On June 1, 2018 Canada’s Minister of Immigration, Refugees and Citizenship Canada implemented a Temporary Public Policy Regarding Excessive Demand on Health and Social Services (the “Public Policy”).

Canada’s Immigration and Refugee Protection Act states that a foreign national is inadmissible to Canada on health grounds if their health condition might reasonably be expected to cause excessive demand on health or social services.

The Law

Health services are defined as any health services for which the majority of the funds are contributed by governments, including the services of family physicians, medical specialists, nurses, chiropractors and physiotherapists, laboratory services and the supply of pharmaceutical or hospital care.

Social services means any social service, such as home care, specialized residence and residential services, special education services, social and vocational rehabilitation services, personal support services and the provision of devices related to those services (a) that are intended to assist a person in functioning physically, emotionally, socially, psychologically or vocationally and (b) for which the majority of the funding, including funding that provides direct or indirect financial support to an assisted person, is contributed by governments, either directly or through publicly-funded agencies.

Finally, excessive demand means a demand on health services or social services for which the anticipated costs would likely exceed average Canadian per capita health services and social services costs over a period of five consecutive years immediately following an immigration  medical examination, unless there is evidence that significant costs are likely to be incurred beyond that period, in which case the period is no more than 10 consecutive years.

The 2018 threshold under Canadian immigration legislation is $6,604.

The Rationale for the Change

The Minister has stated that the following was the rationale for the introduction of the Public Policy.

The current medical assessment of applicants includes an assessment of the costs for services that many see as critical for promoting inclusion. Most notably, this includes special education, social and vocational rehabilitation services, and personal support services. Instead of treating these as costs that must be borne by society, these services should instead be seen as investments that enable participation and inclusion. Additionally, the current policy prevents the arrival of immigrants with health conditions that require health and social services that cost only a small amount more than the average Canadian per capita cost of health and social services. These potential immigrants should instead be facilitated to make economic and social contributions to Canada.

The Public Policy

The Public Policy states that once an immigration medical exam is completed delegated officers may exempt people from medical inadmissibility provisions if they have an application in progress and the costs of the health and social services that would be required to treat the foreign national’s health condition are less than three times the average Canadian per capita health and social services costs over a period of five consecutive years immediately following the most recent medical examination, unless there is evidence that significant costs are likely to be incurred beyond that period, in which case the period is no more than 10 consecutive years.

For practical purposes, this increases the excessive demand threshold from $6,604 to $19,812.

Health services are defined as:

  • Physician services
  • Nursing services
  • laboratory and diagnostic services
  • pharmaceuticals and pharmaceutical services
  • hospital services
  • chemotherapy and radiotherapy
  • dialysis
  • psychiatric services
  • supplies related to these services

Social services are grouped into two groups, and are defined as:

  • Social services closely related to health services:
    • Social services that are provided by a health professional:
      • home care (by a nurse, physiotherapist, respiratory therapist, etc.),
      • palliative care,
      • psychological counseling and
      • the provision of devices related to those services.
    • Medical aids, appliances, and prostheses.
  • Social services that provide constant supervision and care for those who are not able to integrate into society
    • Residential facilities (long-term care, substance abuse services, etc.)
    • Day facilities providing constant supervision (respite care, etc.)

Social services for which costs will now not be included to determine if an applicant meets the eligibility criteria under the Public Policy are:

  • special education services (preparation of an individualized education plan, educational assistants, etc.)
  • social and vocational rehabilitation services (rehabilitation facilities, occupational therapy, behavioural therapy, speech-language therapy, etc.)
  • personal non-professional support services means services such as assistance with activities of daily living (bathing, dressing, feeding, etc.), meal preparation, house cleaning, etc.
  • provision of devices related to those services.

The Eventual Regulatory Change

In addition to the Public Policy, the Government of Canada has announced that it plans on amending Canadian immigration legislation to “support the participation of persons with disabilities in society” and increasing the excessive demand threshold to “three times the average Canadian per capita cost of health and soical services.”