Question Period Note: Health Funding Agreements and Transfers

The Government of Canada is investing close to $200 billion to support provinces and territories (PTs) to strengthen Canada’s universal public health care system, which includes $25 billion over 10 years through the bilateral agreements with jurisdictions.
Bilateral agreements are being negotiated with PTs who are developing 3-year action plans that explain how federal funds will be allocated to support shared health priorities.
o The first of these agreements was announced on October 10, 2023 with the Government of British Columbia, providing the province access to over $1.2 billion over the next three years.
Through these agreements and action plans, PTs will report annually to residents on the targets and timelines they have set to achieve results in their health care systems.

Through the Government’s plan, “Working Together to Improve Health Care for Canadians,” we continue to work closely with provinces and territories on our shared health priorities, including:
o Access to family health services,
o Supported health workers and reduced backlogs,
o Access to mental health and substance use services, and
o Modernized health systems.
Our Government is investing nearly $200 billion over 10 years for health care to support this plan, including $46.2 billion in new funding to improve health care services for Canadians across the country.
Within this funding, we are providing $25 billion over ten years in bilateral agreements to enable provinces and territories to respond to the unique needs of their populations and geography and accelerate health system improvements in the four shared priority areas.
We are making good progress with provinces and territories and recently October 10th, 2023 announced the signing of the first bilateral agreement with British Columbia to provide the province with more than $1.2 billion of federal funding over the next three years. We expect to share news of further agreements with other jurisdictions in the near future.
IF PRESSED (GENERAL) …
Following the announcement of the “Working Together to Improve Health Care for Canadians” plan, our Government:
o Reached agreement in principle on the Plan with all provinces and territories except Quebec; and
o Continues to negotiate tailored bilateral agreements with action plans to outline how federal funds will be used – the first of which was announced October 10, 2023 with British Columbia, providing the province with over $1.2 billion in federal funding over the next three years.
Our Government also supports the Canadian Institute for Health Information in developing and sharing key performance indicators to track progress on priorities outlined in the Plan. A snapshot report was released in August 2023 on common indicators.
The Working Together bilateral agreements include the initial three-year allocation of the $25 billion in new bilateral funding to provinces and territories, as well as the next three years of funding from the remaining $2.4 billion for mental health and addictions from Budget 2017 supported by the 2017 Common Statement of Principles on Shared Health Priorities.
In addition to the Working Together agreements, the Government of Canada is collaborating with provinces and territories to implement a second bilateral agreement focused on the shared priority of helping Canadians age with dignity close to home, with access to home care or care in a safe long-term care facility.
o This agreement will include the remaining $2.4 billon over four years to improve access to home and community care from Budget 2017, and the $3 billion over five years from Budget 2021 to apply standards of care in long-term care facilities and help support workforce stability.
IF PRESSED ON RESULTS …
Our Government is committed to working closely with provinces and territories to ensure results for Canadians.
As part of the Working Together plan, there is a federal, provincial and territorial commitment to collect, use and share health information and to inform Canadians of progress with key common indicators.
This will allow Canadians to see the results of an improved health system.
The Canadian Institute for Health Information (CIHI) is leading a process to review and refine eight initial common indicators and to develop a broader list of indicators, including on Indigenous health. CIHI released an initial snapshot in August 2023 drawing from available data.
Through bilateral agreements, provinces and territories will submit action plans outlining how the funds will be used, and how they will report to annually to residents on targets and timelines they have set in order to demonstrate results.
IF PRESSED ON QUEBEC …
Our Government remains open to working collaboratively with Quebec to finalize an agreement that meets Quebec’s unique health needs and priorities, while ensuring accountability to the public.
All provinces and territories, including Quebec, expressed a preference for a flexible approach to health agreements. Our Government recognizes that jurisdictions have their own unique circumstances.
That is why we are committed to flexible and tailored bilateral agreements, so that provinces and territories, including Quebec, can address the unique needs of their populations and geography, and report on progress to their residents.
Through the investments announced as part of the plan, Quebec is eligible to receive $37.3 billion in federal funding over 10 years, which includes approximately: $4.8 billion for a new bilateral agreement focused on the four shared health care priorities; and, $30.8 billion through the CHT, including $447 million through the immediate, one-time CHT top-up to address urgent needs, especially in pediatric hospitals and emergency rooms, and long wait times for surgeries.
This funding also includes $1.7 billion over five years that has yet to flow to Quebec for mental health and substance use, home and community care, and long-term care.
As discussions continue, our Government is committed to providing flexibility through tailored bilateral agreements that deliver real results and promote greater transparency to Canadians, including Quebec residents.

