Health inadmissibility based on excessive demand is a ground of inadmissibility under IRPA s 38(1)(c). A foreign national is inadmissible if a medical officer determines that their health condition might reasonably be expected to cause an excessive demand on health services or social services in Canada. This ground protects publicly funded health care and social services from costs that significantly exceed what an average Canadian resident incurs.

Excessive demand inadmissibility does not apply to all visa applicants — there are important exemptions, including for refugees and protected persons, and (since 2018) for family members of Canadian citizens and permanent residents.

• IRPA s 38(1)(c) — a foreign national is inadmissible on health grounds if their condition might reasonably be expected to cause excessive demand on health or social services
• IRPA s 38(2) — exemptions: the excessive demand ground does not apply to Convention refugees or persons in need of protection (ss 96 and 97), and does not apply to accompanying family members of persons protected under those sections
• IRPR reg 1(1) — defines "excessive demand" by reference to costs exceeding the applicable cost threshold over the assessment period
• IRPR reg 24 — the 2018 amendments that extended the exemption to spouses, common-law partners, and dependent children of Canadian citizens and permanent residents

What is "excessive demand"?

Excessive demand is defined in the IRPR as a demand on health services or social services for which the anticipated costs would likely exceed the applicable cost threshold — currently measured against average Canadian per capita health and social services costs — over a period of 5 consecutive years immediately following the most recent medical examination. If significant costs are likely to be incurred beyond the 5-year period, the assessment period may be extended to up to 10 consecutive years.

The cost threshold is reviewed periodically by IRCC. The current cost threshold is published on the IRCC website.

What counts as "health services" and "social services"?

For the purposes of this inadmissibility ground:

• Health services include publicly funded physician services, hospital services, laboratory services, and prescription drugs — broadly, services funded by provincial and territorial health insurance plans
• Social services include publicly funded services for care and rehabilitation of persons with physical or mental disabilities — but following the 2018 policy changes, special education, social and vocational rehabilitation services, and personal support services are no longer included in the definition of social services for this purpose. The 2018 reform substantially narrowed the scope of social services that count toward the excessive demand calculation.

How is the assessment conducted?

A medical inadmissibility finding is not automatic. The process is:

• The applicant undergoes an immigration medical examination (IME) conducted by a designated panel physician
• The panel physician's report is sent to a medical officer (a physician employed by IRCC) who reviews it
• If the medical officer determines that the condition may cause excessive demand, a procedural fairness letter is sent to the applicant inviting submissions on the excessive demand finding before a final decision is made
• The applicant may submit medical and other evidence to address the finding — for example, evidence that treatment costs would be lower than anticipated, or that the condition is less severe than assessed
• The visa or immigration officer makes the final inadmissibility decision, taking the medical officer's opinion and the applicant's submissions into account

Assessments are individual — there is no health condition that automatically results in an excessive demand finding. The officer must assess the likely cost of treating and managing the specific applicant's condition in Canada.

Who is exempt?

The following persons are not subject to health inadmissibility on excessive demand grounds:

• Convention refugees and persons in need of protection (IRPA ss 96 and 97) — the protection mandate under the Refugee Convention overrides the health inadmissibility ground
• Spouses and common-law partners of Canadian citizens or permanent residents — as of the 2018 amendments, these persons are exempt regardless of the cost their health condition may impose
• Dependent children of Canadian citizens or permanent residents — also exempt following the 2018 amendments

The IRCC help centre page on who the excessive demand ground applies to provides additional detail on the exemption categories.

The 2018 policy changes significantly narrowed the excessive demand inadmissibility ground. Prior to 2018, the cost threshold was set at three times the average per capita cost; the 2018 reforms tripled the threshold and removed special education and personal support services from the definition of social services. These changes were intended to reduce the number of applicants — particularly persons with disabilities — who were refused on health inadmissibility grounds.

Applicants who receive a procedural fairness letter on excessive demand grounds should seek legal advice promptly. The response window is limited and the submissions made at that stage are the primary opportunity to address the medical officer's concerns before the officer makes a formal inadmissibility finding.

Persons found inadmissible on health grounds may apply for a Temporary Resident Permit (TRP) in compelling circumstances, which provides a discretionary pathway for entry despite inadmissibility. Refugees and protected persons are not subject to this ground and therefore do not need a TRP for this reason.