The Excessive demands on health or social services
“Excessive demand” is used by immigration authorities to refuse permanent residency to people living with HIV on medical grounds. In concrete terms, this criteria means that Canada does not wish to spend more on health or social services for permanent resident applicants than what is already spent on average for Canadian residents.
The final assessment of the application therefore comes down to financial considerations. Given the high cost of the antiretrovirals and medical care needed by people living with HIV, those who apply to become permanent residents represent, for Immigration Canada, a potential “excessive demand on health or social services.”
It is equally important to know that the idea of “excessive demand” doesn’t look solely at the current health of the applicant, but also at their potential long-term healthcare needs. Therefore, the question that immigration authorities will ask is: will this applicant represent an excessive demand on health or social services over the course of the next ten years? The fact that a person does not require care and/or help at the time of application is irrelevant; the calculation looks beyond current costs, and assesses all foreseeable costs that a person could engender. As a result, if it is determined that you have a higher than average risk of being hospitalized or that your medical needs will become too costly in the ten years following your application, the application could be refused.
A ray of hope
On December 31, 2009, the Federal Court made a ruling that requires the government to examine the possibility of a person subsidizing their own medical costs (through private insurance or insurance in their home country).
The Court concluded: “The ability and willingness of applicants to defray the cost of their out-patient prescription drug medication is a relevant consideration in assessing whether the demands presented by an applicant’s health condition constitute an excessive demand.”
Citizenship and Immigration Canada (CIC) must henceforth consider this willingness and ability to pay. Applicants will, however, be asked to supply a realistic and credible mitigation plan explaining how they intend to cover medication costs. The quality of the mitigation plan is the most important element in evaluating the applicant’s ability and intentions, and should portray the actual needs of the person concerned.
In 2010, the Federal Court made another ruling requiring the government to examine any circumstances specific to the applicant, which might prevent a simple, general conclusion from being reached. Immigration authority physicians are now required to individually evaluate each medical file, the medications needed, and the applicant’s eligibility for private insurance and/or their ability to opt-out of the drug insurance plan funded by the province or territory where the applicant intends to reside.
For this reason, a mitigation plan is critical for immigration candidates living with HIV.
