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Ask Tito Mike by Michael Scott  

Inadmissibility on health grounds

and “excessive medical demand”

by Michael Scott

The recent decision of Immigration, Refugees and Citizenship Canada (IRCC) to invite additional applicants from the Parent/Grandparent (PGP) online database has raised many questions, especially related to sponsor’s income for 2018, 2019 and 2020, along with admissibility questions about the older applicants.

Did you know that health issues affect PGP applications in ways different from other family class sponsorships? First, applicants can be declared inadmissible on health grounds. The section of the Act that deals with medical inadmissibility is “health grounds” or s.38 (1): “A foreign national is inadmissible on health grounds if their heath condition (a) is likely to be a danger to public health; (b) is likely to be a danger to public safety; or might reasonably be expected to cause excessive demand on health of social services.”

Inadmissibility on health grounds cover (a) being a danger to the public health refers to applicants who have an infectious disease such as tuberculosis or have been in close contact with someone who has an infectious disease. IRCC must determine how the disease could affect people who are living in Canada, or (b) being a danger to public safety, which would cover someone who could be a risk of suddenly becoming incapacitated physically or mentally. It would also cover someone who has unpredictable violent behaviour. Finally, IRCC may consider applicants inadmissible if their health condition would cause (c) an “excessive demand on health or social services.”

There are no exemptions from IRPA s.38 (1) (a) and (b) but only for (c). The exemption is set forth in the following section, IRPA s.38(2), which specifies that “paragraph (1)(c) does not apply in the case of a foreign national who (a) 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; (b) has applied for a permanent resident visa as a Convention refugee or a person in similar circumstances; (c) is a protected person.” There are other family class applicants, especially parents and grandparents who are not excluded. Your sponsored mother and father or grandmother or grandfather can be refused on health grounds for “excessive medical demand.” The likelihood of this occurring amongst PGP’s normally increases with age.

In terms of excessive costs for PGP, it would cover wait times in Canada or if the services needed to treat their heath condition might exceed the excessive demand threshold. IRCC updates the cost threshold every year based on the latest Canadian average. It amounts to about three times the average cost for health and social services. In 2021, that sum came to roughly $21,796 per year. If the estimated cost is less than that amount the costs for the applicant’s care would not be deemed excessive.

If the PGP applicants are receiving medical care in the home country, they could anticipate being challenged in the form of a warning letter or procedural fairness letter. IRCC has a responsibility to give applicants and their sponsors a reasonable chance to respond to questions they may have about the applicant’s health and possible excessive demand on the health and social services in Canada. You would be given 60 days to respond by coming up with a mitigation plan such as surgery, change of medication or services and a different assessment from a specialist who has been treating the same applicant over time. The dollar figure quoted above was a big improvement (over the three times rule) in terms of giving a realistic figure for ones that were too low. It is important to anticipate potential challenges, and consulting your own physician goes a long way to identify treatment options. Excessive medical demand sounds threatening but it can be confronted and even overcome by changes in the health of the applicant and treatment.

Michael Scott is a Regulated Canadian Immigration Consultant (RCIC, R525678) who has 30 years of experience with Immigration Canada and the Manitoba Provincial Nominee Program. He currently works as a licensed consultant with Immigration Connexion International Ltd. Contact him at 204-691-1166 or 204-227-0292. E-mail:

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