The Ford government says it will not give nurse practitioners billing codes, but will work to bring them into the publicly funded health-care system as the federal deadline to ensure coverage for medically necessary services passes.

More than a year ago, the federal health minister wrote to Ontario, telling the province to come up with a policy to fund and regulate nurse practitioners by April 1.

Despite getting the clarity it had requested, the Ford government missed the deadline.

Health Minister Sylvia Jones said she felt the federal approach lacked uniformity and could download costs.

“There is no additional Canada Health Transfer. We are going to see inconsistency across provinces and territories, but Ontario will be in compliance,” she told reporters on Monday.

“I want to see nurse practitioners practise in our publicly funded system. I want them embedded in our multidisciplinary teams. I want them working in our hospitals.”

Jones said the province hadn’t “done a fiscal” analysis of how much bringing nurse practitioners into the public system would cost.

Nurse practitioners have said they are looking for flexible funding models, such as those for family doctors, who can bill OHIP on a fee-for-service basis or who are paid per patient enrolled.

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Jones said she has “no plans” to let nurse practitioners bill OHIP directly for services through the use of billing codes, saying that would have to be negotiated with the Ontario Medical Association.

The health minister did not say what approach she would take instead to bring nurse practitioners into the public system.

Liberal health critic Adil Shamji said it was a mistake to rule out billing codes before consulting with health-care experts.

“I think that there are many different ways that nurse practitioners could be publicly funded,” he told reporters.

“I’ve spoken to nurse practitioners; some are interested in that model, others are interested in other models altogether, whether they’re paid hourly wages or they’re brought on in a salaried model.”

Critics said it was “shocking” the government had missed the deadline — although Ontario won’t face penalties for non-compliance until next year.

“What has she [Jones] been doing? She’s been in this role for years now,” Ontario NDP Leader Marit Stiles said.

“This government has been in power for eight years. They’ve now missed the deadline for the nurse practitioners’ agreement. And again, did she not have time to figure this out?”

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.

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.”

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Ontario is investing $1.1 billion more in home health care as it grapples with the reality that it is unlikely to achieve its goal of building 58,000 new long-term care beds by 2028.

The funding boost for home care is part of Finance Minister Peter Bethlenfalvy’s 2026 budget that projects a $13.8 billion deficit for the upcoming fiscal year.

But the budget released Thursday also lays out the stark reality of the province’s ambitious goal to deliver 58,000 new or upgraded nursing home beds within two years.

As of February, the province said about 26,000 nursing home beds are “either open, under construction or approved to start construction.”

Bethlenfalvy was asked if the province could still achieve its goal.

“Well, we’re going to continue to try,” he said. “We’re ambitious here.”

The finance minister said the province is not deterred.

“We’re going keep building, and we’ll get as far as we can because it’s the right thing to do,” he said.

The money toward home care will roll out over the next three years. The province is investing about $6 billion total into home care in the next few years, Bethlenfalvy said.

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“A part of our strategy for health care is to help people where they want to be taken care of,” he said.

“I know many, many people who would prefer to age at home … so we’re transitioning to providing that home care.”

The money will go toward hiring more nurses and personal support workers, with the goal of helping thousands more patients receive medical attention at home and providing some relief on overburdened hospitals and long-term care homes.

The new funds follow calls from some in the long-term care industry who wanted to see investment in home care and supportive housing for seniors as a way to help nursing homes, most of which have wait times of months or years.

AdvantAge Ontario, which represents the vast majority of municipal and non-profit nursing homes in Ontario, made the unusual request for more money for other related sectors and asked the government to invest at least $600 million into home care.

Long-term care operators have said the best way for people to get into care homes now is by going through the hospital first. That allows patients to be designated as in crisis, which gives them higher priority over others seeking a long-term care bed.

Data from the Canadian Institute of Health Information shows more than 50 per cent of long-term care admissions are people coming from a hospital, a 67 per cent jump from pre-pandemic levels.

The situation is particularly problematic in Toronto, which is down about 700 beds due to nursing home closures.

In 2019, the province said it would build 30,000 new long-term care beds within the next decade.

Then COVID-19 hit in early 2020, and the virus ripped through Ontario’s long-term care homes, leaving thousands dead. Some homes were so badly hit they needed help from Canada’s military to operate.

The stalled progress on the Progressive Conservatives’ $6.4-billion long-term care plan leaves seniors in a bad spot, said Liberal interim Leader John Fraser.

It’s a lot of “big talk” from Ford with little action, Fraser said.

“They’re pretending, they are not protecting,” Fraser said, referring to the Ford government’s “protecting Ontario” slogan that it has used since last year’s election win.

“The Conservative government is behind on building the number of long-term care beds it said that it would build and that’s really concerning,” said NDP finance critic Jessica Bell.

