Citizenship and Immigration Committee on Oct. 24th, 2017

[Michael MacKinnon]

It's more that with those rolling five-year profiles, in any given year, you will have five years' worth of decisions that are generating savings, so your savings will be on the order of $135 million, perhaps as little as $120—

[The Chair, Liberal, Rob Oliphant]

That's because of years.

It just depends on the vantage point you're using.

[Michael MacKinnon]

Yes.

[The Chair, Liberal, Rob Oliphant]

If you're a province, you're thinking it's $27 million a year.

[Michael MacKinnon]

If you're a province, you're thinking it's $27 million from this year, plus $27 million from next year—

[The Chair, Liberal, Rob Oliphant]

—and from next year, from next year, from next year. Absolutely.

[Michael MacKinnon]

You're probably aggregating it as being roughly $120 to $150 million.

[The Chair, Liberal, Rob Oliphant]

Sorry. I find it difficult language, but I'm not too bright here.

Ms. Kwan is next.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you, Mr. Chair.

I thank the officials for their presentation to the committee.

Mr. Chair, I have a series of questions. I know we're limited in time, so I'm going to put these questions on the record and ask the officials to undertake to provide answers to the committee with respect to them.

I think what's underpinning all of this is one of the most important questions, and that is the information and the evidence the officials can provide to us on how the government sets the current cost threshold for excessive demand. I don't believe that anyone is disputing the information provided by the Canadian Institute for Health Information, but I would like to get to how this figure is being derived. To that end, Mr. Chair, I would like to ask the officials for the following information.

First, how does IRCC set the cost threshold for excessive demand, particularly for social services? It is my understanding that the government uses a figure of $356 for what it spends on social services per capita each year. Where did that figure come from, and is that the correct figure?

Does the current review aim to more clearly define the social services considered when setting the threshold for excessive demand? If yes, how will this be accomplished and accounted for to ensure transparency?

What about applicants who have been denied in previous years for amounts very near to this threshold? We have heard about the number of people who are being assessed in this context. How many people were denied? For those who have been denied, if their threshold was very close to this amount, does IRCC intend to launch a proactive review of these cases or at least provide an avenue for applicants to reapply without incurring additional costs?

We have seen major inconsistencies, at least anecdotally, in how applications involving medical inadmissibility are reviewed and handled, depending upon the medical officer or the immigration office responsible for a particular file. In some cases, medical officers failed to provide any sort of cost estimate to applicants in procedural fairness letters when stating that applicants may be deemed inadmissible, an apparent violation of existing case law, specifically in the Sapru v. Canada 2011 case, which requires that applicants be provided with cost estimates during the procedural fairness process so that they may put forward a reasonable challenge to the government's claims.

To that end, do the officials acknowledge that there are problems in terms of how applicants are handled by one officer or office versus another, and that these problems include significant inconsistencies in how medical officers review the anticipated costs of care in Canada?

Also, has IRCC's review of medical inadmissibility included a review of these inconsistencies? If yes, what efforts has IRCC undertaken to ensure medical officers are aware of and adhering to existing case law regarding procedural fairness?

The Canadian Bar Association has recommended that the processing of cases involving medical inadmissibility be centralized in Ottawa so that these more complicated cases can be given the care and attention they deserve. I wonder whether or not the officials agree. If yes, what is being done to make this happen? If not, why not?

We understand the provinces are being consulted on a range of possible policy changes, including the possibility of expanding groups of persons exempted from these provisions, something that is currently limited to refugees and protected persons. Is this true? If yes, what groups is the government considering for exemptions from medical inadmissibility and excessive demand provisions?

Also, disability advocates from across Canada have spoken out against these provisions, saying that medical inadmissibility discriminates against people with disabilities, forcing them to go through a process that able-bodied persons do not have to. Do the officials and the government acknowledge that this policy unfairly discriminates against persons with disabilities?

