Consumers say it’s ‘frustrating’ to deal with federal health benefits program for First Nations and Inuit

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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When it came to paying for her mother’s medical supplies, Patricia McCartney had two options: wade through months of paperwork or give up and pay out of pocket through the federal Non-Insured Health Benefits (NIHB) program.

McCartney, a member of the Six Nations of the Grand River in southern Ontario, has been her mother’s caregiver for more than 10 years.

His mother is eligible for benefits under the NIHB, which include things like vision and dental care, counseling, 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 foal catheters and dressing aids — has been fraught with hurdles, impacting her mother’s overall quality of life.

“My mom, as a residential school survivor, I really feel like she’s been through a lot now. It is really disappointing that the government is still putting barriers in place so that we can get substandard care,” she said.

According to Indigenous Services Canada, as of March 2025, more than 983,000 First Nations and Inuit clients were eligible for the program. According to Canada’s public accounts, the federal government has spent an average of $1.87 billion per year on the NIHB program over the past five years.

McCartney said she tried over a period of six to eight months to get her mother’s incontinence supplies covered by the NIHB.

“The amount of paperwork that both the pharmacy and the prescriber, in this case her physician, had to complete was very onerous,” McCartney said.

“And by the time we actually got the claim number and got all the necessary information in there, that claim number had expired and you had to start the process all over again.”

McCartney, who is a registered pharmacy technician in Toronto, said the work required to navigate the NIHB program is equivalent to a full-time job.

“There are a lot of barriers out there that actually prevent us from being able to use and access the services that are supposedly available,” he said.

Amy Lamb, executive director of Indigenous Pharmacy Professionals of Canada, said pharmacists are often placed in ethical dilemmas by the NIHB when providing care to First Nations and Inuit clients.

“The fact that the program itself comes with a pharmacist who is essentially the bearer of bad news most of the time means that we are constantly eroding that sense of trust and relationships,” said Lamb, a member of the Métis Nation-Saskatchewan.

“This again continues to reinforce that we are still complicit in structural and policy-based harms.”

Lamb said pharmacies receive lower reimbursement rates from the NIHB for filling prescriptions and are not compensated for the time spent processing the paperwork involved.

As a result, Lamb said some pharmacies are refusing to bill NIHB at all.

Lamb said one of the big challenges with the NIHB is its status as a payer of last resort, meaning customers who benefit from provincial/territorial or private insurance have to access them first.

Lamb said this creates two problems: It can cause administrative delays when providing care and it makes the program inadequate.

“You’re asking other payers to pay for the drugs first. So it’s really not an accurate representation of the cost of the drugs,” she said.

David MacLaren, president of the First Nations Health Managers Association, said the program’s priority over being cost-effective means many clients miss out on new drugs or technologies that their doctors might prescribe them.

More and more customers who pay upfront say they aren’t getting adequately reimbursed by the program because “they’re not keeping up with other insurance’s rates,” MacLaren said.

“We’re about two years behind in rates.”

MacLaren said the program needed to be more fair, with the same level of care available to non-Indigenous people.

“Our customers are more vulnerable than other people, so I don’t think we should have to jump through any more hoops than a regular Joe Blow,” he said.

In 2022, members of parliament tabled a report that listed 18 recommendations to fix the program’s issues, including government recognition of traditional healers, improving medical transportation norms, and modernizing the approval process to reduce delays.

The report and its resolutions were the result of a study conducted by the Standing Committee on Indigenous and Northern Affairs with input from various health care experts, community leaders and individuals.

CBC Indigenous sent a series of questions to Indigenous Services Canada about the NIHB program. The federal government did not respond to whether action had been taken on these recommendations.

In response to criticisms that the program faces heavy administrative burdens and delays, Indigenous Services Canada spokesperson Eric Head said that most claims submitted to the program do not require prior approval, and “the number of providers enrolled with the NIHB program in each benefit area increases every year.”

Claims can be submitted to NIHB electronically (via the Express Scripts Canada NIHB portal), which the chief said “decisions are made in real time”, with payments being made every two weeks.

Claims received by fax or mail or requiring coordination of benefits or third-party payment need to be manually entered into NIHB’s claims processing system, which takes three business days, Head said.

Express Scripts Canada, Head said, “is currently meeting its service standards and has no backlog of claims.”

The chief said NIHB “works with Express Scripts to maintain updated product pricing consistent with provincial and territorial pricing. NIHB will consider covering higher costs if the request is supported by an invoice from the pharmacy.”

Caroline Lidstone-Jones, CEO of the Indigenous Primary Healthcare Council, said submitting a claim electronically is not an option for many people due to a lack of internet access, computer literacy or the ability to pay in advance.

A report by the Assembly of First Nations in 2023 found that 466 First Nations communities did not have high-speed internet.

“I often think about the elders,” Lidstone-Jones said.

“In our remote communities, we are still struggling with stable internet and access to connectivity there.”

AFN has been working with the federal government since 2015 to conduct a multi-year joint review to help improve the program.

In a statement, AFN national head Cindy Woodhouse Nepinak said the NIHB program “must be urgently modernized.”

Woodhouse Nepinak said, “It is now time for the NIHB to evolve from a bureaucratic, exclusionary program to a rights-based, culturally safe system that truly serves First Nations. Anything less than that puts our people at risk and falls short of reconciliation in action.”

Long delays reduce quality of life

After waiting months for approved coverage, McCartney said she began purchasing her mother’s doctor-prescribed supplies out of her own pocket, which she said could amount to about $200 per month on adult diapers alone.

“There aren’t incontinence supplies and things like that, they’re not cheap and you’re not just using one a month. It’s often an everyday thing, and so it’s really frustrating,” she said.

McCartney said the money she is spending on medical supplies for her mother could be spent on personal support workers or nursing care.

McCartney said she sometimes had to skip a month buying incontinence supplies for her mother because she could not afford it. This caused his mother to develop more infections and affect her quality of life.

“I think she’s losing it too because she’s not seen as a person with a condition,” McCartney said.

“He is viewed as case number.”