Provincial Health Plans in Canada to Include Nurse Practitioners Under Medicare
In a landmark shift, Federal Health Minister Mark Holland announced that provincial and territorial health plans will soon cover primary care provided by nurse practitioners, pharmacists, and midwives. The changes, set to take effect on April 1, 2026, aim to strengthen access to universal health care by allowing regulated non-physician health professionals to bill the government for medically necessary services.
The directive comes in response to concerns over patients paying out-of-pocket for essential care, particularly at private nurse practitioner clinics. Holland emphasized that charging patients for such services violates the principles of universal health care under the Canada Health Act.
“This certainly isn’t in the spirit of the Canada Health Act, and this interpretation letter shuts that down,” Holland said in an interview Thursday evening.
The updated interpretation of the Canada Health Act, issued in an official letter to provincial and territorial health ministers, will enable non-physician providers to deliver a broader range of care. Holland noted that this policy reflects the expanded roles and competencies of health-care professionals, including nurse practitioners, pharmacists, and midwives.
“Nurse practitioners, in particular, can help relieve the pressure on primary care physicians and the health-care system as a whole,” Holland said.
The changes won’t take effect until 2026 to give provincial and territorial governments sufficient time to adjust their health insurance plans. Compliance will be enforced through federal health transfer payments, which could be reduced if patients are charged for medically necessary services.
“Ensuring all Canadians have access to care based on their needs, not their ability to pay, is essential,” Holland said.
This directive builds on a March 2023 letter from Holland’s predecessor, Jean-Yves Duclos, which flagged concerns over patients being charged for public health-care services, including virtual care. Ongoing consultations with provinces and territories over the last two years have cultivated agreement on the policy.
Holland acknowledged the growing role of virtual care and telemedicine, stating it remains an area of concern. While billing for virtual services is not yet addressed in the directive, he confirmed discussions are ongoing.
“If you walk into a physical doctor’s office or a virtual one, both should be covered by the Canada Health Act,” he said.
Canadian Doctors for Medicare welcomed the move. In a letter to the Prime Minister’s Office last year, the group’s chair, Dr. Melanie Bechard, advocated for public funding of nurse practitioner and virtual care, highlighting its consistency with the spirit and intent of the Canada Health Act.
“The turn toward episodic care provided virtually by physicians and longitudinal care provided by nurse practitioners was not foreseen in 1984 when the Canada Health Act was passed,” Bechard wrote.
Holland echoed these sentiments, emphasizing the importance of modernizing the Act to address emerging trends and ensure equitable access to health care for all Canadians.
As Canada prepares to implement these changes, provincial and territorial governments will need to adjust their policies and infrastructure to support expanded billing options for non-physician health professionals. This initiative represents a significant step forward in addressing gaps in access to primary care and upholding the principles of universal health care.