Federal Health Minister Mark Holland says provincial and territorial health plans will cover primary care provided by nurse practitioners, pharmacists and midwives.
Holland says regulated health-care professionals who aren’t doctors will be able to bill the government for medically necessary services that would otherwise be provided by a physician.
The minister says the changes are part of a new interpretation of the Canada Health Act that takes effect on April 1, 2026.
He says the move is needed because some patients are paying out of pocket for medically necessary care, including at some private nurse practitioner clinics.
Holland says charging patients for those services isn’t consistent with universal health care and nurse practitioners should instead be able to bill the health-care system the same way doctors do.
He says the changes aren’t happening until next year because provincial and territorial governments need enough time to adjust their health insurance plans.
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Holland issued the directive in an “interpretation letter”—revising which providers fall under Canada’s medicare system—sent to health ministers on Thursday but released publicly on Friday morning.
In an interview Thursday evening, Holland said he was “deeply concerned” about patients being charged for public health-care services.
“That certainly isn’t in the spirit of the Canada Health Act, and this interpretation letter shuts that down,” he said.
The new policy also “empowers” non-physician health-care professionals to provide the full spectrum of care they’re qualified to give, Holland said.
Nurse practitioners in particular can help relieve the pressure on primary care physicians and the health-care system as a whole, he said.
“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 wrote in the letter to his provincial and territorial counterparts.
The changes will be enforced in the provinces and territories through federal health transfer payments, which could be deducted if patients are charged for medically necessary care, he said.
Holland’s directive comes almost two years after his predecessor, Jean-Yves Duclos, expressed concern in a letter to health ministers about patients paying out of pocket for medically necessary treatment.
In that March 9, 2023, letter, Duclos pledged to issue a revised interpretation of the Canada Health Act to prevent that from happening.
Last September, Canadian Doctors for Medicare wrote to the Prime Minister’s Office asking when that “long-awaited” interpretation would be released.
The group’s chair, Dr. Melanie Bechard, said it would help “ensure that all Canadians continue to have access to medically necessary care based on their needs, not on their ability, or willingness, to pay.”
“The turn toward episodic care provided virtually by physicians and longitudinal care provided by nurse practitioners (and other types of providers) was not foreseen in 1984 when the Canada Health Act was passed,” Bechard wrote.
“Clarifying that medically required virtual care or nurse practitioner care must be publicly funded would be consistent with the spirit and intent of the Canada Health Act.”
Holland said the delay was due to ongoing consultation with provincial and territorial governments over the last two years to cultivate agreement on the new policy.
Duclos also identified virtual care and telemedicine as areas where some patients may be inappropriately paying out of pocket.
Holland said billing for virtual care is not addressed in his current directive, but it remains a concern he’s discussing with his provincial counterparts.
“If you walk into a doctor’s office that is a physical doctor’s office or if you walk into a virtual doctor’s office, both of those things should be covered by the Canada Health Act,” he said.
“Both of those things should ensure that a patient isn’t paying for their health-care services.”
