Ontario to blow past federal deadline to publicly fund nurse practitioners

Ontario will not have a policy in place to publicly fund all medically necessary services from nurse practitioners by April 1, as ordered by the federal government, leaving some patients paying out of pocket for primary care.

Health Minister Sylvia Jones pushed the federal government years ago to close what she called a loophole in the Canada Health Act that allowed some nurse practitioner clinics in the province to charge patients fees for primary care.

The government has done that, clarifying that nurse practitioner services equivalent to what physicians provide are covered by the act's requirement that medically necessary services are publicly funded. It has given provinces and territories the April 1 deadline — but Ontario won't be ready.

"The Ministry of Health is actively reviewing and engaged in ongoing discussions with provincial and territorial partners and the federal government regarding implementation expectations of the federal government's direction," spokesperson Ema Popovic wrote in a statement.

Provinces won't start incurring penalties for non-compliance until April 2027. Critics and nurse practitioners say Ontario should not wait.

"The [federal government's] letter really underscores the importance of the provincial government's immediate implementation of a robust, sustainable funding mechanism to support nurse practitioners as key members of health-care workforce," said Michelle Acorn, CEO of the Nurse Practitioners' Association of Ontario.

"The lack of easily accessible funding models has historically limited the number of public positions and practice settings for nurse practitioners in Ontario," she said.

"Flexible funding mechanisms will support nurse practitioners in delivering the timely, high-quality, accessible care that Ontarians deserve where and when they need it."

Nurse practitioners in Ontario can assess patients, order and interpret tests, and prescribe medication and treatment. They work in a variety of settings, including family health teams and community health teams, hospitals and long-term care homes, as well as in more than two dozen publicly funded nurse practitioner-led clinics.

Two years ago, a proliferation of private subscription fee-based nurse practitioner clinics made headlines. Jones responded to opposition and media questions by putting the onus on the federal government to close a "loophole" that allowed them to operate.

"If there is a wedge that is allowing these clinics to happen, then perhaps the member opposite could pick up the phone and call their federal counterparts, because that's what I’ve been doing," she said in question period in March 2024. 

"I'm making the case that if the Canada Health Act allows these for-profits, then we will be shutting them down with the changes to the Canada Health Act and federal government involvement."

Ontario Liberal health critic Dr. Adil Shamji said it is "hypocritical" for Jones to now delay the implementation of what she so strongly urged two years ago.

"To me it suggests that it has always been more convenient for this government to allow patients to pay out of pocket than to fund it within our public medicare," he said.