Medical inadmissibility means an application is refused because of an applicant's health, not because of missing documents. It comes from section 38 of the Immigration and Refugee Protection Act (A38). The branch that affects most families is A38(1)(c): a condition that "might reasonably be expected to cause excessive demand" on Canada's publicly funded health or social services. In practice, an IRCC medical officer projects what the applicant's care would cost over a set assessment period. If that projection exceeds the cost threshold IRCC publishes each year, you normally receive a procedural fairness letter and a chance to reply. If the reply does not persuade the officer, the application is refused.
The important point is that this is one of the few refusal grounds where you are told the problem in advance and invited to answer it. How well that reply is prepared often matters as much as the diagnosis itself.
This article is general information about how the process works. It is not legal advice. Medical inadmissibility, judicial review and appeal rights are legally serious matters, and outcomes depend heavily on the facts of each file. Please speak to a licensed representative (an RCIC or a Canadian immigration lawyer) about your own case.
Key takeaways
- A38 has three branches: danger to public health, danger to public safety, and excessive demand on health or social services.
- Excessive demand is a cost test, measured against a threshold IRCC publishes and updates. It is not a judgement about whether someone is "too sick".
- Some applicants are exempt from the cost test under A38(2) — refugees and protected persons, and sponsored spouses, partners and dependent children.
- You are normally given a procedural fairness letter before refusal, commonly with around 60 days to respond. The deadline is stated in your letter, and that letter governs.
- A mitigation plan works best when it is documentary: written quotes from Canadian providers, a named care arrangement, proof of funds, and a signed Declaration of Ability and Intent.
- Paying privately does not offset everything. Services that only exist within the public system generally cannot be "bought out" of the calculation.
- After a refusal, the officer's reasoning is usually recorded in GCMS. Ordering your notes is the practical way to see what was actually counted and whether your reply was considered.
What section 38 actually says
A38(1) makes a foreign national inadmissible on health grounds in three distinct situations. Applicants often mix these up, and they carry different consequences.
| Provision | What it covers | Typical examples |
|---|---|---|
| A38(1)(a) | Condition likely to be a danger to public health | Active infectious pulmonary tuberculosis; untreated infectious syphilis |
| A38(1)(b) | Condition likely to be a danger to public safety | Conditions carrying a risk of sudden incapacity or of unpredictable behaviour that could harm others |
| A38(1)(c) | Condition that might reasonably be expected to cause excessive demand on health or social services | Conditions needing costly continuing treatment, such as dialysis, high-cost medication, or long-term specialised support |
Note the wording in (c): "might reasonably be expected". It is a forward-looking estimate made on the file, based on the medical evidence available. That is exactly why the evidence you supply about your real, current care needs can change the result.
How the cost threshold works
Excessive demand is defined in section 1(1) of the Immigration and Refugee Protection Regulations by reference to a cost threshold. For many years that threshold was the average Canadian per-capita cost of health and social services. In 2018 IRCC raised it to three times that average and, at the same time, narrowed what counts as a "social service" — special education, social and vocational rehabilitation, and personal support services were removed from the calculation. Health services and prescription drugs still count.
IRCC revises the dollar figure periodically, and recent published thresholds have sat roughly in the region of CAD $25,000 to $28,000 per year (indicative), which works out to somewhere around $125,000 to $140,000 across a five-year assessment. Please treat those numbers only as a rough sense of scale and check the current published amount on IRCC's own website. Do not plan around a figure taken from any article, including this one.
What is counted, and what is not
| Generally counted | Generally not counted since 2018 |
|---|---|
| Publicly funded health services (hospital, physician, specialist, diagnostic) | Special education |
| Prescription drugs covered by provincial drug plans | Social and vocational rehabilitation services |
| Long-term care and certain continuing treatment costs | Personal support services |
Two further mechanics matter more than the exact arithmetic:
- The assessment period is normally five years starting from the most recent medical examination. Where the evidence shows significant costs are likely to continue beyond that, the period can be extended, up to a maximum of ten years.
- Family members are assessed too. In most permanent residence applications, dependants must be examined even if they will not come to Canada with you, and a dependant's condition can affect the principal applicant's admissibility. There are limited exceptions, so check the requirements for your specific class.
Who is exempt from the excessive demand test
A38(2) removes the excessive demand ground for certain people. If you fall into one of these groups, a costly medical condition cannot make you inadmissible under paragraph (c) — though paragraphs (a) and (b) still apply:
- Refugees and protected persons, and their family members
- Sponsored spouses, common-law partners and conjugal partners
- Sponsored dependent children, and certain other family class members covered by the regulations
Economic immigrants — Express Entry, provincial nominees, self-employed applicants and business streams — are not exempt. Parents and grandparents sponsored under the PGP are also not exempt from the cost test. Temporary residents can in principle be assessed as well, but where a medical exam is required for a study or work permit, the assessment reflects the intended period of stay, which usually makes an excessive demand finding much less likely on a short stay.
The process, step by step
What a strong mitigation plan looks like
The procedural fairness letter is your structured opportunity to respond. Canadian courts have set out two principles that matter here. In Hilewitz v. Canada (MCI), 2005 SCC 57, the Supreme Court held that the assessment must be individualised and that an applicant's ability and willingness to pay privately for services had to be genuinely considered rather than dismissed. In Sapru v. Canada (MCI), 2011 FCA 35, the Federal Court of Appeal confirmed that where an applicant files a mitigation plan, the medical officer must actually consider it before a final opinion is given.
