Changes on the Horizon for Canadian Medicare

Attention all health care providers, there are big changes on the horizon for Canada’s medicare system. On January 10, 2025, Canada’s Minister of Health issued a statement announcing the new Canada Health Act (CHA) Services Policy (“CHA Services Policy”). The Canada Health Act is federal legislation that enshrines the rights of Canadians to access to necessary health care services without financial or other barriers. The CHA does this by establishing the criteria that provinces and territories must meet to receive federal funding, including the prohibition on extra- billing and user charges for insured health care services.

The CHA Services Policy states that if a service is considered medically necessary and is part of the “core basket of services”, then it should be covered by a patient's provincial or territorial health care plan whether the service is provided by a physician or a physician-equivalent (such as a Nurse Practitioner). The intention behind this change is to prevent patients from paying for access to care that would be insured if it were provided by a physician. For example, in Ontario, nursing services are generally only insured when they are part of services provided by a physician that are insured under one of the Ontario Health Insurance Plan’s (“OHIP”) Schedules of Benefits. Therefore, some services that would otherwise be understood to be medically necessary are not currently insured by OHIP solely because a physician is not involved in providing the services.

The CHA Services Policy is scheduled to come into effect April 1, 2026, and if it is implemented, we anticipate that the Ontario Minister of Health and Ontario Health Insurance Plan will introduce significant changes leading up to this date to ensure compliance with the CHA Services Policy to avoid interruptions in funding from the federal government. However, with a federal election taking place between the Minister’s announcement and the CHA Services Policy coming into effect, the future of the CHA Services Policy is uncertain.

We look forward to helping our clients to navigate these and other changes to the healthcare system in Ontario.