IRCC Minister Transition Binder 2021: Migration Health

Background

IRCC is the Government of Canada’s centre of expertise on migration health issues

IRCC’s migration health program (staffed by physicians, nurses, epidemiologists, analysts, and more) contributes to key components of the Department’s mission:

• Facilitating the arrival and integration of newcomers while protecting the health, safety and security of Canadians
• Maintaining Canada’s humanitarian tradition by protecting refugees and others in need of protection

This is accomplished through Migration Health Branch’s main activities:

• Facilitating health screening of migrants to prevent the arrival of certain infectious diseases (e.g. active tuberculosis)
• Notifying provinces/territories of the arrival of newcomers to enable follow-up with public health and to support continuity of care (e.g. latent tuberculosis)
• Administering the Interim Federal Health Program, which provides temporary healthcare coverage to refugees, asylum seekers, and other vulnerable populations
• Dedicated research function, knowledge translation, and medical advice on public health issues to inform policy and programs

Health Screening – Immigration Medical Exams

Immigration Medical Exams are the cornerstone of the health screening process. These exams help protect the public health of Canadians and prevent the spread of diseases. The process includes:

• Medical history
• Health exam
• Lab tests for some communicable diseases
• X-rays to check for tuberculosis

[Redacted]

Immigration Medical Exams are required for foreign nationals who plan to:

• apply for permanent residence
• work in healthcare or with children
• visit for more than six months, if coming from a country with a high rate of tuberculosis

Foreign nationals visiting for less than six months do not require an Immigration Medical Exam.

All applicants (except refugees and asylum claimants) pay for their own medical examinations.

Health Screening – Panel Physicians

• Panel physicians are third-party medical professionals who perform Immigration Medical Exams.
• They do not work for IRCC but are designated by the Department to conduct exams for clients.
• Panel physicians submit completed Immigration Medical Exams electronically (or on paper, if necessary), which are then transmitted to IRCC for assessment.

There are over 2,300 panel physicians and radiologists, located in 170 countries, including Canada.

IRCC performs regular quality assurance activities on its Global Panel Physician Network through its four Regional Medical Offices (Ottawa, London, Delhi and Manila).

Health Screening – Assessing Results

IRCC assesses the results of Immigration Medical Exams to rule out inadmissibility on three health grounds under section 38 of the Immigration and Refugee Protection Act:

Danger to Public Health

• Includes active tuberculosis and untreated syphilis
• Applications are put on hold until a client receives treatment for the infectious disease and a follow-up exam is completed

Danger to Public Safety

• Includes conditions such as severe mental health disorders (e.g. an untreated psychotic disorder with a history of violence)

Excessive Demand on Health or Social Services

• A determination of whether an applicant’s health condition(s) would exceed three times the average Canadian per capita cost for health or social services, or would impact wait lists for certain procedures or services
• No condition automatically leads to inadmissibility based on excessive demand
• Certain groups (e.g. refugees) are exempt from excessive demand considerations

Health screening is not just about inadmissibility: IRCC also screens for HIV, latent tuberculosis, and hepatitis, to facilitate treatment and connection to the health system in Canada, to ensure continuity of care.

Annually, 0.13% of applicants who undergo health screening are found inadmissible on health grounds.

Health Screening – Changes to Inadmissibility Criteria

• In 2018, in response to the Standing Committee on Citizenship and Immigration’s 2017 report titled “Building an Inclusive Canada: Bringing the Immigration and Refugee Protection Act in Step with Modern Values”, IRCC put into place a temporary public policy, to be followed by regulatory amendments.
• The temporary public policy raised the excessive demand cost threshold for foreign nationals seeking to come to Canada on a temporary or permanent basis to three times the Canadian average cost per person. It also modified the definition of “health services” and “social services” to provide clarity and remove the reference to certain social services, including special education services.
• These changes are now being regularized through a regulatory initiative which will bring the medical inadmissibility policy in line with inclusivity for persons with disabilities.

The Regulatory Impact Analysis Statement was pre-published in the Canadian Gazette, Part I, in March 2021.

