Accommodation in a public facility
What does the financial contribution consist of?
The ministère de la Santé et des Services sociaux has entrusted the Régie de l'assurance maladie du Québec with administration of the Financial Contribution Program for Accommodated Adults. In this capacity, the Régie must set the amount of contributions paid by accommodated adults.
The financial contribution is the amount the government charges to adults who are accommodated in Québec healthcare facilities. It addresses the concern that accommodated adults be treated equally to persons living at home.
Accommodated adults, like persons living at home, must assume costs related to meeting their basic needs. Since health and social services are free for all Quebecers, the value of these services is not included in calculating the contribution.
The administrative staff of longterm care facilities have access to online services
for registering accommodated persons or making changes in their files. These services are available in French only.
How is the contribution determined?
The following factors are taken into account in determining the contribution:
Category of room
The monthly room rates vary depending on the type of room.
Category/Monthly Rates
- Private room $1 711.80
- Semi-private room $1 431.00
- Room with 3 or more beds $1 063.80
Ability to pay
The above prices are maximum rates. For a person who cannot afford these rates, the amount of the contribution is determined on the basis of the person's ability to pay (income, possessions, savings, and family situation). The following family deductions may apply:
- $197.00 per month for your personal expenses;
- $1 102.53 per month if you have a non-accommodated spouse;
- $553.51 per month for each dependent child age 18 or over;
- $441.46 per month for each dependent child age 17 or under.
The Régie de l'assurance maladie du Québec is now offering a simulation tool for calculating the financial contribution.
How is the contribution calculated?
- After admitting the person, the facility sends the Régie the form entitled Registration or Changes, properly completed.
- The Régie then sends the accommodated person or his/her representative (with a copy to the facility) a notice indicating the amount payable for the room occupied and the procedure to be followed if the person feels that his/her financial or family situation justifies a reduction in the amount of the contribution.
- The person pays the accommodation facility the amount shown on the notice from the Régie
Applying for a reduction in the contribution
- The person must fill out and send the Régie the form entitled Application for Exemption or for Re-evaluation, available from the accommodation facility.
- The Régie then examines the application, taking into account the person's liquid assets Liquid assets
Bank accounts, guaranteed investment certificates, stocks, savings bonds, RRSPs, RRIFs, etc., possessions Possessions
Principal residence, cottage, building, land, automobile, etc. The value of pre-arranged funeral services is not included in the value of possessions. and income Income
Old Age Security Pension, Québec Pension Plan or Canada Pension Plan benefits, employment income, a pension from another country, United States social security benefits, salary or disability insurance, CSST benefits, etc. (and those of the person's spouse, where applicable), and the person's family obligations. Calculation of the contribution also takes into account certain deductions, such as those for personal expenses, for the person's spouse and dependants, and for having to break a lease.
- The Régie sends the accommodated person or his/her representative (with a copy to the facility) a new notice indicating the amount payable for the room occupied, which may be less than or equal to the amount previously set.
- The person pays the accommodation facility the amount indicated on the new notice from the Régie.
Calculation of the contribution for a given month takes into account the person's income from the preceding month. For example, the contribution payable on January 1 is set on the basis of income for December.
The contribution varies according to the amount of the Old Age Security pension, indexed every 3 months, and to other income or deductions that are indexed annually.
The accommodated person must notify the Régie (Service de la contribution et de l'aide financières) as soon as possible of any change in his/her family or financial situation.
Who must pay the contribution?
Any persons age 18 and over whose condition requires that they be accommodated in a healthcare facility must pay the contribution.
When is the contribution payable?
In the case of persons living in a residential and long-term care centre, the contribution is payable as of the first day spent in the facility and is calculated in proportion to the number of days of accommodation. The day of arrival is included in the calculation, but the day of departure is not.
In the case of persons accommodated in a rehabilitation centre for alcoholics and other substance abusers, the contribution is payable after 45 days spent in the facility.
