What is IRPA s.38?

IRPA s.38 declares a foreign national inadmissible on health grounds if their condition:

• (a) Endangers public health (typically active tuberculosis, untreated syphilis, etc.)
• (b) Endangers public safety (typically untreated severe mental illness with violence risk)
• (c) Could reasonably be expected to cause excessive demand on health or social services

Most s.38 findings are under (c) — excessive demand.

Excessive demand threshold

In 2018, IRCC tripled the threshold (from ~CAD 6,655 to ~CAD 19,965 per year), and it has been indexed since. As of 2024, the threshold is approximately CAD 27,162/year in projected health/social services costs over 5-10 years.

Conditions that historically triggered excessive-demand findings:

• Severe intellectual disability requiring publicly-funded special education
• HIV requiring expensive ongoing treatment (less of a barrier after threshold increase)
• Late-stage cancer requiring chemotherapy
• End-stage organ disease requiring transplant or dialysis
• Severe autism spectrum disorder requiring continuous support

Excessive demand exemptions

s.38(2) exempts refugees, protected persons, certain family-class sponsored applicants (spouses, common-law partners, dependent children, parents and grandparents), and certain other classes. Refugees / protected persons are never inadmissible for excessive demand.

What to do if s.38 is alleged

You receive a procedural fairness letter (PFL) before the formal finding. You can respond with:

• An alternative healthcare plan (private insurance, sponsor funding) showing the excessive demand will be mitigated
• Updated medical evidence showing the condition is less severe than the Panel Physician's report indicated
• Detailed cost analysis disputing the IRCC medical officer's projected costs

s.38 PFL responses are time-sensitive and technical. Get representation immediately.