Access to Healthcare
By: Chelsia Watson
Gaining access to safe and reliable healthcare can be one of the biggest hurdles new migrants face in Ontario and across Canada. Depending on your immigration status, having access to Provincial healthcare can be straightforward or it can pose a challenge; either way it is important to know your rights and know where you stand. OHIP For All, a group that advocates for equal healthcare in Ontario, spoke to The Peak about how someone with precarious status can safely access healthcare. Please note that although this article is specific to Ontario, many of these services are available across Canada. If you need assistance finding healthcare resources, we recommend searching community health centre’s in your city or going to City Hall for a list of accessible services.
How does my immigration status affect my ability to access healthcare in Canada?
Many people across Canada do not have access to healthcare. In Ontario alone, there are over 500,000 migrants who do not have health coverage because of their immigration status. Access to healthcare varies based on immigration category and status, time spent living in Ontario (typically, Ontarians must be physically present in Ontario for at least 153 days in a 12-month period in order to qualify for healthcare), type of work contract (e.g., most temporary migrant workers have private health insurance). Other profiles include visitors, students, military, and other protected persons. Depending on the permit, most full-time workers may have access to coverage while part-time workers do not. Gaining access to healthcare can be complicated; here are some numbers to consider: there are 250,000 people living in Ontario without status and 80,000 new migrants in the 3 month waiting period. The rest of the 500,000 people without healthcare in Ontario are international students and those with temporary status.
There are various ways that someone can live in Ontario but not have health insurance. The first group includes those who do not have coverage now but will eventually become insured. This is typically made up of Ontarians who have been approved for permanent residency but must wait 3 months after arrival to qualify for health coverage. It encompasses various groups including new immigrants, temporary foreign workers, migrants newly approved for permanent residency and Canadian citizens who were living abroad. Following the three month period, these individuals are able to access the same OHIP coverage as other Ontarians.
The next group of uninsured people will never be eligible for OHIP throughout the entirety of their time in Ontario. This includes visitors and those without status. Individuals without status include people who may have overstayed their visitor’s visa, who are waiting for a decision regarding their immigration case, or who evaded a deportation order. These individuals are among the most vulnerable residents in Ontario and are often forced to choose between their health, safety, and basic necessities.
The last category includes those who were eligible but have lost eligibility. This includes individuals who may have violated a work permit, overstayed their work permit, are in between contracts, or have had a sponsorship breakdown.
My city is considered a Sanctuary City. Does This mean I am able to access health services anywhere in the city?
The Sanctuary City movement is a commitment to ensuring that city services are accessible to all residents of a city, regardless of immigration status. For example, Toronto became a sanctuary city in 2013. This means that all residents of Toronto have access to healthcare services provided by Toronto Public Health. This includes sexual health clinics, vaccinations for students from kindergarten to grade 12 and breastfeeding clinics. Dental services are also available but are intended for low-income patients and consequently eligibility is determined by income. The sanctuary city model does not assist patients in accessing provincially-funded healthcare, including visits to a family doctor, the emergency department, or a specialist. If your city is designated as a Sanctuary City, you may also have access to municipal healthcare services.
Are there specific doctors and/or clinics in that are considered safe for a person with precarious status?
There are a number of resources individuals can consider when determining which clinic is a safe space for them. In Toronto, Access Alliance has put together a list of clinics available for episodic care – that is, medical concerns that do not require significant follow-up. It’s important to note, the Canadian Centre for Refugee and Immigrant Health Care has specialized clinics for children. For patients requiring longer-term access to health services, community health centres are a good option. In order to be eligible to receive services from a community health centre, you must live within the centre’s catchment area. Below is a list of clinics in Toronto that accept uninsured patients. If you reside outside of Toronto, we encourage you to find the nearest Community Health Centre and call to find out what health services are offered.
