The province is not expected to meet the federal government's April 1 deadline to publicly fund nurse practitioner services, leaving patients paying out of pocket.
The federal government issued a directive in January 2025 requiring provinces to publicly fund medically necessary services provided by nurse practitioners by April 1, 2026. The directive mirrors a change Ontario Health Minister Sylvia Jones spent years lobbying Ottawa to make mandatory.
With less than a week until the deadline, the province has no implementation plan and no public timeline.
“They simply don’t want to act and are comfortable with Ontarians paying for health care using their credit card instead of their OHIP card,” said Dr. Adil Shamji, Ontario’s Liberal health critic and MPP for Don Valley East.
The Ontario Ministry of Health did not respond to a request for comment.
More than 2.5 million Ontarians have no family doctor or nurse practitioner. Private-pay NP clinics have emerged to fill the gap, charging patients directly for care that would be free if delivered by a physician under OHIP.
Michelle Acorn, CEO of the Nurse Practitioners’ Association of Ontario, said the province has not communicated its next steps, even to her organization.
“Without clarity from the province, it’s difficult for nurse practitioners to plan for sustainable care delivery, and for patients to know what their access to care will look like moving forward,” Acorn said.
In Kingston, Maryanne Green has been running GreenNPC, a private-pay NP clinic, since the province turned down her funding application in 2023. Her clinic charges patients $1,800 a year for primary care membership, or $225 a month for urgent care access.
“To be honest, I never expected the Ford government to meet the deadline,” she said.
Green applied again when the province issued a second expression of interest for public funds in September 2025. That call, unlike the open process in 2023, was restricted to invite-only applicants.
Green said she reached out to the Ministry of Health to ask whether GreenNPC would be included.
“I did not receive a response,” she said.
Despite the cost, Green said her clinic has never turned a patient away.
“I’m a health-care professional first. A business owner, second,” she said. “Fees are necessary to continue operations, but I will always prioritize the needs of the patient over expedited billing.”
Shamji said the delay is a reversal of the government’s own stated position. He introduced a private member’s bill in 2024 that would have restricted private billing by nurse practitioners. The Conservatives voted it down.
“My legislation, and now the federal government’s interpretation letter, have proved them wrong,” Shamji said.
He said that this could have been resolved 18 months ago.
Under the Canada Health Act, the federal government can make dollar-for-dollar deductions from provincial health transfers for extra-billing after the deadline passes. Ottawa levied $62.2 million in deductions across six provinces for similar violations in March 2025.
Green said she has no confidence that the current government will act.
“It is obvious, in six years of this Ford government, that this is not the team capable of reforming OHIP,” she said.
Shamji agreed that the window for action is closing.
Acorn said the urgency is clear regardless of what the province decides.
“With growing demand and gaps in access, timely implementation of funding models is critical to improving care for Ontarians,” Acorn said.
The federal enforcement mechanism for NP-specific extra-billing takes effect in April 2027, giving Ontario a window before financial penalties begin, but whether the province uses that time to act remains unclear.
