Medical inadmissibility to Canada: excessive demand, explained
Every permanent residence applicant, and many temporary ones, take an immigration medical exam, and a small number receive a letter saying their condition may make them inadmissible. The rule behind it, excessive demand on health and social services, was reformed in 2018 and is narrower than most people fear. This guide explains the three medical grounds, the cost threshold, who is exempt, what the fairness letter asks, and how a mitigation plan works.
Key takeaways
Medical inadmissibility rests on three grounds; excessive demand is the one that matters. The 2018 reforms tripled the cost threshold and excluded special education and most social services. Sponsored spouses and children are exempt. The fairness letter gives 90 days, and specialist evidence plus a mitigation plan is how most cases are won.
- Three grounds: public health, public safety, excessive demand. Almost all findings are the third.
- Threshold: about three times the average per-capita cost, roughly $135,000 to $140,000 over five years in 2026.
- Exempt from excessive demand: sponsored spouses, partners and dependent children; refugees and protected persons.
- A non-accompanying family member can still make an economic applicant inadmissible.
- Fairness letter: 90 days; respond with specialist evidence on cost and a mitigation plan.
The three grounds under section 38
| Ground | What it covers | How often it applies |
|---|---|---|
| Danger to public health | Untreated infectious tuberculosis, untreated syphilis, and a small number of other conditions | Rare; usually resolved by treatment and re-examination |
| Danger to public safety | Conditions involving unpredictable or violent behaviour, or impaired judgment posing a risk to others | Very rare |
| Excessive demand on health or social services | Expected publicly funded costs above the threshold over five years (ten where costs are concentrated later), or adding to waiting lists so as to delay Canadians' care | The ground behind almost every medical inadmissibility finding |
How excessive demand is calculated
The immigration medical exam is read by an IRCC medical officer, who identifies any condition likely to require publicly funded services and estimates its cost over the assessment period, normally five years from the medical, or ten where the condition's costs arise later. That estimate is compared with the excessive demand threshold: three times the Canadian average annual per-capita expenditure on health and social services, updated each year and published by IRCC. The threshold was tripled in the 2018 reform, from roughly $6,600 a year to about $20,000 at the time, and it has risen with costs since; in 2026 it stands in the region of $27,000 to $28,000 a year. What counts is narrower than before 2018 as well: special education, social and vocational rehabilitation services and personal support services are excluded, so the calculation is essentially about health care and residential or long-term care. Conditions that reach the threshold are typically those needing dialysis, expensive specialty drugs, transplantation, or intensive ongoing specialist care.
No list of banned conditions
Who is exempt
The excessive-demand ground does not apply to a spouse, common-law or conjugal partner or dependent child being sponsored in the family class, to refugees and protected persons and their family members, or to certain persons on humanitarian grounds. They remain subject to the public health and safety grounds, which almost never bite. Parents and grandparents under the PGP are not exempt, and neither are economic applicants (Express Entry, provincial nominees, pilots) or their family members. In an economic application every family member is examined, including a spouse or child who is not coming to Canada, and an inadmissible member refuses the whole application.
What happens when the medical raises a concern
- 01
The medical officer's assessment
The panel physician's exam and any requested specialist reports go to an IRCC medical officer, who forms an opinion on the condition and its likely cost.
- 02
The procedural fairness letter
If the opinion is excessive demand, the visa officer must write to you before refusing: the condition, the estimated costs, the services expected, and a deadline, normally 90 days. Nothing is decided yet.
- 03
Your own evidence
A treating specialist's report on the actual diagnosis, prognosis and treatment plan; evidence of the cost of that treatment in the destination province; evidence of what is and is not publicly funded there. Medical officers' estimates are often generic, and specific evidence changes them.
- 04
The mitigation plan
Where costs are real, a declaration of ability and intent to mitigate: private insurance that covers the treatment, evidence of the means to pay for drugs or care not covered, a plan for services in the province, and a signed undertaking. The plan must be credible and specific.
- 05
The decision
The officer weighs the response. Outcomes range from a withdrawal of the concern, to a finding of inadmissibility, to, in some cases, consideration of a temporary resident permit or humanitarian grounds.
The mitigation plan: what works
Since a 2005 Supreme Court decision (Hilewitz), applicants may show that they will not in fact place excessive demand on public services, and IRCC assesses those plans on their credibility. Plans that succeed tend to share four features: a precise account of the treatment actually needed, from the treating specialist rather than a generic profile; a demonstration that the expensive component is not publicly funded in the destination province, or will be privately paid; documented financial ability, in the form of savings, income or insurance, to cover it for the assessment period; and a declaration of intent signed by the applicant. Plans that fail are vague promises, private insurance that excludes the pre-existing condition, or reliance on a provincial drug plan the applicant would in fact qualify for, which counts as public cost. Choose the destination province with the funding rules in mind; what is a public cost in one province is private in another.
