Updates to the new interpretation of the Canada Health Act

Last year, the Federal Minister of Health announced the CHA Services Policy (the Policy), which aimed to expand provincial and territorial health coverage to include “medically necessary” services provided by additional classes of health care providers—such as nurse practitioners, pharmacists, and midwives—where public coverage has historically been limited to those same services only when provided by a physician. At the time, Parliament was prorogued, and it was not clear whether the Policy would be pursued.

This year, the federal government announced its intention to move forward with the Policy. As of April 1, these additional classes of health care providers will no longer be able to seek reimbursement from private insurers or charge patients out of pocket for “medically necessary” services otherwise covered by the public health system. Instead, those services will be covered by provincial and territorial health coverage. Health care providers who leverage non-physicians, such as nurse practitioners, for patient care may need to reconsider their fee models going forward.

What you need to know

• In its recently published 2026-2027 Department Plan, the federal government indicated that it intends to move forward with the Policy, which will come into effect on April 1, 2026.
• Nurse practitioners, pharmacists, and midwives will no longer be able to seek reimbursement from private insurers or charge patients out of pocket for medically necessary services otherwise covered by the public health system. Instead, those services will be covered by provincial and territorial health coverage.
• Provinces and territories must amend their health insurance legislation to align with this new interpretation of the Canada Health Act (the CHA) to avoid the withholding of health care funding they receive through federal transfer payments.
• Until the provincial and territorial governments implement changes to their health insurance legislation, businesses and health care providers are not expected to face enforcement action if private insurers or patients pay for the cost of medically necessary health care services provided by these additional classes of health care providers. However, Canada’s federal government could seek to take additional measures should provincial and territorial governments not respect the new interpretation.

The new interpretation of the Canada Health Act

Last year, the Federal Minister of Health announced the Policy, which expands provincial and territorial health coverage to include “medically necessary” services provided by additional classes of health care providers—such as nurse practitioners, pharmacists and midwives—where public coverage has historically been limited to those same services only when provided by a physician. This was done via a letter from the federal Ministry of Health to all provincial and territorial ministers of health¹. There has been no formal amendment to the CHA; instead, the federal government has expanded its interpretation of who is considered a “physician” under Canadian public health insurance to include a broad scope of health care professionals, including nurse practitioners, pharmacists, and midwives, when providing “physician-equivalent services”. The new policy change will come into effect on April 1, 2026².

Implementation of the new Policy

In its 2026-2027 Departmental Plan, the federal government indicated that it will be moving forward with this policy change. As a result, patient charges for “medically necessary” services provided by health care professionals providing physician-equivalent services (for example, nurse practitioners) will be considered extra billing and user charges under the CHA.

The CHA is the federal legislation that dictates the minimum requirements that provincial health plans must meet to receive eligible health care funding through federal transfer payments. For example, under the CHA, public plans must cover “medically necessary” or “medically required” hospital, physician, and surgical-dental services to receive federal funding. If a province/territory’s health care system does not comply with the CHA, then federal transfer payments can be withheld. Once the new interpretation of the CHA is implemented, patients should not be charged for services that would otherwise be covered by a provincial or territorial health care plan if delivered by a physician.

While the Policy takes effect on April 1, 2026, it is expected that the initial implementation period will be extended for one year to give provinces and territories time to align with the Policy without facing compliance measures during the first year of transition: for example, to update their fee models where required³. This transition period reflects the federal government’s commitment to working collaboratively with provinces and territories to ensure Canadians have access to the care they need. Stakeholders should continue to monitor the Policy and transition period for relevant changes as the federal, provincial, and territorial governments seek to work through the complexity of this transition.