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Canada: Care providers say Ottawa takes far too long to pay for health services for First Nations kids

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Some health care providers say bureaucratic red tape at the federal level is holding up vital therapies for First Nations children, causing some kids to experience further developmental delays and leaving their businesses in financial distress.

Several speech-language pathologists interviewed by CBC News said their clients are waiting six to 12 months for funding approvals from Indigenous Services Canada (ISC) to begin sessions under the Jordan's Principle policy.

That policy states that when federal and provincial governments disagree over which government is responsible for providing services to First Nations children, they must help the child first and argue over the bills later.

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The speech-language pathologists told CBC News it can take even longer for the department to pay for their services. Some say they have been waiting for payment for over a year.

They said that most other third-party payers approve funding in 10 to 30 business days and pay out within 30 days.

Rachel Pessah, owner of Bright Spot Therapy Services in Timmins, Ont., suspended services for 22 First Nations children this month. She said she hasn't been paid by the department for the sessions and needs to pay her employees.

"It's been an incredibly stressful year so I've had to consider laying off staff," Pessah said. "I've had to consider actually closing my business because of the delays."

Gail Tippeneskum's six-year-old daughter Olivia — one of Pessah's clients — can't access speech therapy sessions until ISC pays Bright Spot Therapy Services.

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"I am concerned about my daughter now ... what if she doesn't learn or doesn't talk as well now because she's not having that one-on-one time with the workers?" Tippeneskum said.

Service providers say the delays are pushing many independent operations to the brink of bankruptcy, while causing children to face further developmental challenges and fall behind in school.

"I love the program and what it was designed to do … But I feel like it's really failing their primary objective of not having children fall through the cracks," Pessah said.

"The longer kids wait for these services, the wider the gap is between where they're at and where they need to be for their age."

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Jordan's Principle is named after Jordan River Anderson of the Norway House Cree, who died in 2005 at the age of five in the midst of a two-year disagreement between Manitoba and Ottawa over who would pay for his care.

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In 2017, the Canadian Human Rights Tribunal ordered Canada to process requests to First Nations children within a 12 to 48 hour timeframe and stop imposing service delays before funding is provided.

But service providers and families say that policy is failing.

Crystal Jacobs, a member of Moose Cree First Nation, is trying to access speech language therapy for her 6-year-old daughter Mercy — who is non-verbal, has a rare, undiagnosed genetic disorder and requires around-the-clock care.

Jacobs said she received help from the federal government in the past to cover the cost of a special-needs stroller and a temporary stay in a hotel.

But over the past year, Jacob said, she's had to wait months to hear back from Indigenous Services that her requests had been denied.

"I was told ... a couple of times, they've helped me out in the past and I should just be thankful for that," Jacobs said.

"I just feel like my daughter is being discriminated against for being disabled."


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Indigenous Services Minister Patty Hajdu said Thursday she would commit to a review of the federal government's application of Jordan's Principle.

"If there are delays in children getting access to service, I absolutely want to know about that and I absolutely will commit to reviewing why that's the case," Hajdu said. "Providers need to be paid in a timely fashion."

In a statement issued to CBC News, the department said it processed 81 per cent of all invoices within 15 business days between April and September 2021.

"Our goal is to pay invoices within 15 business days of receipt," said Megan MacLean, ISC spokesperson.

"If a service provider advises ISC that they have experienced a delay or overpayment, ISC works with them to resolve the payment issue."

Calls to eliminate the red tape

Timmins-James Bay NDP MP Charlie Angus said his office spent several months trying to find a solution for unpaid speech-language pathologists such as Pessah.

"When a service is needed by a child and a family, it damn well better be there," Angus said.

"For a government to delay and refuse to pay so that children are being denied services — they're playing with the lives and futures of this generation of children."

Charlie Angus sitting at a table: Timmins-James Bay New Democrat MP Charlie Angus said he wants to know why clinicians are experiencing long delays in receiving approval and payment for Jordan's Principle cases. © Parliament of Canada Timmins-James Bay New Democrat MP Charlie Angus said he wants to know why clinicians are experiencing long delays in receiving approval and payment for Jordan's Principle cases.

Cindy Blackstock, executive director of the First Nations Child and Family Caring Society, said she's disappointed by the delays, but not surprised.

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"It's really sad for me because I know that means a child has gone without that service for up to a year, and it's inexcusable," she said.

Blackstock said she's heard of similar problems from other clinicians. She said she raised the issue with the Canadian Human Rights Tribunal last September.

Now, she said, it's past time for the federal government to act.

"We want to see them kind of unwind the red tape around Jordan's Principle," Blackstock said.

"They need to go back to basics. What we need is a professional letter and the consent of the guardian. That should be enough for processing a request. They also need to up their staff, if staffing is an issue."

Cindy Blackstock, executive director of the First Nation Child and Family Caring Society, is calling on the federal government to 'unwind the red tape' around Jordan's Principle. © CBC News Cindy Blackstock, executive director of the First Nation Child and Family Caring Society, is calling on the federal government to 'unwind the red tape' around Jordan's Principle.

Carla Willock, clinical director and owner of the Victoria Speech and Language Centre in Victoria, B.C., said the federal government's interpretation of Jordan's Principle requires a family to submit more documents than any of her other clients, and leaves them in limbo for months.

"It's almost as if they are trying to create a barrier for families to access that funding," Willock said.

Businesses refusing to work with Jordan's Principle

Clinicians told CBC News that even after funding is approved, they sometimes struggle to adapt the programming to meet a child's evolving needs.

The federal government pays service providers only for the services it approves. Clinicians say that if they're only being paid to deliver one session per week to a child, and that child suddenly needs a second session, it can be very hard to convince the department to pay more.

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They also say the department directs them to charge the families themselves for missed sessions — a heavy financial burden for many households.

They're calling on the department to loosen the rules to allow them to adapt programming as they see fit.

"A lot of businesses are either refusing to work with JP (Jordan's Principle) because we don't get paid or are looking at the possibility of bankruptcy," said Alana MacIntyre, a speech-language pathologist and owner of Spark Rehabilitation in Sault Ste. Marie, Ont.

MacIntryre said she would like federal representatives to sit down with providers to come up a process that doesn't penalize children who need help.

"When the processes work, they work really well for the kids," MacIntyre said.

"But when they don't work, it really impacts the children and the providers because fiscally we can't manage it."

The problem is also affecting waiting lists for other children.

Chelsey Chichak, a registered speech-language pathologist based in Langley, B.C., said she often has to hold spots for children seeking therapy under Jordan's Principle while she waits for the federal government to make a decision.

"My greatest fear is that we will have somebody come to us and say, 'I would like your services, but I can only use Jordan's Principle,' and us having to say, 'I'm sorry. We cannot accept that program because of the delays in applications and reimbursement because it is impacting our businesses across Canada,'" she said.

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