First Nations Health Benefits Program: Clients Share Frustrations

Joy SpearChief-Morris is the recipient of the 2025 CJF-CBC Indigenous Journalism Fellowship, established to encourage Indigenous voices and better understanding of Indigenous issues in Canada's major media and community outlets. When it comes to paying for her mother’s medical supplies, Patricia McCartney has had two options: months of paperwork through the federal Non-Insured Health Benefits (NIHB) program or giving up and paying out of pocket. McCartney, a member of Six Nations of the Grand River in southern Ontario, has been her mother’s caregiver for over 10 years. Her mother is eligible for benefits under NIHB, which covers things like vision and dental care, counselling, prescriptions, travel for medical services and medical supplies and equipment for First Nations people and Inuit. But McCartney said trying to get coverage for her mother’s medical supplies — from adult diapers and bed pads to foyer catheters and dressing aids — has been filled with barriers, impacting her mother’s overall quality of life. “My mom, as a residential school survivor, like I really feel like she's been through enough now. It's really frustrating that even now the government still continues to put up barriers in place so that we have substandard care,” she said. According to Indigenous Services Canada, as of March 2025, over 983,000 First Nations and Inuit clients were eligible for the program. The federal government has spent an average of $1.87 billion per year on the NIHB program over the last five years, according to Canada’s public accounts. McCartney said she tried for a period of six to eight months to get her mother’s incontinence supplies covered by NIHB. “The amount of paperwork that was required to be completed by both the pharmacy and the prescriber, in this case her physician, was so daunting,” McCartney said. “And by the time that we actually received a claim number and got all the required information into them, that claim number was then expired and you had to start the process all over again.” McCartney, who is a registered pharmacy technician in Toronto, said the work it takes to navigate the NIHB program amounts to a full-time job. “There's so many barriers in place that really prevents us from being able to utilize and access the services that are supposedly available,” she said. Executive director of Indigenous Pharmacy Professionals of Canada, Amy Lamb said pharmacists are often placed in ethical dilemmas by NIHB on delivering care to First Nations and Inuit clients. “The fact that the program itself comes with a pharmacist essentially being the bearer of bad news most of the time, means that we are consistently eroding that feeling of trust and relationships,” said Lamb, who is a member of Métis Nation-Saskatchewan. “It's consistently reinforcing, again, that we are still participants in structural and policy based harms.” Lamb said pharmacies receive low reimbursement rates from NIHB for filling prescriptions and are not compensated for the time taken to do the paperwork involved. As a result, Lamb said some pharmacies are refusing to bill to NIHB at all. Lamb said one of the big challenges with NIHB is its position as the payer of last resort, meaning clients who have benefits from provincial/territorial or private insurance must first use those. Lamb said this creates two problems: it can cause administrative delays when delivering care and it leads to the program becoming underfunded. “You are asking other payers to pay for the drugs first. So it is not an accurate representation of actually what the drugs cost,” she said. David McLaren, president of First Nations Health Managers Association, said the program’s priority to be cost-effective means many clients miss out on newer drugs or technologies their doctor could prescribe to them. More and more clients who pay up front say they are not getting enough reimbursed by the program because “they are not following the rates of other insurances,” McLaren said. “We're about two years behind in the rates.” McLaren said the program needs to be more fair, offering the same level of care available to non-Indigenous people. “Our clients are more vulnerable than most, so I don't think we should have to jump through hoops more than the regular joe blow,” he said. In 2022, members of Parliament presented a report which listed 18 recommendations to fix issues with the program, including government recognition of traditional healers, improving medical transportation criteria, and modernizing the approvals process to decrease delays. The report and its resolutions were the result of a study conducted by the Standing Committee on Indigenous and Northern Affairs, with testimonies from various healthcare experts, community leaders and individuals. CBC Indigenous sent a series of questions about the NIHB program to Indigenous Services Canada. The federal government did not answer whether there has been action on these recommendations. In response to criticisms that the program faces a heavy administrative burden and delays, spokesperson for Indigenous Services Canada Eric Head said the majority of claims submitted to the program do not require prior approval, and “the number of providers enrolled with the NIHB program increases every year in each benefit area.” Claims can be submitted to NIHB electronically (through the Express Scripts Canada NIHB portal), which Head said are “adjudicated in real time,” with payments made every two weeks. Head said claims received by fax, or mail or requiring co-ordination of benefits or third-party payment need to be entered into NIHB’s claim processing system manually, which takes three business days. Express Scripts Canada, Head said, is “currently meeting their service standard and there is no backlog of claims.” Head said NIHB works with Express Scripts to “maintain up-to-date product pricing consistent with provincial and territorial pricing. NIHB will consider covering a higher cost if the request is supported by an invoice from the pharmacy.” Caroline Lidstone-Jones, CEO of the Indigenous Primary Healthcare Council, said submitting claims electronically is not an option for many people because of lack of internet access, computer literacy, or the ability to pay up front. A report by the Assembly of First Nations in 2023 found 466 First Nations communities did not have high-speed internet. “I think of elders quite frequently,” Lidstone-Jones said. “In our remote communities, we still struggle with just accessibility of stable internet and connectivity there.” The AFN has been working alongside the federal government since 2015 to conduct a multi-year joint review to help improve the program. In a statement, AFN National Chief Cindy Woodhouse Nepinak said the NIHB program “must be urgently modernized.” “It is time for NIHB to evolve from a bureaucratic, exclusionary program into a rights-based, culturally safe system that truly serves First Nations. Anything less continues to put our people at risk and falls short of reconciliation in action,” Woodhouse Nepinak said. Long delays leading to decreased quality of life After waiting months for approved coverage, McCartney said she ended up purchasing the supplies her mother’s doctor prescribed out of pocket, which she said can be about $200 a month on adult diapers alone. “Incontinence supplies and such are not, they're not cheap and you're not just using one a month. It's a frequent everyday thing, and so it's just really frustrating,” she said. McCartney said the money she’s spending on medical supplies for her mother could be spent on personal support workers or nursing care. McCartney said she has sometimes had to skip a month when buying her mother’s incontinence supplies because she can’t afford it. This has led to her mother getting more infections and impacting her quality of life. “ I feel like she's even losing that because she's not being seen as a person with a condition,” McCartney said. “She's seen as a case number.”