One realistic caution. Hilewitz concerned social services, and since 2018 several of those services are no longer counted at all. For publicly funded health services and provincially covered drugs, courts and IRCC have generally taken the view that an offer to pay privately cannot remove a cost the public system would still bear, because provincial health insurance covers residents automatically. A mitigation plan therefore does its best work on the items that can genuinely be purchased privately, and on correcting an over-stated medical projection.
A reply that tends to be persuasive is documentary, specific and arithmetical. It usually contains:
- A correction of the medical facts, where warranted. A current specialist report showing the condition is stable, well controlled, or needs less intervention than assumed can reduce the projected cost at its source. This is often the single most valuable element.
- A line-by-line answer to the officer's figure. Take each item in the cost estimate — medication, therapy, monitoring, devices — and respond to it with a written quote from a named Canadian provider, on the provider's letterhead, dated.
- Proof of ability to pay. Bank statements, fixed deposits, investment holdings, property valuations, employment or business income. The funds should plausibly cover the plan for the whole assessment period and sit on top of your settlement funds, not inside them.
- Proof of intent. The signed Declaration of Ability and Intent, plus a short personal statement in your own words explaining how the family will actually manage and fund the care.
- A named plan, not a promise. "We will arrange private care" carries little weight. "We have contacted this named clinic in Brampton, which charges this amount per session, and we will fund it from this account, which currently holds this balance" is what an officer can assess.
Practical sequencing: request Canadian provider quotes on the day the letter arrives. Getting written, itemised quotes from abroad is almost always the slowest part, and a plan that arrives with estimates instead of quotes is much weaker. If you genuinely cannot meet the deadline, request an extension in writing before it expires, with a reason.
If you have already been refused
A refusal letter citing A38 tells you the ground, but rarely the reasoning. It will not usually show the cost breakdown the medical officer used, the assumptions behind it, or how your reply was weighed. That detail sits in the officer's file entries.
Ordering your CAIPS/GCMS notes through an ATIP request is the practical way to read it: the decision narrative, the cost figure relied on, and whether your mitigation plan was assessed or passed over. Be aware that some material can be withheld or redacted under the exemptions in the Access to Information Act and the Privacy Act, and that detailed medical assessment records are held separately by IRCC's health branch, so the medical file may need its own request. Even so, the officer's reasoning is usually visible, and it tells you the thing that decides your next step: whether the refusal turned on the medicine or on the money. You can see the format in our redacted sample.
If you would like a first read before ordering anything, upload your refusal letter to the free Refusal Engine on our homepage — it identifies which grounds the officer relied on and explains what each one means. Related walkthroughs sit in our guides.
Frequently asked questions
Does one abnormal test result make me medically inadmissible?
No. A diagnosis by itself is not inadmissibility. Under A38(1)(c) the question is whether the projected cost of your health services and prescription drugs over the assessment period exceeds the published threshold. Many chronic conditions — well-controlled diabetes, hypertension, treated thyroid disease — fall well below it and pass without any comment.
Will offering to pay privately always save the application?
Not always. IRCC must consider a credible plan, but an offer to pay cannot remove costs the public system would carry anyway, such as insured hospital and physician services. Plans succeed most often where the projected cost was over-stated on the medical evidence, or where the expensive element is something that can truly be bought privately.
Can I appeal a medical inadmissibility refusal?
It depends on the stream. A refused family class sponsorship generally carries a right of appeal to the Immigration Appeal Division, where humanitarian and compassionate factors can be argued — this matters most for parent and grandparent sponsorships, since sponsored spouses, partners and dependent children are already exempt from the cost test. Economic and temporary resident refusals generally have no appeal to the IAD; the routes there are an application for leave and judicial review at the Federal Court, or a fresh application with better evidence. Judicial review deadlines are short and strict — broadly 15 days for a decision made inside Canada and 60 days for one made outside — so speak to a licensed representative quickly rather than waiting.
Is my child's condition assessed even if the child stays behind in India?
Usually yes. In most permanent residence applications, dependants must be examined even when they are not accompanying you, and their projected costs can affect your own admissibility. The exemptions in A38(2) are the main relief, and a small number of classes have their own rules, so confirm the requirement for your specific application.
How long do I have to answer a procedural fairness letter?
Commonly around 60 days from the date of the letter, but this varies and your letter states the actual deadline — follow that, not a general figure. Extensions are sometimes granted if you ask in writing, with reasons, before the deadline passes.
Does my condition affect a visitor visa or study permit?
It can, but far less often. A medical exam is only required in certain situations, and where excessive demand is assessed for a temporary resident, it is measured against the intended period of stay rather than five years, which makes the threshold much harder to reach.
Where to go from here
Medical inadmissibility is technical, but it is also unusually answerable, because the law requires IRCC to tell you the concern and to consider your response. What you cannot answer is a refusal you do not understand. If A38 appears on your letter, the first step is to get the officer's actual reasoning in front of you, and the second is to take that reasoning to a licensed representative.
Order your CAIPS/GCMS notes at caipsnotesapply.com/apply — from ₹2,500 + GST, delivered in 25–30 days, with a plain-English written interpretation available on our Tier 3 service. Questions first? See the FAQ or write to us. We are Pro Lifeset Overseas Pvt. Ltd., a government-licensed Indian immigration consultancy (Licence No. 849/DC/PTA/PLA/LC-3/2024), Patiala, Punjab.
This article is general information about Canadian immigration procedure and is current to the date of publication. Law, policy and the published cost threshold change. Nothing here is legal advice, and no outcome is promised or implied. For advice on your own file, consult an RCIC or a Canadian immigration lawyer.