The Ford government says it will belatedly align with federal guidelines on nurse practitioners, a policy the province asked Ottawa to clarify two years ago.

The federal government had set an April 1 deadline for provinces to have a policy in place to fund all medically necessary services from nurse practitioners.

It’s a deadline Ontario will miss, although provinces won’t be penalized by the feds until April 2027.

“We will be in compliance with the now-clarified federal guidelines,” Health Minister Sylvia Jones promised on Tuesday morning.

After repeatedly calling on the federal government to close what she called a loophole in the Canada Health that allowed some nurse practitioner clinics to charge out of pocket for care.

Now that Ottawa has acted, and Ontario is set to miss its own commitment, Jones is suggesting she’s not satisfied with the steps the federal government has taken.

“What they’ve said is, ‘It’s your problem, you fix it,’” she told reporters. “So, we’re going to have a whole bunch of different fixes across the Canadian jurisdictions. I was looking for some leadership from the federal government to make sure that there was consistency. We obviously aren’t going to get that.”

In January 2025, the federal government wrote to all provinces telling them to create a public funding model for nurse practitioners. That letter set the April 2026 deadline Ontario will now miss.

Jones insisted work had begun on getting Ontario in line, but didn’t explain why it wasn’t complete or when it will be ready to enforce.

“We have already begun, we’ve made investments in nurse practitioners,” she said, pivoting to talk more broadly about primary care.

“We want them to be in the publicly funded system and as I said we will do that.”

Nurse practitioners in Ontario can assess patients, order and interpret tests, and prescribe medication and treatment. They work in a variety of settings, including family health teams and community health teams, hospitals and long-term care homes, as well as in more than two dozen publicly-funded nurse practitioner-led clinics.

Two years ago, a proliferation of private subscription fee-based nurse practitioner clinics made headlines. Jones responded to opposition and media questions by putting the onus on the federal government to close a “loophole” that allowed them to operate.

“If there is a wedge that is allowing these clinics to happen, then perhaps the member opposite could pick up the phone and call their federal counterparts, because that’s what I’ve been doing,” she said in question period in March 2024.

The next month, Jones formally wrote to the federal government asking them to make the change.

“As you are aware, the federal Canada Health Act (CHA) sets out what services are publicly funded in provincial health care systems,” Jones wrote.

“However, the CHA does not contain provisions with respect to the permissibility of non-physician providers, for example Nurse Practitioners, charging patients for care that would be covered under the CHA if performed by a physician.”

While Ontario began funding 25 nurse practitioner-led clinics in 2011, the Ford government expanded the program by including an additional seven clinics under the funding envelope in the early 2020s.

In her letter in 2024, Jones asked the federal government to “work with provinces and territories on a Canada-wide solution to close this loophole, to guard against unintended consequences, and prohibit nonphysicians from charging for publicly funded services.”

Ontario Liberal MPP Adil Shamji blasted the government for missing the deadline — and suggested they should reimburse patients who are forced to pay out of pocket.

“(The premier) is going to miss an April 1 deadline imposed by the federal government to stop illegal user fees and extra charges in health care,” he said during question period.

“Will the premier reimburse every single bill that Ontario patients receive from their nurse practitioner after April 1?”

–with files from The Canadian Press

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