“We’ve got an aging population in Ontario, loved ones need a good home for their parents to go into.”

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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.”

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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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The Ford government is beginning work to create a central, electronic system to manage medical records, a move it says is part of its broader plan to connect everyone with a primary care practitioner by 2029.

The policy is in its early stages, with officials reaching out to businesses and providers in Ontario to understand who might be interested in bidding on the proposal in the future and how much capacity they would have.

“We want to get rid of those cursed forms that you have to fill out every time you go to a different clinician,” Health Minister Sylvia Jones explained.

“[We want to] make sure we have a system that can communicate regardless of where we are. So, lab tests, hospitals, primary care providers, we need to make sure that all of those pieces together work. And that work will be ongoing with Supply Ontario.”

She said the key to the new system would be allowing information and documents to be seamlessly shared between different health-care systems and providers. If realized, it would allow hospitals, doctors, home care and other providers to all merge records for continuity of care.

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Jones said the system would be voluntary for patients to opt into.

The government said it is currently seeking vendors who can help manage its new electronic system. Jones said a “number of businesses” would be interested in bidding on the contract, but wouldn’t comment on the cost.

The announcement comes some 20-plus years after the government launched a system called eHealth, which mutated into a scandal.

Ontario began trying to create integrated electronic medical records for patients in the early 2000s, but in 2009, the then-Liberal health minister was forced to resign after the auditor general said the eHealth agency had spent $1 billion but had little to show for it. A followup report from the auditor general in 2016 said $8 billion had been spent to that point on various electronic health record initiatives.

Jones said her new plan would not suffer the same fate, pointing to work she said will take place with the integrity commissioner and the information and privacy commissioner in drafting the plan.

Finance Minister Peter Bethlenfalvy also announced Thursday that next week’s provincial budget will include another $325 million for primary care, as Jones said the government is so far on track toward its goal of attaching everyone in the province to a primary care provider by 2029.

— with files from The Canadian Press

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The Ford government will table its annual budget at the end of March, a financial document the premier has promised will not feature cuts.

During an appearance at the Empire Club in Toronto, Finance Minister Peter Bethlenfalvy revealed he would publish the budget on Thursday, March 26.

The budget confirms the government’s spending plans for the year ahead, along with economic indicators ranging from growth to new housing or spending on vices like alcohol.

Bethlenfalvy has recently vocally complained about how much money Ontario is pouring into the health-care sector, the single largest line in its operating plan, calling it “unsustainable” at an event in Mississauga.

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“We’re in unprecedented territory in terms of the concerns of people. People are scared, they’re worried, they are concerned,” Bethlenfalvy previously said of the current geopolitical and economic climate fuelled, in part, by U.S. President Donald Trump.

At the same time, the finance minister warned that the province was facing a “big headwind, on top of the uncertainty” that threatens to squeeze Ontario even further.

“The economic environment is slowing down, there’s just no question,” the minister said. “We’re growing at the slowest rate we’ve grown post-COVID.”

Ford, however, promised that those pressures wouldn’t result in spending cuts when the budget is unveiled in a few weeks.

“I’ll tell you right now: no, there won’t be,” he said Tuesday when asked about cuts.

“My finance minister is the best finance minister I’ve ever seen. He’s a proven fiscal manager with taxpayers’ money.”

Ford acknowledged that the growth in health-care spending was on his mind, but said he didn’t plan to cut back.

“And yes, when you see the amount that we’re investing into health care, it’s concerning,” he added. “He’s doing his job. But we’re going to continue to invest, continue to increase the funding.”

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Ontario is working toward attaching everyone in the province to a primary care provider, but family health teams are warning that as the government has its sights set on that laudable goal, the foundation of primary care is crumbling.

Family health teams include not just doctors, but also a variety of other health professionals to provide comprehensive care, such as nurses, social workers and dietitians. The government funding for those professionals has not kept pace with inflation or with the wages the same professionals earn in other health-care settings, the family health teams say.

Nurse practitioners could make an additional $20,000 or more per year by working in a hospital, and physician assistants could make an extra $30,000, says the Association of Family Health Teams of Ontario.

“We’re getting funding to bring on more people and attach more Ontarians, but if you don’t actually stabilize the workforce you have and stabilize the capital space that you have, you’re very limited in terms of being able to sustain attachment,” association CEO Jess Rogers said in an interview.

“So we might make our attachment numbers this year, let’s say, or by 2029, but the concern is, we want to make sure Ontarians have access to the care, not that they’re only attached.”

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Family health teams received a 2.7 per cent compensation increase last year, but that followed multiple years of stagnation and does not come close to the level needed to properly recruit and retain professionals, the association says.

Various family health teams and their association made presentations to a legislative pre-budget committee, asking for $430 million over five years to close what they call a structural wage gap, and for $115 million in already committed workforce funding to be released.