In the case of persons accommodated in a general and specialized hospital, the contribution is payable for the time during which, after having been discharged from acute care, the person is waiting to be admitted to long-term care but cannot return home because of his or her state of health. No contribution is payable for as long as the person's condition calls for acute care. However, after 45 days, the person is considered to be receiving long-term care and must pay the contribution, unless a physician certifies in the person's medical record that, because of the person's condition, he or she still requires acute care. This certification must be renewed every 30 days.
Products and services provided to accommodated adults by the facility
The products and services provided by the facility are under the responsibility of the ministère de la Santé et des Services sociaux, in accordance with circular 1995-10 issued for this purpose. The facility provides, free of charge:
(a) products and services necessary for personal hygiene, such as:
- paper products or other products indicated in the individualized services plan, or any other products required because of an accommodated person's particular condition;
- skin creams, shampoo, deodorant, soap, toothpaste and facial tissue;
- laundering and care of the person's linen and clothing. These tasks may, however, be performed by the person's family;
(b) any equipment used by an accommodated adult for therapeutic purposes.
Products and services that accommodated adults must pay for themselves
The following products and services must be paid for in full by accommodated adults and are also indicated in circular 1995-10 issued by the ministère de la Santé et des Services sociaux:
- hairdressing services;
- personal care products (cosmetics, hairspray, lotions, etc.);
- tobacco and newspapers;
- meals ordered from outside;
- a personal telephone, rental of a television set;
- special care of clothing (dry cleaning, mending, etc.).
Recourse in the event of dissatisfaction with service quality
Persons who feel that the care they are receiving is unsatisfactory may request the intervention of the service quality commissioner of their accommodation facility.
Application for review
If you disagree with a decision of the Régie, you can apply for an administrative review. You have 6 months, from the date the letter of decision is deposited in your mailbox or handed to you in person, to contest the decision.
Form to fill out
First, you must fill out an Application for review.
To appeal a decision regarding healthcare received outside Québec, a technical aids program or a financial assistance program, you must use the form also.
It is important that you enclose the relevant original documents (bills, proof of payment, medical documents, etc.) and you specify the matter being contested, and any facts and dates to be corrected. If you need more space than that provided on the form, attach a separate, signed sheet.
Send your application for review to the following address:
Direction de la révision
Régie de l'assurance maladie du Québec
Case postale 6600
Québec (Québec)
G1K 7T3
We recommend that you keep copies of the documents provided.
Analysis of your application for review
The agent of the Régie who analyzes your application for review will contact you, if required, to clarify your expectations. If necessary, the agent will assist you in the process of gathering relevant information to complete the file.
The review of your application is based on the new information provided by you and the documents already on file. Those documents must cover the entire period at issue. Missing information may delay the processing of your file.
After the agent has reviewed your file, he/she will notify you in writing of the Régie's new decision.
The Régie's commitment
We will process your application in keeping with our values: respect, responsibility, fairness and attentiveness.
We also undertake to follow up on your application for review within 40 days of receiving it, if your file is complete.
The Régie's decision
Under the Health Insurance Act, the Régie has 90 days to render its decision following an application for review.
If, after you've filed your application, you wish to provide supporting documents or comments, the 90-day time limit will run from the date the Régie receives the documents.
Moreover, if the Régie deems that it needs additional documents or information, it may extend the time limit by another 90 days.
Finally, if the Régie does not meet the deadlines, you may wait for its new decision, or contest the previous decision before the Tribunal administratif du Québec (TAQ).
Do you disagree with the Régie's new decision?
If you believe that the decision rendered in follow-up to your application for review does not respect your rights, you have 60 days (from the date the decision is delivered to your address) to contest it before the TAQ.
Other details
The contribution is payable on the first day of every month to the management of the accommodating facility.
The contribution is calculated by the Service de la contribution et de l'aide financières of the Régie de l'assurance maladie du Québec.
For further information about this program, contact the facility concerned.