Specifically what I'm talking about is the process of forcing people with disabilities through a separate and segregated process of medical review, by virtue of the fact that they have a disability. This, to me, is a textbook case of discrimination, and the outcome, whether admitted or not, is irrelevant, in that the person with disabilities is discriminated against prior to these decisions ever even being made.

To that end, does IRCC intend to make persons with disabilities, particularly dependent children of economic applicants, exempt from these provisions? If yes, what disabilities will be exempted, and how will the government determine the list of exempted disabilities and conditions?

[Dawn Edlund]

Thank you for the questions.

[The Chair, Liberal, Rob Oliphant]

You have a minute and a half left.

[Dawn Edlund]

I'll touch on a couple of them. We'll provide written responses to the others.

Mr. Chair, the question was asked about how we establish the cost threshold. We have two different component parts to that cost threshold. The first is looking at the annual report from the Canadian Institute for Health Information. It provides an annual look at per capita usage by Canadians in relation to health and social services. In 2017 that number was $6,299. A second component is that we then look at the definition of excessive demand and our definition of social services.

We compared the types of services that the Canadian Institute for Health Information covered, and some parts of our definitions of social services were not covered by the Canadian Institute for Health Information—

[Jenny Kwan, NDP, Vancouver East, BC]

I wonder if I can interject. Can the committee get your definition in writing, then, of what you define to be social services and get that list from you?

[Dawn Edlund]

Absolutely. It's actually part of the regulations. It's a defined term in the regulations.

Some of the pieces that are not covered in the Canadian Institute for Health Information for social services, for example, are global home care, some specialized residence and residential services, special education services, social and vocational rehabilitation services, and personal support services. Those are all part of our regulation, and the Canadian Institute for Health Information doesn't cover those.

In 2004 we undertook a study by looking to sources such as Statistics Canada and Health Canada, speaking with provinces and territories about their data, and then calculating those missing services that aren't in the CIHI numbers and what that actually turned out to be. We provided that baseline in 2004, and we've actually increased that by the cost of inflation every year, so in 2017 that's now $356.

[Jenny Kwan, NDP, Vancouver East, BC]

Can the committee get that study so we can review what was undertaken and have that information?

[Dawn Edlund]

Do you mean the baseline study?

[Jenny Kwan, NDP, Vancouver East, BC]

Yes.

[Dawn Edlund]

Yes.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you.

[The Chair, Liberal, Rob Oliphant]

I think that's your time. You'll get another shot at this.

Go ahead, Ms. Zahid.

[Salma Zahid, Liberal, Scarborough Centre, ON]

Thank you, Chair, and thank you to our witnesses.

In your opening remarks, you gave us some numbers for the people who were medically inadmissible. I would like to know what percentage of the negative decisions due to excessive demand were overturned over the last few years by a ministerial intervention, the Federal Court, or the IRB.

[Dawn Edlund]

On the number of cases overturned, I don't think we have those numbers with us at the moment, but there certainly have been decisions by the Federal Court and by the immigration appeal division over the years, some of which have upheld the medical inadmissibility finding and some of which have overturned the medical inadmissibility finding. We can do further research and provide that to the committee.

In response to an earlier question, I also spoke about the possibility of people getting.... Sometimes after the medical inadmissibility recommendation by the medical officer, the individuals then provide information—for example, in relation to social services—and they satisfy the visa officer that they actually are not inadmissible. That happens there.

Some people withdraw their applications. Some people end up with temporary resident permits. Some people are granted visas on humanitarian and compassionate grounds. A range of results can happen after the initial medical officer recommendation.

[Salma Zahid, Liberal, Scarborough Centre, ON]

Is it possible to get some numbers on that?

[Dawn Edlund]

Yes.

[Salma Zahid, Liberal, Scarborough Centre, ON]

Next, when a decision of inadmissibility due to excessive medical demand is rendered, the applicant has the opportunity to submit a plan to show how they can mitigate the impact. Over the last few years, how many and what percentage of these plans have been accepted?