They came to Canada to escape political instability in Iran. Now, Quebec is denying them health coverage
Open work permit holders not eligible for provincial public insurance
When a metal ladder fell and hit Somayeh Ahmadiseddigh in the head at work earlier this month, she was dizzy, nauseous and had trouble standing up.
A colleague drove her to the hospital in Quebec City, but when she arrived, she was told it would cost $1,200 to see a doctor because she did not have a provincial health-care card.
Although she had private insurance, the hospital receptionist said she'd have to pay upfront and claim the cost with her insurance company later.
"I didn't know if I would get my money back," said Ahmadiseddigh.
She and her brother tried a few other hospitals, but got the same response. She returned home not knowing the extent of her injury.
"My brother stayed up all night beside my bed in fear that something would happen to me," said Ahmadiseddigh.
The following day, she paid $250 to be seen at a walk-in clinic, which diagnosed her with a minor concussion.
The whole experience left her feeling angry and vulnerable.
Due to the political instability in Iran, Ahmadiseddigh moved to Quebec City with her daughter, Céline, last year.
"I couldn't stay because I didn't want to wear a hijab and there were several occasions that I had an incident with the morality police and I didn't feel safe and my family was worried," said Ahmadiseddigh.
She obtained an open work permit, which is valid for three years. But, in Quebec, this group of workers is not eligible for public health insurance coverage, known as RAMQ.
"It's discrimination in my opinion," said Ahmadiseddigh. "I think it's not humane."
Special measures for Iranian nationals
In 2022, an Iranian woman named Mahsa Amini was arrested for failing to properly wear a hijab. She later died in police custody.
Protests followed and there was a brutal crackdown by the Iranian regime.
In response, the Canadian government made it easier for Iranians to stay in the country if they were already here to study, work or spend time with family.
The government also allowed Iranians, like Ahmadiseddigh, who came to Canada on a visitor visa, to apply for an open work permit, which could help them earn permanent residency.
This temporary immigration policy was introduced in 2023 and is in place until the end of February 2025.
But it is up to each province to determine eligibility criteria for public health and drug insurance plans.
"The harmonization between what's done in the province of Quebec and what's done at the federal level in terms of immigration isn't always perfect," said Nicolas Simard-Lafontaine, an immigration lawyer and vice-president of the Canadian Immigration Lawyers Association.
Quebec is more accommodating if immigration is driven by economic needs and benefits Quebec businesses, but isn't as eager to have temporary residents it didn't specifically ask for, said Simard-Lafontaine.
"Quebec has a tougher stance on immigration," he pointed out.
But there are exceptions.
When it comes to open work permits, both post-graduate open work permits and the dependents of international students in Quebec are eligible for RAMQ.
The province also extended health-care coverage late last year for Ukrainian refugees who also have open work permits, said Simard-Lafontaine.
'Maybe I chose the wrong place to immigrate'
A RAMQ spokesperson told CBC the Ukrainian situation is unique.
But Sahar Soltani doesn't understand why Iranian nationals are being treated differently..
At the end of 2024, nearly 11,000 Iranians had open work permits in Quebec, according to statistics from Immigration, Refugees and Citizenship Canada (IRCC).
Soltani moved to Quebec City with her husband and four-year-old daughter last year. She works and pays taxes in Quebec and takes French classes part time.
A few months ago, she qualified for supplemental health coverage through her job at Dollarama, but can't take advantage of it because she has to have RAMQ to access it.
Friends who settled in other provinces have not had the same kind of challenges.
"I feel like I am falling behind," said Soltani, who is constantly worried about getting sick or seriously injured.
She looked into private insurance, but it is too expensive and only intended for emergencies.
She and her husband were told to change their work permit to a closed permit or apply for permanent residency, but that is not an easy option for newcomers and it can take years to get permanent residency.
The hardship comes at a time when Quebec is re-assessing its immigration policy. Last year, it froze some of the immigration paths for people to become permanent residents. The freeze targeted skilled workers and foreign students.
Premier François Legault, who has long maintained that cultural practices of immigrants, particularly from Muslim countries, pose a threat to Quebec's values, also called on Ottawa to redistribute asylum seekers in the province elsewhere, including people who have already settled here.
"Maybe I chose the wrong place to immigrate," said Soltani.
After CBC Montreal placed a message on an Iranian chat group, dozens of Iranians reached out to share similar frustrations, including people who have delayed starting a family because of the lack of health support for pregnancy and childbirth.
Another man with blood cancer said he'd had coverage under a post-graduate work permit, but it was set to expire, leaving him just an open work permit and no access to RAMQ. He had no idea how he would get the medical follow-up and scans he needs to monitor his condition.
Easier to qualify in other provinces
In Ontario, temporary residents may qualify for health-care coverage if they have a valid work permit – either open or closed – and work full-time for an Ontario employer for at least six consecutive months.
Similar rules apply in British Columbia
Although there are a few exceptions, Quebec has long denied coverage to people who have an open work permit, said Y. Y. Chen, an associate professor at the University of Ottawa's faculty of law and expert on the intersection of international migration and health.
"This is not a new issue," said Chen. "Prior to this particular community, there were plenty of other communities who experienced the same thing."
Chen suspects Quebec may be worried the worker isn't going to stay in the province or work for a company in Quebec. They may also be concerned about so-called medical tourism.
Unlike most other work permits, an open work permit does not list the name or location of a specific employer.
"It takes a lot of effort to move from one country to another," said Chen. "To think that people are willing to go through all that just to access health care and then they will just move back? I think, at least for a majority of people, that seems unlikely."
He empathizes with workers who are not able to access health care and said it can feel quite exclusionary when they are paying into the system.
"There's a lack of reciprocity, a lack of equality," said Chen. "If these individuals are eventually going to be part of our community, then why not set them up on good footing, allow them to thrive as opposed to putting them in such a precarious situation that they develop poor health."
But Chen said there could be several simple solutions.
The interim federal health program (IFHP) provides limited, temporary health-care coverage for refugees and refugee claimants.
Due to the unstable situation in Iran, the same benefits could be extended to the Iranians, Chen said.
The federal immigration minister also has discretionary authority under this program to provide coverage on a case by case basis, but Chen is unsure how people would apply.
In 2009, Citizenship and Immigration Canada sent out an operational bulletin about the lack of health-care coverage for post-graduate work permit holders in Ontario and Quebec. At the time, both provinces required the name and location of a specific employer.
Ontario relaxed its rules and required the foreign worker be employed full-time by an employer for a minimum of six months.
Quebec also agreed to make RAMQ available to post-graduate work permit holders and asked the federal government to flag it in the remarks section of the work permit.
"Perhaps a similar arrangement could be an acceptable solution for the challenges facing Iranian nationals under the temporary program," said Chen.
Answers not forthcoming
The federal government did not respond to questions about whether the Iranians could be included in the IFHP.
"In Canada, provinces and territories manage health care," said IRCC spokesperson Julie Lafortune in an email.
"As part of the government's efforts to ensure transparency and provide necessary information, we communicate relevant details to people through client outreach and web updates."
RAMQ said the eligibility criteria for health-care coverage is determined by Quebec's Health Ministry.
The ministry did not answer CBC's questions about its policy concerning open work permit holders like these Iranian temporary residents.
Ahmadiseddigh left Iran because she wanted a better life for her family.
She hopes Quebec will reconsider to help make that a reality.
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With files from Aatefeh Padidar