Temporary applications and TRPs
Work and study permit applicants take a medical if they are from a designated country, have lived in one recently, will work in a health or childcare setting, or are staying more than six months in some categories. Excessive demand applies to temporary applications too, though the shorter period usually keeps costs below the threshold. Where a person is inadmissible on medical grounds and there is a strong reason for entry, a temporary resident permitcan be issued at the officer's discretion, and TRP holders on medical grounds can in some cases later apply for permanent residence under a dedicated public policy after a period in Canada.
Disclosure: never hide a condition
Applicants sometimes stop a medication before the exam or omit a diagnosis, hoping to avoid the assessment. The medical history questionnaire asks directly, panel physicians order tests, and a condition discovered later, in a subsequent application, a provincial health record or a claim, becomes misrepresentation, with a five-year ban that a medical inadmissibility finding does not carry. Declare the condition and fight the cost estimate; that is a contest you can win.
Where a consultant fits
Responding to a medical fairness letter, coordinating specialist evidence, drafting a mitigation plan and preparing a TRP or humanitarian request are within a licensed RCIC's practice. Judicial review of a refusal at the Federal Court, and appeals by sponsors to the Immigration Appeal Division, are not, and we refer them to counsel. See our page on consultants and lawyers.
Compliance note. Wild Mountain Immigration is a licensed RCIC practice (CICC R706497). The threshold figure is IRCC's and is updated annually; confirm the current amount on canada.ca. Nothing here is medical advice or a guarantee of outcome.
Frequently asked questions
What is medical inadmissibility in Canada?
Section 38 of the Immigration and Refugee Protection Act makes a person inadmissible if their health condition is likely to be a danger to public health, a danger to public safety, or might reasonably be expected to cause excessive demand on health or social services. Almost all findings are on the third ground, and it is assessed against a published cost threshold over five years (ten in some cases).
What is the excessive demand threshold?
IRCC sets the threshold at three times the Canadian average per-capita cost of health and social services, updated each year. For 2026 it is in the region of $27,000 to $28,000 per year, about $135,000 to $140,000 over five years. A condition whose expected publicly funded cost exceeds that, or that would add to existing waiting lists, can be excessive demand. Confirm the current figure on canada.ca; it changes annually.
Who is exempt from excessive demand?
Sponsored spouses, common-law and conjugal partners and dependent children, refugees and protected persons, and certain humanitarian cases are exempt from the excessive-demand ground (though not from the public health and safety grounds). Parents and grandparents being sponsored are not exempt. Economic applicants and their family members, including non-accompanying dependants, are assessed.
Which conditions cause medical inadmissibility?
There is no list of banned conditions; it is about expected cost and service demand. Conditions that commonly trigger a review include those needing dialysis, expensive biologic or specialty medications, ongoing specialist care, intellectual disabilities requiring special education or social services, and some cancers and organ conditions. Since 2018 reforms, special education and many social services are no longer counted, and the cost threshold was tripled, so far fewer people are found inadmissible than before.
What happens if a medical exam raises a concern?
IRCC sends a procedural fairness letter setting out the medical officer's assessment, the expected costs and the deadline to respond, usually 90 days for medical matters. You can dispute the diagnosis or the cost estimate with your own specialist evidence, or submit a mitigation plan showing how the demand on public services will be reduced, for example private insurance, a credible plan to pay, or evidence the treatment is not publicly funded in the province of destination.
Can a disability make me inadmissible to Canada?
Not in itself. Since 2018 the assessment excludes special education, social and vocational rehabilitation and personal support services from the calculation, and the cost threshold is three times higher. Many people with disabilities, and families with disabled children, are admitted. What matters is whether publicly funded health or social service costs would exceed the threshold, and a mitigation plan can address that.
Does a dependent child's condition affect the whole family?
Yes, for economic applications: if any family member, accompanying or not, is inadmissible, the principal applicant's application is refused, unless that member is exempt. A non-accompanying child who is medically inadmissible can still refuse the family. Family-class sponsored children are exempt from excessive demand.
Can I get a temporary resident permit if I am medically inadmissible?
Yes, a TRP can be issued where the need to enter or stay outweighs the risk, for example a worker whose employer needs them or a family reunification case. It is discretionary and temporary. For permanent residence, the routes are a successful fairness response, a mitigation plan, or humanitarian and compassionate consideration.
A medical concern on your file?
A licensed RCIC coordinates the specialist evidence, builds the mitigation plan and answers the fairness letter inside the 90 days.