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CIMM Committee Report

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Mr. Robert Oliphant, M.P.
Chair
Standing Committee on Citizenship and Immigration
House of Commons
Ottawa ON  K1A 0A6

Dear Colleague:

Pursuant to Standing Order 109 of the House of Commons and on behalf of the Government of Canada, I am pleased to respond to the 15th Report of the Standing Committee on Citizenship and Immigration, entitled “Building an Inclusive Canada: Bringing the Immigration and Refugee Protection Act in Step with Modern Values”, tabled on December 13, 2017.

I would like to sincerely thank the Committee members for giving their time and attention to this valuable study examining the Federal Government’s policies and guidelines regarding medical inadmissibility of immigrants.  I appreciate the views, analysis and recommendations of witnesses and the Committee on the health admissibility provisions of the Immigration and Refugee Protection Act (IRPA).

The Government shares the Committee’s perspective that Canadians value diversity and inclusion.  The current objective of the excessive demand provision is to strike a balance between protecting publicly-funded health and social services and facilitating immigration to Canada, while also supporting humanitarian and compassionate objectives in Canada's immigration policy.  While the provision has been in place for more than 40 years, it no longer aligns with our country's values on the inclusion of persons with disabilities in Canadian society.  Therefore, the Government recognizes the need to make the excessive demand policy more fair and inclusive of persons with disabilities, while also protecting publicly-funded health and social services.

Implementation of Policy Changes

Addressing recommendations 1, 2, and 4(d).

Given the complexity and interdependency of issues related to excessive demand policy, the Government intends to implement substantial changes to the excessive demand policy.  Once these changes take effect, the Government will undertake a process of thorough data gathering and analysis, in consultation with provinces and territories, as to the impacts of eliminating the provision, as recommended by the Committee.

The Government understands that there are certain aspects of this policy that run counter to our broader objectives of participation and inclusion.  As currently defined, the policy includes the assessment of costs for services that are critical for promoting inclusion, most notably special education, social and vocational rehabilitation services, and personal support services.  Instead of treating these as costs that must be borne by society, these should instead be seen as investments that enable participation and inclusion.  With this in mind, the Government will seek regulatory amendments to remove these services from consideration under the excessive demand policy in order to better balance the fair treatment of persons with disabilities and the protection of publicly-funded health and social services.  This will benefit applicants with children who have disabilities and others needing these services.

At the same time, the Government acknowledges that the current level of protection at times has prevented the arrival of immigrants with relatively low costs, who could otherwise make a contribution to Canada.  To address this, the Government will propose regulatory amendments to triple the threshold for excessive demand.  This would increase fairness by facilitating immigration for applicants with health conditions that typically require a limited range of health and social services at a relatively low cost (i.e., exceeding the current cost threshold but less than three times the current threshold).  As shared with provincial/territorial governments, our assessment is that the incremental impacts on health-care systems each year will be relatively minor, while several hundred applicants who would have otherwise been denied entry to Canada will have their arrival facilitated.

However, further to presentations at the Committee’s hearings, the Government recognizes that individuals with very high medical costs can have an impact on our health-care systems that is disproportionate, and that while this may only make up a small part of overall health-care costs, it can have significant effects at the community level.  For this reason, the Government will also explore and consult with provinces and territories on the impacts of the Committee’s recommendation to repeal the excessive demand provision.  With respect to the intended policy changes of redefining the social services considered under the provision and increasing the cost threshold, we are committed to ongoing engagement with provincial and territorial governments, including through the regulatory process, to ensure effective implementation and to track the impact of these changes.  Furthermore, information collected under a revised policy, reflecting the increased cost threshold and the changes to the definition of social services, would provide the Government with additional data on which to draw conclusions about the impacts of full elimination.

The Committee’s recommendation to expand the list of persons exempted from the excessive demand provision will not be implemented because the Government believes that the above changes are the best approach for addressing fairness and inclusion.

