TORONTO — Provincial and territorial health plans will cover primary care provided by nurse practitioners, pharmacists and midwives starting next year, federal health minister Mark Holland announced on Friday, which those professionals say will allow compensation for more services they're qualified to give.
Holland said regulated health-care workers who aren't doctors will be able to bill the government for medically necessary services that would otherwise be provided by a physician.
The changes are part of a new interpretation of the Canada Health Act that takes effect on April 1, 2026, the minister said, noting that the move is needed because some patients are paying out of pocket for medically necessary care, including at some private nurse practitioner clinics.
Holland said 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.
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.
Michelle Acorn, CEO of the Nurse Practitioners' Association of Ontario, called the move "a significant win."
"This actually represents the culmination of years of advocacy by (the) Nurse Practitioners' Association and nurse practitioners across provinces and territories," Acorn said in an interview on Friday.
"We've been working and advocating so hard to ensure that there is timely access to accessible health care so that we leave no one behind.”
Acorn said some nurse practitioners have "reluctantly" had to charge patients for a range of health-care services — from birth control to managing chronic diseases like diabetes and respiratory conditions — because they aren't able to bill the government for their time.
The association doesn't expect the change to affect about 30 nurse-practitioner-led clinics already funded by the Ontario government, she said, noting that almost half of Canada's nurse practitioners are in that province.
Claire Dion Fletcher, vice-president of the Canadian Association of Midwives, said after years of advocacy with health ministers, "basic" midwifery services — from prenatal to six weeks after birth — are already funded by all provinces and territories.
But including midwives in the updated billing rules means they may be able to provide other services they're qualified to offer but "are not necessarily within our current model of compensation," she said in an interview.
Those services include testing for sexually transmitted diseases, providing birth control, abortion care and vaccinations.
”This announcement seems to indicate that there will be more ability for ... midwives to work to our fullest scope, which is something that is really important and that we think would increase access to sexual and reproductive health care for all Canadians," Dion Fletcher said.
Joelle Walker, vice-president of public and professional affairs with the Canadian Pharmacists Association said pharmacists already provide various levels of primary care — including diagnosing illnesses and prescribing medication — depending on the province or territory.
She hopes the new policy will increase the services pharmacists can bill provincial health plans for.
”Pharmacists have been at the forefront of primary care for a long time," Walker said.
”We look at this as an important statement about the fact that regardless of the provider that's providing medically necessary health care that those services should be covered."
Holland said the long lead time for allowing non-physicians to bill the government for care is necessary for the provinces and territories to adjust their health insurance plans.
In an emailed statement on Friday, a spokesperson for Ontario Health Minister Sylvia Jones said they were "reviewing the federal government’s response to understand how it will impact the delivery of high-quality, publicly funded care in Ontario."
Between nurse practitioners and doctors, the province will be "connecting every person in the province to a primary-care provider over the next five years," Ema Popovic wrote in the statement.
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 stop 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."
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."
— With files from Allison Jones
This report by The Canadian Press was first published Jan. 10, 2025.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Nicole Ireland, The Canadian Press
