Refugees caught in health care Catch 22

If you’re on income assistance in Nova Scotia, you’re eligible for pharmacare – unless, that is, you’re a refugee claimant.

The Department of Community Services’ Employment Support and Income Assistance policy contains misleading information on medical expenses for refugees, says Gillian Zubizarreta, Settlement Coordinator at the Halifax Refugee Clinic.

As a result, she says, Department policy effectively discriminates against refugee claimants on income assistance because of their immigration status.

“They don’t get the same access as everyone else on income assistance.”

Section 5.11.7 of the ESIA policy states that medical expenses for immigrants and refugees including medications, dental and preventative treatments will be “provided for by the Federal government.”

And that was true for refugee claimants — once. But since 2012, major cuts to Interim Federal Health program for refugee health care has left many refugees without access to that funding.

Part of the confusion comes from the fact that refugee classification is, well, confusing, and since 2012, the status of one’s refugee claim has a significant effect on the kind of coverage that is available.

Some refugees are resettled by the Federal government, and have access Federal health funding. This still applies, even after the 2012 cuts.

But if you’re not in this category – if, for instance, you apply for refugee status from within Canada  – then unless you’re a pregnant women or a child, you’re pretty much out of luck while the claim is being processed.

As of 2012, many refugee claimants only get Federal health coverage for urgent and essential care. Refugee claimants also don’t have access to health cards, and are therefore ineligible for provincial funding.

So why does the ESIA policy say they’re covered? Despite the confusion around refugee status, the answer to that question, at least, is simple.

“[Section] 5.11.7 is totally wrong,” says Zubizarreta.

Essentially it’s a bureaucratic black hole; the provincial policy makes it looks like the Federal government provides the necessary coverage for all refugees regardless of status, removing the incentive for the province to do anything to fill the gaps.

“Refugee claimants are stuck in the middle of two levels of governments passing the buck back and forth.”

But not only do refugee claimants not have the Federal coverage the ESIA policy says they have – they have no supplemental coverage at all.

“[Refugee claimants] have no provincial health cards, and Income Assistance has no administrative process to make them eligible for pharmacare.”

Income Assistance used to allow refugee claimants in Nova Scotia to make special needs requests to cover medications, but this is no longer DCS policy.

The information in the ESIA manual is confusing for caseworkers in Community Services, says Zubizarreta, because their own policy tells them their refugee claimant clients have access to supplemental services, when in most cases they don’t.

“Caseworkers have to educate themselves despite their policy.”

Zubizarreta says she met with the Director of Community Services in April 2014 and pointed out the errors in wording of the policy. Thus far, no amendments to the policy have been made.

Department spokesperson Lori Errington said in a statement that although there are challenges accessing federal support, most refugees are covered – when they’re not, the Department encourages refugee claimants who can’t afford essential medications to approach the nearest Community Services office. The statement did not say whether the policy would be changed.

The Department of Health and Wellness has put funding towards the Refugee Health Clinic, which provides basic treatment for refugee claimants who lack coverage, but this does not directly address the issues around access to pharmacare for refugee claimants on income assistance.

It is true that the portion of the population affected by this is not a large one – of the small number of refugees in Nova Scotia, most are government sponsored – but even in provinces where the refugees affected number in the thousands, there’s still confusion.

In 2014, the Ontario government defied the federal cuts, implementing the Ontario Temporary Health Program (covering, among other things, pharmacare for refugee claimants on social assistance).

But mixed messages and confusion are a huge problem in Ontario too, says Francisco Rico-Martinez, Co-Director of the FCJ Refugee Centre in Toronto, and the application process for IFH is so confusing that many refugee claimants don’t even bother applying, making them ineligible for the OTHP as well.

“Our biggest problem is the lack of information that the refugee claimant has; they don’t know what they have access to. So they say ‘what the heck, I won’t use it.’”

So the complexity of the challenge is not unique to Nova Scotia.  But the solution need not be so complicated, says James Hutt, Director of the Nova Scotia Health Coalition.

If the lack of health cards for refugee claimants can’t itself be solved, overcoming that administrative barrier through something such as a number system to keep track of claimants using pharmacare could be a fix, he says.

In 2014 the Supreme Court declared the cuts to the IFH unconstitutional and ordered the government to reinstate part of the funding. A Federal appeal hearing on that decision has been postponed until December, suggesting that the incoming Liberals may make good on their promise to reverse the IFH cuts.  This could mean that without any adjustments to Nova Scotia’s EISA manual, the information contained in it could once again be accurate.

But even if that were to happen, that doesn’t mean the Department of Community Services shouldn’t be held accountable, says Zubizarreta.

“It would be amazing if [the IFH] gets restored, but it’s problematic because it lets the [Department] off the hook” she says. “All these years they weren’t doing anything, people were suffering.”