 1
Requirement 1
Chronic and severe illness without known treatment
Very severe and persistent motor disabilities
OR
Requirement 2
Neurogenetic, congenital or metabolic disease without known treatment
Very significant symptoms in the first months of life
Disease that limits life expectancy to childhood
For situation C to apply:
- A disease is considered to limit life expectancy to childhood when it is associated with death before age 18 in most affected children, despite optimal care.
- A child with very severe persistent motor disabilities is a child who has both:
- gross motor skills that remain below those of the average healthy child a quarter of his or her age, despite receiving recommended treatments (e.g. a 12-month-old child with skills below those expected of a 3 month-old child);
- oral-motor disabilities that result in significant challenges with regard to eating.
- To assess the condition of a child born prematurely, the child's age is adjusted by subtracting the number of weeks of prematurity, until the age of 36 months.
- The term "complex medical care" means care that meets all of the following conditions:
- It is administered on a daily basis, and the care routine is very demanding.
- It is administered for the child's survival, as it compensates for the dysfunction of an organ or system.
- It is not frequently administered to children in the same age group as the child.
- It requires specialized equipment or a person to be available at all times to address any changes in the child's clinical condition.
Analysis of eligibility : assessment of the severity of the disability
Eligibility is not determined solely upon the diagnosis, it is also based on the severity of the child's limitations in carrying out life habits.
Disabilities and severity of limitations
A child is disabled if there is a significant discrepancy between the level of carrying out his or her daily life habits and the level expected for a child of his or her age who does not have any physical impairment or mental function disability. Where the
discrepancy related to the standard becomes extreme (in relation to very severe and multiple disabilities), and therefore the disability is very severe, the child's situation can entitle him or her to the Supplement for Handicapped Children Requiring Exceptional Care based on defined rules.
The five following elements are taken into account to assess the child's limitations in carrying out his or her life habits:
- The assessment of the limitations considers the child's abilities and disabilities regarding various physical and mental skills.
- The child's disabilities can be improved with age and stimulation or following therapeutic interventions.
- New disabilities can be pointed out over time.
- For the same diagnosis, two children can have different abilities and disabilities.
- The disabilities related to all the diagnoses of the child are taken into account.
- The more the child has disabilities (in numbers and severity), the greater the level of his or her limitations in carrying out his or her life habits according to what is expected from a child of his or her age will be.
- Between a child's birth and age 18, a child with no health problems goes from being totally dependent on an adult to being completely autonomous in carrying out life habits. The expectations regarding his or her participation are very different depending on the child's age.
- Certain disabilities can have different consequences if we compare a newborn with a child of school age or a teenager.
- Example: a two-year-old child who is still not toilet trained will not be limited as compared to a 12-year-old child in the same situation.
- The child's various living environments can include, as the case may be, his or her family environment, daycare, school, etc.
- A facilitator is an environmental factor (physical or social) which facilitates the ability to carry out life habits.
- An obstacle is an environmental factor (physical or social) that inhibits the ability to carry out life habits.
- The child's significant limitations in carrying out his or her life habits are assessed after treatments and measures likely to improve the child's state of health have started.
- A child cannot be considered to be eligible if the treatments or measures likely to improve his or her state of health are not applied, without good reason.
Severity of the limitations
Regarding situation A and in certain cases for situation B, we must assess the severity of the limitations in carrying out the child's life habits to determine his or her eligibility.
In the case of the Supplement for Handicapped Children Requiring Exceptional Care, two degrees of limitations in carrying out a life habit are defined in the Regulation. As a result, only these two degrees of limitations are taken into account when analyzing applications. They are absolute and serious limitations.
Absolute limitation
- The child is completely unable to perform a life habit in an autonomous manner for the child's age despite the presence of facilitating environmental factors, such as technical aids, arrangements, or the assistance of another person. In other words, the child has major disabilities and is absolutely incapable of carrying out a life habit according to the norm expected for his or her age, despite the implemented facilitators.
- The child shows little or no individual autonomy. Carrying out the life habit depends entirely on the adult, and the child is unable to participate, or only participates minimally for his or her age.
Serious limitation
- The child always or nearly always has considerable difficulty carrying out a life habit in an autonomous manner for the child's age despite the presence of facilitating environmental factors, such as technical aids, arrangements, or the assistance of another person. In other words, the child has severe disabilities and carries out the life habit, but incompletely, and the final result is considerably impaired compared with the expected norm for his or her age, despite the implemented facilitators.