Pending the coming into force of the regulatory amendments that are needed to implement the changes in the definitions, I plan to use my authority under section 25.2 of IRPA to put into place a public policy.  This public policy would allow for the exemption of the excessive demand provision for foreign nationals who meet certain conditions (excessive demand caused by costs related to certain social services; or costs for health or social services that do not exceed three times the current threshold).  This will allow us to implement in a timely way the changes that are needed to ensure the alignment of this provision with Canadian values.

With this approach, the Government intends to take steps to bring the excessive demand policy in line with our values around inclusion and participation, while at the same time maintaining the balance between facilitating the arrival of skilled immigrants and protecting Canada’s publicly-funded health-care systems.  This will also have the effect of facilitating the arrival of families where a member has a health condition that may require less costly services, focusing the provision on those with conditions that require very costly treatment and care.  At the same time, it would allow the Government to gather new data on the impact of the policy changes and to engage with provinces and territories on the impacts of repealing the excessive demand provision.

Evaluation of Program Changes

Addressing recommendations 3 and 5.

The Government agrees with the Committee’s perspective around the importance of collecting data with respect to the excessive demand policy.  IRCC will monitor the ongoing impacts of the excessive demand provision, as well as the impact of policy changes, on the Department, clients, and, to the extent possible, provinces and territories.  With respect to the Committee’s recommendation for a full parliamentary review, the Government and its officials will make itself available to the Committee, should it wish to conduct such a review.

Administrative Measures to Improve Client Service

Addressing recommendations 4(a), (b), (c), (e) and (f).

The Government welcomes the Committee’s advice on ways to improve the administration of excessive demand policy and will implement measures to improve the client experience.  IRCC will centralize excessive demand applications to one office in Canada to allow for greater consistency and efficiency ‎in decision-making, since one dedicated team of decision makers will handle all excessive demand decisions.

A plain-language review and revamp of departmental procedures and products will aim to facilitate the application process and ensure that communications to clients are made clear and coherent.  This will include greater clarity in how we outline the reasons for inadmissibility and describe how to develop a mitigation plan under the revised policy to overcome a finding of excessive demand.

The Government agrees with the recommendation that training for decision makers and medical officers is essential, and will explore options for supplementing existing training or tailoring it as necessary following changes to the excessive demand policy.  As IRCC’s decision makers and medical officers currently receive robust, targeted training on assessing and processing potential excessive demand cases, the new curriculum will expand existing skills and knowledge.  Supplementary training will cover changes to regulations, jurisprudence, revised program delivery instructions, and standard operating procedures, and will continue to involve on-the-job coaching and regular quality assurance reviews.  The objective of ongoing training is to ensure that decision makers (migration officers) and medical officers are well-equipped to continue rendering decisions in keeping with legislation, policy and evolving case law.

The Government will continue to rely on the annual average Canadian per capita health services costs identified by the Canadian Institute of Health Information (CIHI), as derived from annual reporting by provinces and territories.  The Government will also undertake an expert analysis of the methodology for setting the threshold, and ensure that the formula can be presented in a transparent manner to applicants and the public.  To adjust for the removal of certain social services from consideration under the policy, IRCC will need to revise the cost threshold, including the small supplement added for other relevant social services that are not reported on by CIHI.

Conclusion

The Government of Canada is committed to making changes to the excessive demand provision that will strike the appropriate balance and be reflective of Canadian values of an inclusive country for persons with disabilities, while taking time to collect additional data and explore with provinces and territories the Committee’s recommendation to repeal the excessive demand provision.

In conclusion, I would like to thank the Committee for the comprehensiveness of their analysis and the depth of their report.  The work of the Committee has helped to significantly advance the department’s fundamental review of the excessive demand policy.  I welcome their continued interest in this area.

Yours sincerely,

Ahmed Hussen, P.C., M.P.
Minister of Immigration, Refugees and Citizenship