Newcomers say they're left in limbo by 'unfair' changes to Manitoba health card requirements

Patients afraid to see a doctor. Children unable to get vaccinated. Families not allowed to apply for food hampers as they struggle to put meals on the table.

These are just a few ripple effects newcomers say have followed the Manitoba government's new requirements to apply for a Manitoba health card.

Before the change, applicants only needed proof of their citizenship or permanent residency in Canada.

Now, Manitoba's health department requires proof they live in the province, such as a lease agreement, a document confirming employment or a notarized letter from a landlord.

It's a requirement newcomer co-ordinator Boris Ntambwe said is difficult for new Canadians to fulfil. Ntambwe said because many immigrants and refugees stay in transitional housing when they first arrive, they don't have the kind of paperwork the province is asking for.

Ntambwe co-ordinates the housing and the refugee assistance program at Accueil ​​​​francophone — an organization that helps newcomers and refugees settle in Manitoba. People he helps house stay in transitional housing for an average of 35 days, he said. 

Because they don't have a permanent residence, those newcomers are left in limbo during that period, unsure of what might happen if they need medical care before they secure permanent housing, he said.

"That's one of the biggest challenges we have," said Ntambwe.

It's unclear when the changes took effect, but some newcomers say they first noticed the new regulations as early as January of this year.

A spokesperson for the health department declined an interview request, but said in an emailed statement the new requirement was motivated by changes in recent years to documents issued by Immigration, Refugees and Citizenship Canada.

"As such, to ensure compliance with the eligibility requirements of The Health Services Insurance Act, documentation demonstrating residency is required," the spokesperson said.

That legislation says health insurance is reserved for Manitoba residents, which it defines as a person who is legally entitled to be in Canada, makes their home in Manitoba and is physically present in the province for at least six months in a calendar year.

The spokesperson would not clarify when the province noticed these changes to federal immigration documents, or what particular documents factored into its decision to change the requirements.

When asked about the issue during question period at the Manitoba Legislature Thursday, Health Minister Cameron Friesen also blamed unspecified changes at a federal level for the changes to Manitoba's health-card system.

He said the province is working with the federal government to find solutions.

"This is a complex issue," said Friesen. "Our officials are engaged to find solutions to issues that are arising. I can tell you that we've even arbitrated some of these as recently as this week. But the issue is pertaining to federal treatment of the rules, which have changed recently."

The federal immigration department did not immediately respond to a request for comment from CBC News.

'What if something happens?'

It's a situation leaving people like Louisa Edema, who arrived in Winnipeg from Nigeria at the beginning of November, living in fear of what will happen if someone in her family gets sick or injured.

Edema went to the health department's insured benefits office on Carlton Street four times before her application for a health card was accepted last week. Now, she said she still has to wait four to six weeks before it arrives in the mail. (The provincial spokesperson said the average wait time for coverage is around three weeks.)

Edema said she's worried about her daughters, one-year-old Ara and three-year-old Hephzibah.

"What if something happens?" she said, looking down at Ara in her stroller at one of their visits to the Carlton Street office. "Without the health card, I cannot access the health system, which is unfair."

Accueil ​​​​francophone's Ntambwe said some newcomers he works with have gotten expensive hospital bills after emergency room visits because they don't have health cards to present when they arrived. 

When he spoke to CBC News in late November, he said two more bills, for $1,077 each, had just come across his desk.

Ntambwe said so far, the province has covered all his clients' medical bills. But he said he was told that decision is up to the province, and hasn't gotten clarification on the criteria for accepting or rejecting a claim.

"So in case they refuse to pay, there's no clarity," he said. "It puts us in a very challenging situation."

The provincial spokesperson said coverage can be backdated if a person incurs medical costs before they receive a health card they've applied for, but would not specify whether these costs will be covered in all cases.

'Delaying is denying'

Refugee co-ordinator Seid Oumer Ahmed said he's been meeting with health department officials since he first noticed the new requirement in March.

He wants to know exactly why the change was made, and whether different paperwork that newcomers are likely to have might be accepted — such as an unnotarized letter from a resettlement assistance program provider, sponsorship agreement holder or settlement service provider.

He said he's still waiting for answers — and the uncertainty has led some newcomers to avoid seeking medical treatment out of fear they'll get a bill they can't pay, he said.

"A lot of people are not comfortable just going to the hospitals or to walk-in clinics, because they don't know whether they're reimbursed or not," said Ahmed, a refugee response co-ordinator at the Manitoba Association of Newcomer Serving Organizations.

"And some, they don't have even [the] means to pay out of their pocket."

The consequences of living in Manitoba without a health card go beyond the walls of a hospital, Ahmed said. Children can't be registered for school without one, and they also can't get recommended immunizations, which puts them and others at risk of contracting preventable illnesses, he said. 

And because many charitable organizations — like Winnipeg Harvest and the Christmas Cheer Board — require a Manitoba health card for identification, people aren't able to access these services as they wait for their application to be processed, Ahmed said.

"It has a lot of ripple effects. I don't think they realized all these consequences," he said. 

As of Thursday afternoon, the health department's website and health-card registration form still make no mention of the new requirement. The provincial spokesperson said the health department is working on updates to its website and clarification of its processes, based on consultations with newcomer groups, including the one Ahmed works for.

Ahmed said he and representatives from other newcomer groups have met with the province twice since June to come up with a solution, with another meeting scheduled for later this month — and he's tired of waiting for something to change.

"Delaying is denying health coverage, in my perspective," he said. "An individual could die just because of this, because of the delay."