Dental care benefits for First Nations and Inuit lag behind Canadian standards, dentists say

Joey Spearchief-Morris is its recipient 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.

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Janine Manning needed a root canal.

While a fairly common procedure, Manning’s dentist recommended he see a specialist due to the specific injury to his tooth.

Manning is a member of the Chippewas of the Nawash Unceded First Nation in southern Ontario, and uses the federal Non-Insured Health Benefits program (NIHB) that covers things like dental care for First Nations people and Inuit.

But when it came to paying the bill, Manning was told the federal program would cover only $159 of the approximately $2,200 procedure.

Manning was able to get about $1,400 from her private insurance, but she still had to pay about $600 out of pocket.

“It feels like it’s such a frustrating system that doesn’t really support Indigenous people who are just trying to access dental services,” Manning said.

The NIHB program covers things that are not insured by Medicare, such as vision and dental care, mental health counseling, prescriptions, travel for medical services, and medical supplies and equipment. It is positioned as the payer of last resort, meaning customers who receive benefits from provincial/territorial or private insurance must access them first.

Dentists and users of the program, like Manning, say the program is not in line with modern costs and procedures. Dentists are dropping out of the program due to the administrative burden, creating access issues for First Nations and Inuit clients who are not able to pay upfront.

A program stuck in the 1970s

According to the 2023-2024 annual review of the NIHB program, approximately 344,898 customers accessed dental benefits. The dental benefits program had the third largest expenditure in that fiscal year, with more than $379 million spent.

But according to Caroline Lidstone-Jones, chief executive of the Indigenous Primary Health Care Council, barriers to access to dental care are the number one complaint when it comes to the NIHB.

“Many NIHB eligible First Nations people face long wait times, partial approval, providers who don’t take NIHB, and major travel barriers,” she said.

“These challenges often turn treatable dental problems into preventable tooth loss.”

Lidstone-Jones, a member of Batchewana First Nation, recently had to have a root canal herself.

He said it took four rounds of paperwork over six months between the NIHB and his dentist to deny his preclearance for the procedure.

Her private insurance paid for a crown on her tooth and she ultimately had to pay about $1,000 out of pocket, while the NIHB paid zero.

“Because it’s so expensive, there are a lot of people who aren’t able to participate in that level of care,” Lidstone-Jones said.

Manning said she submitted an appeal for coverage of her root canal, but after waiting eight weeks for a response, it was rejected.

Dr. Aaron Bury, chief executive of the Canadian Dental Association, said the NIHB program needs to move forward in the 21st century.

Barrie, who has been a dentist in Ontario for nearly 40 years, said more modern dental procedures may require “long, laborious processes” to be approved by the NIHB, “if it’s approved at all.”

“Many of the concepts present in the NIHB program actually date back to the 1970s and 1980s,” Bury said.

“Certainly given the issues we hear about, the dentists we deal with in the CDA are providing a high level of care.”

Bury said a big issue with NIHB is the preauthorization or pre-authorization process when it comes to certain dental procedures, which he said is not only lengthy but creates uncertainty.

“Making so much effort and still getting a ‘no’ answer is usually a frustration for the patient, but it’s also a frustration for the dentist and the dental office,” he said.

Bury said that issues like this and other negative experiences with NIHB, such as delayed payments, are why many dentists “don’t view this program very positively” and have opted out of it.

As a result, finding dental providers who bill NIHB is an ongoing issue for clients.

David MacLaren, president of the First Nations Health Managers Association, said some members of his community in Kebowek First Nation in Quebec have to travel long distances to find a dentist, which the bill would direct the NIHB to. But the NIHB, which covers travel for medical procedures, does not always pay for the visit if there are other dentists nearby.

“We call service providers and say, do you fully accept the NIHB program? Are you going to charge our customers?” MacLaren said.

“I don’t think people who are on Sun Life should have to do that.”

resolution but no solution

A parliamentary report conducted by the Standing Committee on Indigenous and Northern Affairs on the NIHB in 2022 noted administrative issues with the dentistry program – such as the need to modernize approval processes – and the impact on the overall oral health of First Nations and Inuit.

The report issued 18 recommendations, but the federal government did not respond when asked by CBC Indigenous whether the recommendations had been acted upon.

Indigenous Services spokesperson Eric Head said in a statement to CBC Indigenous that the NIHB’s approach to setting maximum dental fees is “dynamic.” Fees are reviewed on an annual basis and adjusted for “various factors, including inflationary pressures”.

Dental associations and providers can establish or adjust their own fee rates as part of their business models, Head said.

“The number of providers enrolled with the NIHB program in every benefit area is growing every year,” Head said, and sees a 10 percent increase in enrollment in dental between 2021 and 2025.

First Nations and Inuit who use the NIHB program are also eligible for the new Canadian Dental Care Plan (CDCP) if they meet its income requirements.

But while NIHB is generally considered the payer of last resort with other public or private insurance, customers must bill NIHB before attempting to access CDCP.

“There will be no service stacking or duplication of coverage between the CDCP and NIHB programs,” Head said.

“It is expected that the NIHB program will cover all eligible services with no gap between the two schemes.”

From red tape to win-win-win

Dr. Scott Leckie, who has been a dentist in Winnipeg for 35 years and is a supporter of the program, said sometimes offices have to devote a full-time clerk just to processing NIHB paperwork.

CDCP and NIHB use similar fee structures, which Bury said are “somewhere much lower or significantly lower” than the fee structures established by each provincial dental association.

Both dentists agreed that matching the fee structures of dental associations with those of most private insurance companies would be an improvement.

Leckey said there is a need to conduct a comprehensive review of the administration of the NIHB dental program to ensure that its preclearance requirements are consistent with those of other public and private dental programs.

Bury said that for the NIHB to be successful in its work, it needs to create a “win-win-win” program for patients, providers, and the government, which it is no longer able to achieve.

Bury said many First Nations clients require more care than the average Canadian when it comes to dentistry and the NIHB is not designed to meet that.

“It is set primarily for cost control, so in that respect, the government meets its objectives,” he said.

“But once you’ve accomplished that objective, does it work for the dentist in terms of being able to provide the care that they want to provide? Not necessarily. Does it work for the patient? No, because they don’t get the care,” he said.

Lidstone-Jones said the “red tape” associated with the NIHB program makes it particularly difficult for the elderly and children to access preventative dental care, leading to greater impacts on quality of life, self-esteem and mental health.

“Sometimes people don’t understand that these are real, real-life people who are trying to get care through this system.”