Earlier this year, the federal government released its budget for 2022 (the "2022 Budget").1 Amongst numerous significant expenditures in the 2022 Budget is the provision for a national dental care program for lower-income families (the "Dental Program").
This bulletin starts by offering a brief history of government funding for dental care in Canada and subsequently, provides an overview of what we know now about the Dental Program, and the uncertainties that still exist.
Background
The Dental Program follows the "Supply and Confidence Agreement" entered into by the Liberal Party of Canada (the current minority government at the federal level) and the New Democratic Party ("NDP") in March 2022. Under that agreement, in exchange for the NDP agreeing to support the Liberal government on confidence and budgetary matters, the Liberals committed to prioritizing a number of actions, including the implementation of a national dental care program (a program for which the NDP has been advocating).2
Unlike many physician and hospital services, dental services—other than certain surgical dental procedures performed in hospitals ("Surgical-Dental Services")—are not covered by the Canada Health Act.3 At a high level this means that, unlike most physician and hospital services, the provinces and territories are not required by the Canada Health Act to insure (i.e., pay for) dental services other than Surgical-Dental Services in order to receive their complete share of the Canada Health Transfer (being the primary mechanism by which the federal government provides provinces and territories with funding for health care). Though government dental programs do exist, they are available to a limited number of Canadians. By way of example only, the federal government provides funding for a range of dental services to eligible First Nations people and Inuit through its "Non-Insured Health Benefits Program" or "NIHB".4 At the provincial level, Ontario's Ministry of Health, for example, provides funding for certain dental services rendered to children and youth (under 17 years of age) from low-income families.5
Accordingly, and due to the fact that one-third of Canadians do not have private dental insurance, it is estimated that between seven and nine million Canadians are unable to access adequate dental care on account of the cost.6
2022 Budget
Through the 2022 Budget, the federal government committed to providing funding of $5.3 billion over five years for the Dental Program, starting with $300 million in the 2022-2023 fiscal year and increasing to $1.7 billion in year five, being the 2026-2027 fiscal year.7
While the 2022 Budget provided limited details regarding the implementation of the Dental Program, it did confirm that the program would be restricted to uninsured families with an annual income of less than $90,000, and that families earning below $70,000 annually would not have to make any co-payments.8 Moreover, the 2022 Budget stated that the funding available through the Dental Program would first be available to eligible individuals under the age of 12 during 2022, and would then be expanded in 2023 to include eligible individuals under the age of 18, seniors, and persons living with a disability, with full implementation by 2025.9
Developments Since 2022 Budget
In July, the federal Minister of Health ("Minister") released a "request for information" (the "Dental Program RFI") from the dental industry to support Health Canada's development of the Dental Program. Following the Dental Program RFI, and Health Canada's engagement with provincial and territorial "partners",10 the federal government introduced legislation on September 20, 2022, to address the first stage of the Dental Care Program. If passed, Bill C-31, the Cost of Living Relief Act, No. 2 (Targeted Support for Households) ("Bill C-31"),11 would enact the Dental Benefit Act (the "Act"). Pursuant to the Act, a new "interim" dental benefit plan (the "Dental Benefit") would be established,12 which would remain in effect until a permanent program is implemented (which the government has committed to doing by 202513). As of the date of this bulletin, Bill C-31 is at second reading in the Senate, having passed third and final reading in the House of Commons on October 27, 2022.
Bill C-31 provides that the Dental Benefit will be available in 2022-2023 to families with an "adjusted income" of under $90,000 per year and who do not have access to dental insurance ("Eligible Families"), in respect of children under the age of 12.14 More specifically:
- for the purposes of determining the income of Eligible Families, the term "adjusted income" is used by Bill C-31. Bill C-31 provides that this term generally has the same meaning as it has in section 122.6 of Canada's Income Tax Act;15
- the Dental Benefit will only be available in respect of eligible individuals (during the first period of December 1, 2022 to June 30, 2023 and the second period of July 1, 2023 to June 30, 2024, children under 12) who have received or will receive dental care services (as defined below) during the applicable period and in respect of whom the eligible parent16 is in receipt of a Canada child benefit on that date;17
- the Dental Benefit may be available to persons who are covered by another government program or plan, but only to the extent that the person's dental care services are not (or will not be) fully paid or reimbursed by such program or plan;18 and
- the Dental Benefit will be a direct, up-front, tax-free payment to Eligible Families who make an application for the Benefit, with the amount of such payment over the two years being dependent on the family's income as follows:
|
Adjusted Income of Eligible Family |
Dental Benefit Payable PER YEAR |
| Below $70,000 | $650 for each eligible child |
| Between $70,000 and $79,999 | $390 for each eligible child |
| Between $80,000 and $89,999 | $260 for each eligible child |
The Dental Benefit will be applied for through the Canada Revenue Agency. As part of the application, applicants will need to attest that the person in respect of whom the application is made:
- does not have access to private dental coverage (i.e. coverage for dental care services under a contract of insurance, whether obtained on the basis of employment, purchased privately or otherwise); and
- has received dental care services during the relevant period to which the Dental Benefit applies or, that the applicant intends for such person to receive dental care services during such period.19
As noted above, the Dental Benefit will be paid directly to Eligible Families who apply for same and will not necessarily be paid on a reimbursement basis. While an applicant may apply for the Dental Benefit in respect of past dental care services (such that the Dental Benefit could be used as reimbursement for costs already incurred), an application may also be made in respect of future dental care services. However, in either event, Eligible Families who have received the Dental Benefit will be required to provide documentation (e.g., receipts) evidencing their proper use of the Dental Benefit for dental care services, upon request of the Minister. Bill C-31 confers the Minister with broad authority to require persons to provide any information or document in order for the Minister to: (i) verify compliance with; or (ii) prevent non-compliance with, the provisions of the Act.20
Bill C-31 defines the "dental care services" in respect of which the Benefit may be applied as "[...] services that a dentist, denturist or dental hygienist is lawfully entitled to provide, including oral surgery and diagnostic, preventative, restorative, endodontic, periodontal, prosthodontic and orthodontic services".21 Notably, if an Eligible Family incurs expenses for dental care services that are less than the amount of Dental Benefit that they have received, there does not appear to be any mechanism whereby they are able to return the unused portion of the Benefit. However, persons who knowingly report false or misleading information when applying for the Dental Benefit (which, as noted above, requires an attestation to be made that the person with respect to whom the application for benefits is made has received or will receive dental care services during the time period to which the Benefit applies), or apply for and receive the Dental Benefit knowing that they are ineligible to receive it, could face a fine of up to $5,000.22
In 2023, until the time that the Dental Benefit is fully implemented in 2025, the Dental Benefit will be available in respect of children under the age of 18, seniors, and persons living with a disability.