A spokesperson for Health Minister Sylvia Jones said the province is investing a lot in family health teams, including more than $600 million this year.

“Ontario is the first Canadian jurisdiction to pass legislation that establishes a framework for its publicly funded primary care system, and through our $2.1 billion Primary Care Action Plan, we are both investing more in family health teams across the province and connecting everyone to a primary care provider by 2029,” Ema Popovic wrote.

Meghan Peters, executive director of a family health team in Sudbury, said some staff take on second jobs to make ends meet, though some could make tens of thousands of dollars more per year in different areas of the health sector.

“Passion for primary care is no longer enough to justify staying,” she told the pre-budget committee.

“And when these skilled professionals leave, the foundation of primary care weakens. Our ability to provide essential services, programs, timely access and comprehensive care is compromised. The ones that suffer most are our patients. As our health care professionals leave, our patients see longer wait times, reduced services, cancelled programs and face unattachment.”

Recruitment and retention across various areas of the health sector are a particular challenge for northern and rural Ontario, and family health teams say they are no exception.

Shannon Kristjanson, executive director of the Greenstone Family Health Team, told the committee they are funded for four nurse practitioners but only have one position filled.

“(At) the hospital, which is in the same parking lot as where we are — you can make around $40 an hour more as a nurse practitioner,” Kristjanson said.

“So it’s really difficult to recruit or retain almost all of the positions in health care in the north, but specifically nurse practitioners, just because of the pay difference.”

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Ontario’s finance minister is expressing concerns about the rate of health-care spending in the province, calling the current $91.5-billion budget both “unprecedented” and “unsustainable.”

When Peter Bethlenfalvy addressed the Mississauga Board of Trade in January, he outlined some of the issues that appear to be weighing on his mind as he crafts the upcoming budget set to be delivered in late March.

“We’re in unprecedented territory in terms of the concerns of people. People are scared, they’re worried, they are concerned,” Bethlenfalvy said of the current geopolitical and economic climate fuelled, in part, by U.S. President Donald Trump.

At the same time, Bethlenfalvy warned that the province was facing a “big headwind, on top of the uncertainty” that threatens to squeeze Ontario even further.

“The economic environment is slowing down, there’s just no question,” the minister said. “We’re growing at the slowest rate we’ve grown post-COVID.”

Adding to the GDP concerns, the finance minister pointed out that “flattening” population growth is another factor his department is closely watching as it decides how to allocate billions in spending.

“Eighty-five per cent of the spending in the budget is actually for social spending. About 15 per cent is for infrastructure and the economy,” Bethlenfalvy explained.

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“We have a slowing population and a slowing economic growth and a trajectory of social spending that’s been, frankly, unprecedented. So we’re going to have to manage that challenge.”

Later, during a fireside chat, the minister put it more clearly: “Our health-care spending is unsustainable. We just have to deal with reality that we can’t keep spending, particularly when our population is flattening.”

The comments come at a time when hospitals warned the government they are facing a billion-dollar structural deficit and are now preparing for “difficult decisions” unless the Ford government increases health-care funding in its upcoming budget.

The Ontario Hospital Association said health-care costs have risen by six per cent a year, largely due to a growing and aging population and inflation, forcing health-care institutions to erode their capital and borrow money to stay afloat.

Rob Cerjanec, a Liberal MPP from Ajax, said the finance minister’s comments are “incredibly concerning,” especially for residents who want assurances that health care will be available when needed.

“When we hear a minister of finance talking about health-care spending being unsustainable, I mean that could be the difference between life or death for somebody,” Cerjanec said.

“We have great pride in our public health-care system. We need to strengthen our public health-care system.”

Recently, Ontario’s financial accountability officer revealed that the province was projecting a “significantly slower pace” of health-care spending in the next few years compared with the previous three.

The 2025 budget projected that health-care spending would grow by an average rate of 0.7 per cent between 2025 and 2028.

By contrast, the health-care budget grew by 6.6 per cent on average between 2021 and 2024.

“Over the 34-year period from 1990-91 to 2023-24, health sector spending grew at an average annual rate of 5.0 per cent,” the budget watchdog notes. “If the Province’s health sector spending plan in the 2025 budget is achieved, it would be the slowest three-year growth rate since 1993-94 to 1996-97.”

When Global News asked the finance minister whether his “unsustainable” remark meant he was considering cutting spending, Bethlenfalvy rejected the notion.

“We’re not going to cut health-care spending,” the finance minister said, before adding that his goal is to deliver health spending in an “efficient, effective and innovative way.”

Bethlenfalvy said that includes focusing on reducing surgical wait times, easing hallway health care and expanding access to family doctors.

The minister added that the use of artificial intelligence to help physicians take notes and using tracking devices on gurneys and wheelchairs are examples of innovation to free up resources and stretch precious health-care dollars.

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