Ottawa is now opening the door to allow health practitioners other than doctors — nurse practitioners, pharmacists, midwives — to provide medically necessary care to be covered by provincial and territorial health plans.
In a long-awaited letter to the provinces and territories, Health Minister Mark Holland says if a service is considered medically necessary it should be covered by the public health care system — whether provided by a doctor or a “physician equivalent.”
Friday’s move comes 20 months after the federal health ministry promised a new interpretation of the Canada Health Act.
“There has been an expansion in scopes of practice for many regulated health care professionals (e.g. nurse practitioners, pharmacists, midwives) to better utilize the full extent of their competencies, knowledge and skills to increase access to needed care,” Holland says in his letter, released Friday. “This now permits these professionals to deliver some of the same services that would normally be insured if provided by a physician.”
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Is paying out-of-pocket for medically necessary care allowed?
The minister notes that there is no area where this has been more evident than in team-based primary care, where nurse practitioners have been integrated into the primary care system, “greatly increasing access for Canadians while helping to relieve pressure.”
The changes will take effect April 1, 2026, Holland said, to give the provinces and territories time to review the administration of their health care plans and make any adjustments.
In March 2023, former health minister Jean-Yves Duclos said he would issue a letter clarifying that patients must not pay out-of-pocket for medically necessary care.
Duclos also warned the provinces and territories that federal health funding would be withheld if they failed to uphold the Canada Health Act, which bans the practice of charging patients for access to care already insured under public health plans like OHIP. The Act, passed in 1984, did not address medical care provided virtually or by practitioners other than doctors.
Since Duclos’ announcement, health practitioner advocacy groups have been pressing for the new interpretation to save patients from paying out-of-pocket for care.
In his letter, Holland says his new interpretation would be enforced through federal regulations designed to curb extra-billing and user charges.
He also said he was aware that some private surgical clinics are offering patients opportunities to “jump the queue” for procedures, such as cataract surgeries, knee or hip replacement, and hernia repair, in exchange for a fee.
“I am concerned that this practice could undermine the fundamental principle of Medicare,” says Holland, “where access to care should be based on health need rather than the ability or willingness to pay.”
