Health inadmissibility — excessive demand
Overview
Section 38 of IRPA renders a foreign national inadmissible on health grounds if their health condition is likely to be a danger to public health or public safety, or is likely to cause excessive demand on Canada's health or social services. "Excessive demand" means that the anticipated cost of health or social services for the person (over a 5-year period, extendable to 10 years) would likely exceed the per-capita cost for Canadians — currently approximately $128,445 over 5 years (as at 2024, adjusted annually). Refugees, protected persons, and their family members are exempt from the excessive demand ground.
Health inadmissibility assessments are carried out by designated medical officers (Designated Medical Practitioners — DMPs) and reviewed by IRCC Medical Officers. An immigration medical examination (IME) is required for most visa applicants. A finding of excessive demand triggers a procedural fairness letter before the application is refused.
Legal basis
- IRPA s 38(1)(a) — inadmissibility where the health condition is likely to be a danger to public health
- IRPA s 38(1)(b) — inadmissibility where the health condition is likely to be a danger to the safety of the public
- IRPA s 38(1)(c) — inadmissibility where the health condition is likely to cause excessive demand on health or social services
- IRPA s 38(2) — exemptions: protected persons, Convention refugees, and certain family class members are exempt from s 38(1)(c) (excessive demand) but not from the danger grounds
- IRPR s 1 — definition of "excessive demand": anticipated health or social services costs that are likely to exceed an amount that is 3 times the per-capita cost of health and social services for Canadians (calculated over a 5-year period, extendable to 10 years)
- Immigration Medical Examination (IME) — mandatory medical assessment conducted by DMPs; results transmitted to IRCC for review
How it works
Three grounds under s 38
1. Danger to public health (s 38(1)(a))
This ground targets communicable diseases that pose a risk to the Canadian public. The primary conditions that can trigger this ground include active tuberculosis, syphilis, and certain other notifiable diseases. The applicant can be found inadmissible even if the condition is treatable, if treatment has not yet been completed or confirmed.
2. Danger to public safety (s 38(1)(b))
This ground applies where a person's health condition makes them likely to endanger the safety of others. It is less commonly invoked and is reserved for conditions involving a risk of harm — for example, uncontrolled severe mental illness involving violent behaviour.
3. Excessive demand on health or social services (s 38(1)(c))
This is the most frequently applied health inadmissibility ground. IRCC Medical Officers calculate the anticipated cost of health and social services the applicant is likely to require over a 5-year period (extendable to 10 years where the applicant's condition warrants it). If the anticipated cost exceeds the per-capita threshold — which is approximately $128,445 over 5 years as of 2024, adjusted annually using CPI data — the person is found inadmissible.
Health services include: physician consultations, hospital services, prescription drugs. Social services include: in-home support, residential care, special education programs, and other government-funded support. Both public and provincially funded services count.
Who is exempt from excessive demand?
The following are exempt from the s 38(1)(c) excessive demand ground only (they remain subject to danger grounds):
- Convention refugees and protected persons
- Dependants of Canadian citizens or permanent residents who are sponsored under the family class, where the sponsor is a spouse or common-law partner
- Persons applying under certain humanitarian grounds
Note: the exemption does not extend to applicants in the economic class or to other categories. A principal applicant under Express Entry who is found inadmissible on excessive demand grounds will be refused, even where the condition is a child's disability.
Procedural fairness process
Before refusing an application on excessive demand grounds, IRCC is required to send a procedural fairness letter (PFL) informing the applicant of the finding. The applicant has an opportunity to:
- Provide updated medical evidence
- Demonstrate that the cost calculation is incorrect
- Submit a Mitigation Plan — a detailed plan showing how the anticipated costs will be funded through private means (private insurance, family support, advance deposits) rather than the public purse
A credible and detailed Mitigation Plan that addresses each anticipated cost can overcome an excessive demand finding. IRCC has accepted Mitigation Plans in cases involving conditions such as Down syndrome, autism spectrum disorder, and other conditions where private funding for special education and support can be demonstrated.
Practical effect: economic class applicants
For economic class applicants (including Express Entry), health inadmissibility on excessive demand grounds is a significant risk where the applicant or a family member has a permanent disability requiring ongoing support services, or a chronic medical condition with significant pharmaceutical or hospital costs. The assessment covers all family members on the application, even if they are not intending to travel to Canada (accompanying and non-accompanying dependants).