Whether a caregiver in Canada requires an immigration medical exam to apply for permanent residence depends on whether that person applies for permanent residency through the Live-in Caregiver Program, the Caring for Children Class or the Caring for People with High Medical Needs Class.

Operational Bulletin 232

On August 20th, Citizenship and Immigration Canada released Operational Bulletin 232Live-in Caregiver Program: Revised in Canada Medical Examination Procedures.  Operational Bulletin 232 provided guidance regarding an amendment to the Immigration and Refugee Protection Regulations that then Conservative Government of Canada made in 2010.  The amendments introduced a new s. 30(1)(g) to IRPR, which then read:

30(1)(g) A foreign national who has applied for permanent resident status and is a member of the live-in caregiver class is not required to submit to a medical examination under subsection (1).

Section 30(1)(g) of IRPR applied only to live-in caregivers, and medical examinations for family members remained unchanged. It also did not affect the initial overseas examination to qualify for a work permit as a live-in caregiver.

However, while medical examinations for live-in caregivers not required, officers did have the discretion to require that a live-in caregiver one.  Operational Bulletin 232 specified how this discretion was to be exercised. The Bulletin stated:

  • Officers should only consider requesting that a live-in caregiver complete a medical examination as part of an application for permanent residence if the officer has reason to believe that the live-in caregiver has a health condition that is likely to endanger public health or safety.
  • Should the officer believe that this is the case, then the officer shall consult with National Headquarters / Case Management Branch on the details of the case in question for consideration prior to requesting that the applicant complete a medical examination.
  • Where a live-in caregiver has already completed a medical examination as part of their application for permanent residence, and is currently in the stages of procedural fairness correspondence based on a medical notification indicating inadmissibility due to excessive demand, then the officer should consider whether an exemption of the inadmissibility may be warranted on humanitarian and compassionate/public policy grounds.
  • Should NHQ/CMB indicate that a live-in caregiver should complete a medical examination as part of their application for permanent residence, and the caregiver is subsequently found to be inadmissible on health grounds, then the applicant may choose to request consideration on humanitarian and compassionate/public policy grounds. Further consultation with NHQ/CMB will be undertaken prior to refusal of any such requests for consideration under humanitarian and compassionate/public policy provisions.

Medical Exam Requirements in The Caring for Children Class and the Caring for People with High Medical Needs Classes

On November 29, 2014 Chris Alexander, then the Minister of Citizenship and Immigration Canada, introduced Ministerial Instructions that limited new applications to the Live-in Caregiver Program, and introduced the the Caring for Children Class and the Caring for People with High Medical Needs Class.  These programs were similar to the Live-in Caregiver Program in that each provided a pathway to permanent residency for people who were working in caregiver positions.  However, for whatever reason, the medical exemption under Operational Bulletin 232 that was provided to Live-in Caregivers was not extended to people applying under the two new immigration programs.

The admissibility section for both the Caring for Children Class and the Caring for People with High Medical Needs Class now both state:

The principal applicant and all their dependants are required to undergo medical examinations up front and submit their medical results with their initial application. The processing office should verify that these results are still valid and, if they are not, request a new medical examination.

Rather than expand the medical examination exemption, the Liberal Government of Canada instead on May 17, 2017 repealed s. 30(1)(g) of the IRPR, although they included transitional provisions so that Live-in Caregivers who had already applied for permanent residency could continue to be exempted from the need to undergo an immigration medical examination.

Was the Removal of the Medical Exam Requirement Deliberate? 

The government has never provided a reason for why the medical examination requirement under the Live-in Caregiver Program did not extend to the Caring for Children Class and the Caring for People with High Medical Needs Class.  One has to wonder whether the issue was even flagged during the drafting of the Ministerial Instructions that created the two new caregiver programs.  Similarly, the Liberal repeal of s. 30(1)(g) was one of many sections that were repealed to, to quote the government, “reduce redundancies.”  Were they fully aware of the medical exam exemption that they were removing?

The medical exam exemption should be re-introduced and expanded to include all caregivers.  There are a few reasons for this.  The first is the general unfairness of allowing individuals to work in Canada as foreign workers, collecting taxes from them, and then kicking them out of the country if they get sick.  This applies to all foreign workers.  The second is that the cost of a medical examination is typically around $300.00, a not insignificant amount to many caregivers.   At a minimum, should the government not be inclined to re-introduce the exemption, then it would be nice to be given a rationale for why not.