Federal Health Minister Mark Holland says provincial and territorial health plans will cover primary care provided by nurse practitioners, pharmacists and midwives.

Holland says regulated health-care professionals who aren鈥檛 doctors will be able to bill the government for medically necessary services that would otherwise be provided by a physician.

The minister says the changes are part of a new interpretation of the Canada Health Act that takes effect on April 1, 2026.

He says the move is needed because some patients are paying out of pocket for medically necessary care, including at some private nurse practitioner clinics.

Holland says charging patients for those services isn鈥檛 consistent with universal health care and nurse practitioners should instead be able to bill the health-care system the same way doctors do.

He says the changes aren鈥檛 happening until next year because provincial and territorial governments need enough time to adjust their health insurance plans.

Holland issued the directive in an 鈥渋nterpretation letter鈥� 鈥� revising which providers fall under Canada鈥檚 medicare system 鈥� sent to health ministers on Thursday but released publicly on Friday morning.

In an interview Thursday evening, Holland said he was 鈥渄eeply concerned鈥� about patients being charged for public health-care services.

鈥淭hat certainly isn鈥檛 in the spirit of the Canada Health Act, and this interpretation letter shuts that down,鈥� he said.

The new policy also 鈥渆mpowers鈥� non-physician health-care professionals to provide the full spectrum of care they鈥檙e qualified to give, Holland said.

Nurse practitioners in particular can help relieve the pressure on primary care physicians and the health-care system as a whole, he said.

鈥淭here has been an expansion in scopes of practice for many regulated health-care professionals (e.g., nurse practitioners, pharmacists, midwives) to better utilize the full extent of their competencies, knowledge and skills to increase access to needed care,鈥� Holland wrote in the letter to his provincial and territorial counterparts.

The changes will be enforced in the provinces and territories through federal health transfer payments, which could be deducted if patients are charged for medically necessary care, he said.

Holland鈥檚 directive comes almost two years after his predecessor, Jean-Yves Duclos, expressed concern in a letter to health ministers about patients paying out of pocket for medically necessary treatment.

In that March 9, 2023, letter, Duclos pledged to issue a revised interpretation of the Canada Health Act to prevent that from happening.

Last September, Canadian Doctors for Medicare wrote to the Prime Minister鈥檚 Office asking when that 鈥渓ong-awaited鈥� interpretation would be released.

The group鈥檚 chair, Dr. Melanie Bechard, said it would help 鈥渆nsure that all Canadians continue to have access to medically necessary care based on their needs, not on their ability, or willingness, to pay.鈥�

鈥淭he turn toward episodic care provided virtually by physicians and longitudinal care provided by nurse practitioners (and other types of providers) was not foreseen in 1984 when the Canada Health Act was passed,鈥� Bechard wrote.

鈥淐larifying that medically required virtual care or nurse practitioner care must be publicly funded would be consistent with the spirit and intent of the Canada Health Act.鈥�

Holland said the delay was due to ongoing consultation with provincial and territorial governments over the last two years to cultivate agreement on the new policy.

Duclos also identified virtual care and telemedicine as areas where some patients may be inappropriately paying out of pocket.

Holland said billing for virtual care is not addressed in his current directive, but it remains a concern he鈥檚 discussing with his provincial counterparts.

鈥淚f you walk into a doctor鈥檚 office that is a physical doctor鈥檚 office or if you walk into a virtual doctor鈥檚 office, both of those things should be covered by the Canada Health Act,鈥� he said.

鈥淏oth of those things should ensure that a patient isn鈥檛 paying for their health-care services.鈥