ARCHIVED – Temporary Public Policy Regarding Excessive Demand on Health and Social Services

Background

• The Department recently conducted a fundamental review of the policy on excessive demand on health and social services, as specified in sections 38(1)(c) and 38(2) of the Immigration and Refugee Protection Act (Act) and as defined at section 1 of the Immigration and Refugee Protection Regulations (Regulations) (see Annex A). This resulted in a decision to change the policy.
• Canada’s health admissibility provisions for immigration applicants are designed, in part, to reduce impacts on Canada’s publicly funded health and social services systems. Under the current policy, a foreign national is inadmissible if they have a health condition that might reasonably be expected to cause an excessive demand on health or social services.
• 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. As a result, the following changes are being proposed:
  • A revision of the definition of “social services” in the Regulations is planned to focus the immigration medical assessment on those publicly-funded social services that are closely related to health services and related to the provision of constant supervision and care for those who are not able to integrate into society. Changing the definition will bring the policy in line with Canadian values on supporting the participation of persons with disabilities in society. At the same time, it will continue to protect health and social services for Canadians.
  • A revision of the definition of “excessive demand” in the Regulations is also planned to increase the existing cost threshold to three times the average Canadian per capita cost of health and social services. Changing the definition will facilitate immigration for applicants with health conditions that typically require health and social services that cost only a small amount more than the Canadian average per capita cost of health and social services (i.e., exceeding the current cost threshold but less than three times the average Canadian per capita costs), while continuing to protect health and social services for Canadians.
• Implementation of a public policy that is aligned with the above changes will allow the Department to take immediate steps to promote the inclusion of persons with disabilities in Canadian society and to remove a barrier for persons who require health and social services that cost only a small amount more than the average Canadian per capita cost of health and social services, but who could otherwise contribute to Canada. At the same time, it will continue to protect health and social services for Canadians.

Public Policy Considerations

• As such, I hereby establish that there are sufficient public policy considerations, in accordance with section 25.2 of the Act, that justify the granting of exemptions from the requirements in the Act listed below to foreign nationals who meet the conditions (eligibility requirements) set out below.
• This temporary public policy will apply to applications for visas or other required documents, for permanent or temporary residence.

Eligibility Criteria and Conditions

Once an immigration medical exam is completed, based on the public policy considerations, delegated officers may grant an exemption from paragraph 38(1)(c) of the Act (medical inadmissibility due to excessive demand on health or social services) to foreign nationals (principal applicant or their dependent family members) who would otherwise have been found inadmissible under paragraph 38(1)c and who meet the following criteria and conditions:

1. The foreign national (principal applicant or their dependent family member) must have a temporary or permanent resident application that was received on or after April 16, 2018 or was pending as of that date, was sent back by the Court for redetermination on or after April 16, 2018, or was sent back by the Immigration Appeal Division for reconsideration on or after April 16, 2018; and
2. The costs of the health and social services (listed in Section 1, Annex B) 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 required under paragraph 16(2)(b) of the Immigration and Refugee Protection Act, 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.

Applicants who are required to undergo an immigration medical examination (IME) pursuant to subsection 16(2)(b) of the Immigration and Refugee Protection Act and who are not exempt under subsection 30(1) of the Regulations will continue to be so required.

Pending application: For the purposes of this public policy, an application is considered to be pending up until it is either approved, refused, withdrawn or abandoned.

Provisions of the Act for which an exemption may be granted:

• Section 38 (1) (c) – “A foreign national is inadmissible on health grounds if their health condition might reasonably be expected to cause excessive demand on health or social services”

Start and End dates

This public policy will be implemented on June 1, 2018 and ends once regulatory changes come into force.

Annex A: Relevant Legislative and Regulatory Provisions

Immigration and Refugee Protection Act

38 (1) A foreign national is inadmissible on health grounds if their health condition

• is likely to be a danger to public health;
• is likely to be a danger to public safety; or
• might reasonably be expected to cause excessive demand on health or social services.

38 (2) Paragraph (1)(c) does not apply in the case of a foreign national who

• has been determined to be a member of the family class and to be the spouse, common-law partner or child of a sponsor within the meaning of the regulations;
• has applied for a permanent resident visa as a Convention refugee or a person in similar circumstances;
• is a protected person; or,
• is, where prescribed by the regulations, the spouse, common-law partner, child or other family member of a foreign national referred to in any of paragraphs (a) to (c).

Immigration and Refugee Protection Regulations

1(1) Definitions

Excessive demand is:

• 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 the most recent medical examination required under paragraph 16(2)(b) of the Act, 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; or
• a demand on health services or social services that would add to existing waiting lists and would increase the rate of mortality and morbidity in Canada as a result of an inability to provide timely services to Canadian citizens or permanent residents.

health services means 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 services, 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,

• that are intended to assist a person in functioning physically, emotionally, socially, psychologically or vocationally; and
• 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.

Annex B: Assessment of the costs of Health and Social Services under the Temporary Public Policy Regarding Excessive Demand on Health and Social Services

Section 1: Services for which costs will be included to determine if an applicant meets the eligibility criteria and conditions under the public policy

Health services:

• 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:

• 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.)

Section 2: Social services for which costs will not be included to determine if an applicant meets the eligibility criteria and conditions under the public policy

• 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.