- The child shows little autonomy for his or her age. Carrying out the life habits depends mainly on the adult, and the child is only partially participating for his or her age.
For the same child, the degree of limitation in carrying out the life habit may vary over time. The child's disabilities may improve with age, stimulation or following therapeutic treatments. Therefore, the child may become less limited as he or she ages. Conversely, participation requirements increase with age. For a level of disability that remains similar, an older child may therefore be considered more limited because the gap between him or her and his or her peers regarding carrying out the life habits has widened significantly over time.
Life habits considered
The life habits taken into consideration when processing applications are those that a child should be able to carry out, depending on his or her age, with respect to his or her personal care and social life. The life habits are the following:
Depending on the child's age, this includes the following activities:
- Breastfeeding or drinking from a baby bottle, a sippy cup or straw, a bottle, a mug or a glass.
- Eating enough food to ensure his or her growth.
- Swallowing liquids and foods of different textures and consistencies without severe choking or aspiration pneumonia.
- Bringing food to the mouth with his or her fingers.
- Using different utensils (the child's ability to use them is what will be taken into account, not his or her choice to do so).
- Opening containers, having a snack or helping prepare a simple meal (bowl of cereal or sandwich).
- Using a toaster, microwave and other kitchen tools.
Depending on the child's age, this includes the following activities:
- Becoming toilet trained for urine and bowel movements. Using the toilet.
- Ensuring personal hygiene (washing hands and face, bathing or showering, brushing teeth, caring for hair, etc.).
- Dressing and undressing himself or herself (upper and lower body).
- Using sanitary pads or other menstrual hygiene products appropriately.
- Participating in health care and following treatment instructions.
Depending on the child's age, this includes the following activities:
- Lifting his or her head;
- Turning onto his or her back when on his or her stomach and vice versa;
- Assuming and maintaining a sitting position;
- Crawling;
- Rising from the floor or a chair;
- Standing;
- Moving from one position to another;
- Walking;
- Using stairs.
Depending on the child's age, this includes the following activities:
- Seeing and hearing.
- Being attentive to verbal messages.
- Understanding and using gestures.
- Understanding pictograms (images) and using them to communicate.
- Understanding verbal instructions (simple and complex).
- Expressing himself or herself verbally using words and sentences.
- Expressing himself or herself in a way that others can understand.
- Speaking to communicate with another person (greeting and naming a person, making comments and requests, protesting, answering, asking questions, telling stories or recounting an event, providing explanations, arguing, discussing, etc.).
Depending on the child's age, this includes the following activities:
- Connecting with others.
- Sharing interests with others.
- Showing interest in others.
- Taking into account what others say.
- Maintaining affective relationships with his or her family (parents, brothers and sisters).
- Building and maintaining bonds with other children.
- Participating in group activities and working as a team.
- Maintaining relationships with adults other than his or her parents.
- Adapting his or her behaviour in relationships with others (respecting authority, avoiding aggressive and disrespectful behaviour, etc.).
- Complying with social conventions (greeting people, using appropriate language, respecting rules in different contexts, respecting others' personal space, etc.).
Depending on the child's age, this includes the following activities:
- Having the ability to adapt to different environments.
- Memorizing information to use in everyday life (basic personal information, simple instructions, steps in routines, routes between familiar places, etc.).
- Understanding and respecting rules and safety instructions.
- Collaborating in activities and tasks expected of him or her, according to his or her age and environment.
- Developing his or her autonomy regarding daily routines, tasks and activities.
- Being able to ask for help when necessary.
- Controlling his or her behaviour and not endangering others or himself or herself.
- Solving everyday problems (reacting to unexpected situations, trying out solutions when facing difficulties, etc.).
- Staying alone for short periods of time.
- Recognizing the value of money, making small purchases, etc.
Depending on the child's age, this includes the following activities:
- Being able to interact with his or her environment (exploration, appropriate use of toys and objects).
- Developing play skills (block games, puzzles, role play or pretend play, board games, etc.).
- Developing preschool skills (drawing, cutting, crafts, knowledge of colors and shapes, etc.).
- Learning school notions (reading, writing, calculating, etc.).