The CRA's application portal for the Dental Benefit will be available following Royal Assent of Bill C-31, with a target implementation date of December 1, 2022. The Benefit would retroactively cover expenses for dental care services incurred on or after October 1, 2022.23,24
Looking Ahead
Although details of the first phase of the Dental Program have now been released, it remains to be seen how exactly the federal government will develop a comprehensive national long-term dental care program, which they have committed to doing by 2025, and what such program will look like. As noted above, the government has solicited input from industry and other stakeholders via an RFI to support the government's creation of the longer-term dental program, including what role industry can play in the program. However, at the date of this bulletin, the government has not yet released the results of the RFI. The government has also stated that provinces and territories have been engaged in the design and timelines of the full program;25 yet, it currently appears that this will be a stand-alone, federally administered initiative. This is how the NDP, who first conceived of the dental care program, had intended it to be.
We will continue to monitor for any further updates.
Footnotes
1. The 2022 Budget is available here: https://budget.gc.ca/2022/report-rapport/toc-tdm-en.html.
2. See the NDP's "It's time for a national dental plan that covers everyone", online: https://www.ndp.ca/dentacare.
3. https://laws-lois.justice.gc.ca/eng/acts/c-6/page-1.html.
4. See Government of Canada's "Dental benefits for First Nations and Inuit", online: https://www.sac-isc.gc.ca/eng/1574192221735/1574192306943.
5. See Ontario's Ministry of Health's "Healthy Smiles Ontario", online: ontario.ca/healthysmiles. Notably, the Health Smiles Ontario program is not mandatory for dental professionals and it appears that a significant disparity exists in some cases between the amount payable by the program to dental professionals for covered services, on the one hand, and the customary fees for such services, on the other hand.
6. Message from the Minister of Health regarding Request for Information from Industry on Proposed National Dental Care Program, online: https://www.canada.ca/en/health-canada/news/2022/07/message-from-the-minister-of-health-regarding-request-for-information-from-industry-on-proposed-national-dental-care-program.html.
7. See The 2022 Budget, Chapter 6, Section 6.1.
8. The Canadian Dental Association defines a "co-payment" as that portion of a bill for services that is the responsibility of the insured or benefit payable. See: https://www.cda-adc.ca/en/oral_health/talk/copayment.asp. However, despite the fact that the 2022 Budget co-payments being required from families earning between $70,000 and $89,999.99 annually, the concept of co-payments does not appear in Bill C-31.
9. Ibid note 7.
10. Ibid note 6.
11. https://www.parl.ca/DocumentViewer/en/44-1/bill/C-31/third-reading ("Bill C-31").
12. Bill C-31, Part 1, Preamble.
13. See Government of Canada's "Making Dental Care More Affordable: The Canada Dental Benefit", online: https://www.canada.ca/en/department-finance/news/2022/09/making-dental-care-more-affordable-the-canada-dental-benefit.html.
14. Ibid note 13.
15. Bill C-31, Part 1, s. 2(2). More specifically, Bill C-31 provides that the term "adjusted income" has the same meaning as is given to that term by section 122.6 of the Income Tax Act, except that the reference to "at the end of the year" in section 122.6 is to be read as a reference to "on December 1, 2022 in the case of an application made under section 5 or paragraph 7(a) and on July 1, 2023 in the case of an application made under section 6 or paragraph 7(b)". See Section 122.6 of the Income Tax Act: https://laws-lois.justice.gc.ca/eng/acts/i-3.3/page-95.html#h-299563.
16. Bill C-31, Part 1, s. 2(1) provides that the term "eligible parent" has the meaning given to the term "eligible individual" in section 122.6 of the Income Tax Act.
17. Bill C-31, Part 1, ss. 5-6.
18. Bill C-31, Part 1, s. 4(1)(d).
19. Bill C-31, Part 1, s. 10(1).
20. Bill C-31, Part 1, s. 16. Notably, the term "Minister" is defined by the Act to mean "Minister of Health". However, it is unclear whether the authority conferred by section 16 on the "Minister" is intended to refer to the Minister of Health (as the use of the term "Minister" in this case suggests) or the Minister of Revenue (who is referenced in numerous sections in Bill C-31 leading up to this section 16).
21. Bill C-31, Part 1, s. 2(1).
22. Bill C-31, Part 1, s. 23.
23. See Government of Canada's "Government of Canada introduces legislation to make life more affordable for Canadians", online: https://www.canada.ca/en/department-finance/news/2022/09/government-of-canada-introduces-legislation-to-make-life-more-affordable-for-canadians.html.
24. Ibid note 13.
25. Ibid note 13.
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