IRCC has updated its internal medical inadmissibility instructions as of January 2, 2026, to apply a new excessive demand cost threshold of $144,390 over 5 years (or $28,878 per year) when assessing immigration applicants’ health conditions. This change directly affects how officers decide whether an applicant’s expected use of publicly funded health and social services is considered an “excessive demand.”
What exactly changed for 2026?
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The financial ceiling IRCC uses to define “excessive demand” has been increased from the 2025 level of $135,810 over 5 years ($27,162 per year) to $144,390 over 5 years ($28,878 per year) for 2026.
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IRCC’s program delivery instructions and medical refusal guidance have been revised so medical officers now assess new files against this higher 2026 threshold when calculating projected costs of health and social services.
How IRCC calculates excessive demand
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The “excessive demand cost threshold” is set at three times the average per‑person public spending on specified health and social services in Canada, based on national expenditure data and updated annually.
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When an applicant has a health condition, IRCC projects the cost of medically necessary services (doctor visits, hospital care, certain drugs, medically related social services, etc.) over at least 5 years and compares this total to the current threshold.
Who can be medically inadmissible
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Medical inadmissibility can arise for three main reasons: danger to public health (for example, untreated active TB), danger to public safety (for example, risk of sudden incapacity or violent behaviour), or excessive demand on health or social services.
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These rules apply to most people applying to visit, study, work, or immigrate permanently, including many economic‑class and some family‑class applicants.
Who is exempt from excessive demand rules
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Refugees, protected persons and their dependants are exempt from medical inadmissibility on excessive demand grounds, even if their projected costs exceed the threshold.
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Certain family‑sponsorship cases, such as sponsored spouses, common‑law partners and dependent children, are also exempt from the excessive demand cost test, though they can still be refused for public health or safety risks.
Procedural fairness letters and mitigation plans
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If IRCC believes an applicant may be medically inadmissible, the officer issues a procedural fairness letter explaining the diagnosis, projected services, cost calculations and the potential finding of inadmissibility, and gives the applicant 90 days to respond or request an extension.
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In excessive‑demand cases, officers may invite a mitigation plan, where the applicant shows updated medical evidence, lower‑cost treatment options, private coverage, or realistic measures that keep public costs below the threshold so the application can still be approved.
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