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Ontario can do the same for autism. A Single-Entry Model (SEM) is the proven structural reform behind major Canadian and international waitlist reductions. Applied to the Ontario Autism Program, it could materially shrink the gap between registration and service, without first closing the $385M funding gap.
Direct answer
Outcome analysis of the Saskatchewan Surgical Initiative (2010-2014) · Verified 2026-08-10
In brief
Source: MCCSS FOI via OAC · May 2026 | Updated May 13, 2026
Today, children registered with AccessOAP wait, sometimes for years, for an "invitation" issued by registration date. In a working SEM, a child whose Determination of Needs is complete is matched to the next available qualified provider in their region as soon as that capacity exists. This eliminates the administrative delay between "you can be served" and "you are being served."
Today, families select a provider after their funding invitation, and discover the provider has its own wait. In a working SEM, all providers in a region share a single capacity pool. The constraint shifts from chronological invitation order to actual delivery capacity. The Saskatchewan Surgical Initiative made exactly this shift; results: 75% wait reduction.
Pooled matching alone moves the bottleneck, without provider capacity, families are still rationed. The FAO has noted the OAP requires significant workforce expansion. Direct workforce funding: BCBA training pipelines, RBT certification subsidies, university-affiliated programs (McMaster, Western, U of T), incentives for rural practice. Treat workforce as part of the structural reform, not an afterthought.
Single-Entry Model variants have produced measured wait-time reductions across multiple healthcare service categories. The OAP architecture would be applying techniques with documented effectiveness, not experimenting in a new domain.
| Program | Period | Documented result | Mechanism | Source |
|---|---|---|---|---|
| Saskatchewan Surgical Initiative | 2010-2014 | 75% reduction in patients waiting >3 months (15,352 → 3,824) | Centralized registries + pooled referrals + capacity expansion | pmc.ncbi.nlm.nih.gov |
| Vancouver OASIS | Ongoing | Significant osteoarthritis wait reduction | Single-Entry Model for orthopaedic referrals | healthcoalition.ca |
| Winnipeg Central Intake | Ongoing | Reduced specialty-referral waits | Pooled specialty-referral intake | healthcoalition.ca |
| NHS England 18-Week Target | 2008 | Achieved 18-week max referral-to-treatment | Funding boosts + targets + performance management | ICES Canada lags behind report |
| Ontario Rehab Wait Strategy | 2010s | Improved client throughput | Acuity prioritization + self-management education + audits (85% sites) | pmc.ncbi.nlm.nih.gov |
A Single-Entry Model reduces friction. It does not create new funding. The FAO 2020 analysis found that serving all registered children at 2018-19 service levels would require $1.35B/year. The 2026-27 OAP budget is $965M. The annual shortfall is $385M.
Source: Financial Accountability Office of Ontario (2020); MCCSS FOI via OAC · May 2026 | Updated May 13, 2026
Even an optimally-implemented SEM cannot deliver care that is not funded. The structural reform (SEM) and the fiscal reform (close the $385M gap) are complementary. Both are needed. The intake change needs little new money; the workforce change does. The fiscal gap requires sustained budget commitment over multiple cycles.
See Cost to Clear the Waitlist for the fiscal-reform analysis.
Design phase. Convene a working group with AccessOAP, MCCSS, FAO, OAC, ARCH, A4A, and provider representatives. Specify pooled-matching algorithm; define provider capacity reporting. Workforce expansion plan begins.
Pilot phase. Implement pooled matching in 1-2 regions (e.g., Eastern Ontario + a Northern region). Compare wait times to control regions. Refine based on data.
Provincial rollout. Scale pooled matching to all regions. Workforce expansion produces first new BCBA/RBT cohorts.
Measurement & refinement. Public quarterly reporting on wait times, capacity, and outcomes. Performance management against targets (analogous to NHS 18-week target). External audit of the pooled-matching system to ensure equitable access.
Source: End The Wait Ontario proposal | Updated 2026-08-10
How many children are on the Ontario autism waitlist in 2026?
As of May 13, 2026, 91,974 children are registered with the Ontario Autism Program. However, only 20,711 (22.5%) have an active Core Funding Agreement. This represents ~300% growth in registrations since 2019, with 71,263 children still waiting for essential funding.
Source: MCCSS FOI via OAC · May 2026 · Open source record
A Single-Entry Model (SEM) is a healthcare service-design pattern in which all referrals for a given service category enter through one centralized intake, are assessed and triaged together, and are matched to the next available qualified provider, regardless of which clinic, hospital, or provider originally received the referral. SEMs treat all providers in a region as a pooled resource rather than separate parallel queues.
The Saskatchewan Surgical Initiative (2010-2014) reduced patients waiting more than 3 months for surgery by 75%, from 15,352 to 3,824, through centralized registries, pooled referrals, and capacity expansion. Vancouver's OASIS and Winnipeg's Central Intake achieved similar results for osteoarthritis and specialty referrals.
AccessOAP is a single-entry intake organization. The OAP architecture has the central intake but lacks the most important feature of a working SEM: a pooled-provider matching system. Children registered with AccessOAP are placed in a chronological queue and wait years for an "invitation", not matched to the next available qualified service-delivery provider as soon as they need service. The result is the bottleneck shown in current FOI data: enrolment growth (~11/month) is far below registration growth (~918/month), so the queue grows.
Three structural changes: (1) Convert AccessOAP from a registration-and-invitation system to a pooled provider-matching system. Children would be matched to the next available qualified provider in their region as soon as Determination of Needs is complete. (2) Treat all OAP-approved providers in a region as a single pooled resource. Provider capacity becomes the constraint, not chronological invitation order. (3) Expand provider capacity in parallel through workforce-development funding (BCBA training, RBT certification, university-affiliated programs). Without capacity expansion, pooled matching alone moves the bottleneck.
No. At current net clearance rates, the waitlist grows net ~907/month while active funding grows ~242/month, so the queue continues to widen. The FAO estimated $1.35B/year is needed to serve all ~40,700 registered children at 2018-19 service levels. The 2026-27 budget is $965M, a $385M annual shortfall. A SEM does not solve underfunding; it reduces friction in the system that exists. Both reforms are needed: structural (SEM) and fiscal (close the $385M gap).
The intake change needs little new money; workforce changes need additional funding.
Directly paired with official government filings, FOI releases, and audited datasets.
91,974
children are registered in the Ontario Autism Program
According to the FAO (2020 report), OAP funding covers less than one-third of estimated need at 2018-19 service levels
$965M
Ontario allocated $965M to the Ontario Autism Program in 2026-27
22.5%
Only 20,711 children have active funding agreements (22.5%), less than one in four
Founder & Autism Advocate
Lived experience: Parent of autistic child navigating OAP system