Interim Federal Health Program

In Canada

• provides limited and temporary coverage of healthcare benefits to refugees, asylum seekers, and other vulnerable populations, which includes:
  • Basic coverage similar to provincial/territorial healthcare insurance
  • Supplemental coverage (e.g. vision care) and prescription drug coverage similar to coverage provided by provinces/territories to Canadians who receive social assistance
  • Coverage of the cost of an Immigration Medical Exam

Overseas

• covers pre-departure medical services for resettled refugees destined for Canada, including:
  • Immigration medical exams and follow-up treatment of certain health conditions (e.g. active tuberculosis)
  • Vaccinations
  • Outbreak management and control activities (e.g. COVID-19, Ebola)
  • Medical support in transit

Discretionary Coverage

• The Minister of IRCC has discretion to provide full or partial coverage of healthcare costs to an individual or group who aren’t eligible under the Program if they are facing urgent and compelling circumstances. The Minister may request that an appropriate senior official responsible for the Program make this decision on the Minister’s behalf.

IRCC does not reimburse clients directly.

IRCC does not issue payment to provinces/territories.

IRCC does not supplement provincial/territorial or private coverage.

Interim Federal Health Program – Costs

• The Interim Federal Health Program continues to play a critical role in offsetting the impact of migrants’ health expenses on provinces and territories.
• However, the cost of the Program has been increasing year over year, aligning with increases in numbers of refugees and asylum claimants.

IFHP Expenditures

• FY 2016-17 – $74,277,429
• FY 2017-18 – $122,548,067
• FY 2018-19 – $163,725,293
• FY 2019-20 – $228,455,380

Source: SAP Financial System

Note: These figures include all costs related to service utilization as well as general Program delivery, such as contracted services to Immigration Holding Centres and administrative fees paid for claims processing.

IFHP Beneficiaries

• FY 2016-17 – $130,000
• FY 2017-18 – $154,421
• FY 2018-19 – $193,386
• FY 2019-20 – $242,346

Source: IFHP Claims Database

COVID-19 Pandemic – Emergency Response

Changes to the Interim Federal Health Program

Program beneficiaries were affected by reduced in-person medical services and uncertainty around COVID-19 and travel

• Program coverage was updated to include teleservices and virtual medical appointments. This helped maintain access to health services and ensured continued, timely coverage.
• IRCC signed an agreement with the International Organization for Migration to deliver COVID-specific pre-departure medical services for refugees being resettled to Canada (e.g. testing, isolation services, and pre-embarkation health checks). This has helped facilitate safe and timely resettlement for refugees, while addressing public health risks prior to arrival.

IRCC monitors international public health risks for situational awareness and their potential impacts on migration policies and programs. IRCC employs health experts who advise on the implications of ongoing health risks, who assist in responding to these health risks, and who provide scientific and evidence-based advice to inform options in response to health events.

COVID-19 Pandemic – Impacts on our Work

Innovative Measures to Facilitate Health Screening

The COVID-19 pandemic and associated border and travel restrictions forced IRCC to consider unique approaches to facilitate the processing of foreign nationals.

• This included extensions for deadlines to submit medical exam results, proactive reassessments of recently expired medical examinations, and exemptions from second medical examinations for low-risk, in-Canada applicants.
• These measures are accelerating IRCC’s thinking around potential changes to health screening going forward, to consider how the risk landscape has changed to maximize our impact and better attain our public health goals.

COVID-19 Vaccination Initiative for Migrants

Effective June 2, 2021, IRCC launched a voluntary initiative to offer COVID-19 vaccination, or confirm vaccination status, for all Canada-bound migrants who undergo an Immigration Medical Exam.

• While COVID-19 vaccination status will have no bearing on admissibility, the initiative supports efforts to reduce transmission of COVID-19, to protect public health in Canada, and to facilitate entry and travel to Canada.

Migration Health Program – Outcomes

• Better health status positions migrants for ongoing integration into Canadian society and success in Canada.
• Early detection, prevention and management of public health risks in migrants lowers long-term healthcare costs.
• The program mitigates high incidence of certain diseases (e.g. active tuberculosis) among the foreign-born.
• This allows us to continue to protect the health of Canadians and maintains public confidence in the immigration system.

Key Takeaways

Canada’s immigration priorities have impacts on public health and the healthcare system

• IRCC’s migration health program exists to advise on how to best manage these impacts and to facilitate immigration while protecting the health and safety of Canadians.
• The program is a supportive partner to immigration, humanitarian goals, settlement and integration.
• Ambitious growth in immigration levels, unpredictable surges in asylum intake, and fast-moving policies for vulnerable populations require innovations in rapid and flexible health screening.
• Preventing the arrival of certain infectious diseases from abroad, and helping vulnerable migrants address their health issues through the Interim Federal Health Program, helps ensure the sustainability of Canada’s publicly-funded healthcare systems.