- East End Community Health Centre
- South Riverdale Community Health Centre
- Sherbourne Health Centre
- Flemingdon Health Centre
- Access Alliance Multicultural Health and Community Services
- Davenport-Perth Neighbourhood and Community Health Centre
- Unison Health and Community Services
- LAMP Community Health Centre, Black Creek Community Health Centre
- Stonegate Community Health Centre
- Rexdale Community Health Centre
- Regent Park Community Health Centre
For Patients who Identify as Indigenous
- Anishnawbe Health Centre (no catchment area)
Are doctors required (by law) to report a person they suspect is without status?
Doctors are not required by law to report individuals solely due to their immigration status. However, doctors are required to report all patients (name, contact information, and relevant medical conditions), regardless of immigration status, to public health if:
- The patient has certain infections such as HIV, gonorrhea, chlamydia, tuberculosis
- The patient has a license and is considered to be unsafe to drive
- Child abuse or neglect is suspected
Am I able to get a health card? How do I get one?
You can get a health card if you meet the place of residence and immigration status requirements. In Ontario, you can get a health card by going to a Service Ontario Centre. If you are outside of Ontario, the process to obtain a health card will be similar. It is suggested that you can call ahead of time to ensure you bring the correct documents. If you require other documents or would like assistance getting your health card, you can visit an ID clinic. In Toronto, ID clinics are offered through various organizations.
Place of residence requirements include:
- being physically in Ontario for 153 days in any 12‑month period
- being physically in Ontario for at least 153 days of the first 183 days immediately after you began living in the province
- make Ontario your primary home
Immigration status requirements (you must meet at least one) include:
- are a Canadian citizen
- are an Indigenous person (registered under the federal Indian Act)
- are a permanent resident (formerly called a “landed immigrant”)
- have applied for permanent residence,
- are in Ontario on a valid work permit and are working full-time in Ontario, for an Ontario employer, for at least six months
- are in Ontario on a valid work permit under the federal Live-in Caregiver Program
- are a convention refugee or other protected person (as defined by the Immigration and Refugee Board of Canada)
- have a Temporary Resident Permit (only certain case types, e.g. 86 through 95)
- are a clergy member who can legally stay in Canada and is ministering full time in Ontario for at least six months
- your spouse and any dependents also qualify if you do
Toronto ID Clinics:
- Street Health
- Unison Health and Community Services
- Parkdale Queen West Community Health Centre
- Regent Park Community Health Centre
If I do not have a health card, do I need to pay upfront for doctor visits?
This may vary depending on the hospital or clinic that you visit. Research same-day clinics in your city, many cities have community clinics that you can access for free. Some of these health centres are able to provide primary care depending on where you live. If you access health care outside of these options, including most clinics and hospitals, you will most likely be billed after you use the service. The clinic or hospital will establish a payment plan if necessary.
What if I need urgent medical attention? Can I go to my nearest hospital’s ER?
If there is an emergency, it is encouraged that you go to the nearest hospital. However, it is important to note that you may be asked to pay for the cost of your hospital visit and that you may be asked for payment in cash upfront before receiving treatment.
What are my rights once I am receiving medical care?
As a patient, you have a right to:
- Receive safe and proper care.
- Give or refuse consent for any procedure, and for any reason.
- Have a medical professional clearly explain health problems and treatments to you.
- Participate in health care decisions.
- Ask questions and express concerns.
- Request a second opinion; within reason.
- Be assured that personal information is confidential.
- Request to access your health information records.
- Request the transfer of your health records to another medical professional; you may be charged a fee.
What kind of work is ‘OHIP For All’ doing to advocate for healthcare rights for all people regardless of immigration status?
OHIP For All is a campaign that spreads awareness on health-related issues in Ontario. There are many groups similar to OHIP For All across Canada. This platform unites healthcare professionals, students, and other advocacy groups to come together and organize rallies and events that ultimately mobilize groups of people. We have spread awareness in mainstream media engagement, strong social media platforms, migrant community engagement, and direct lobbying with the various provincial political parties