Budget 2023 outlines the federal government’s plan to provide close to $200 billion over ten years in health transfers to provinces and territories, including $46.2 billion in new funding through new Canada Health Transfer measures, tailored bilateral agreements to meet the needs of each province and territory, funding for personal support workers, and an increase to the Territorial Health Investment Fund. In addition, Budget 2023 announced $2 billion over 10 years to address Indigenous health priorities and $505 million over five years, starting in 2023-24, to the Canadian Institute for Health Information (CIHI), Canada Health Infoway, and other federal data partners.
GDP-Driven Growth: As the Canada Health Transfer’s escalator is based on GDP growth, an additional $141.9 billion is projected to be provided over the next ten years through the Canada Health Transfer, over and above the $45.2 billion provided in 2022-23.
Canada Health Transfer Top-Up: The $2 billion CHT top-up to address urgent pressures in emergency rooms, operating rooms, and pediatric hospitals was transferred to PTs in June 2023. It builds on $6.5 billion in top-ups provided throughout the pandemic.
Canada Health Transfer Five Percent Guarantee: The federal government will provide top-up payments to achieve Canada Health Transfer increases of at least five percent per year for the next five years. The last top-up payment will be rolled into the Canada Health Transfer base at the end of the five-year period, resulting in a permanent funding increase. This represents an estimated $17.1 billion over ten years in additional funding through the Canada Health Transfer.
Tailored Bilateral Agreements: The federal government will provide $25 billion over ten years through a new set of bilateral agreements to address individual provincial and territorial health system needs, such as expanding access to family health services, supporting health workers and reducing backlogs, increasing mental health and substance use support, and modernizing health systems.
Bilateral agreements are intended to be flexible and provinces and territories have options to tailor their respective Action Plans in response to the unique needs of their populations and geography.
The Working Together to Improve Health Care for Canadians Plan identifies an initial set of 8 common indicators. On August 2, 2023, CIHI released an initial snapshot of these indicators on their website.
CIHI is leading a collaborative process to review and report annual progress on these common indicators. In addition, CIHI is working with federal, provincial and territorial governments and data partners to identify a broader list of new indicators, including new Indigenous health indicators. This work will also seek to improve the availability of indicator data that can be sorted by population characteristics.
Personal Support Worker Wage Support: The federal government will provide $1.7 billion over five years to support hourly wage increases for personal support workers and related professions.
Territorial Health Investment Fund: The federal government will provide $350 million over ten years in recognition of medical travel and the higher cost of delivering health care in the territories. This represents $35 million per year, an increase from the previous $27 million.
Home and community care and mental health and addictions services: In 2017, the federal government committed $11 billion over 10 years specifically targeted to improve home and community care, and mental health and addiction services, and provinces and territories agreed to a Common Statement of Principles on Shared Health Priorities.
At that time, the federal government negotiated and signed Agreements with each province and territory that set out details of how each jurisdiction would use federal funding to improve access to home and community care, and mental health and addiction services. Initial agreements expired after five years and new agreements covering fiscal year 2022-23 were established.
Currently, $4.8 billion of the $11 billion commitment remains available to support targeted provincial and territorial efforts to improve access to home and community care and mental health and addiction services over the next four fiscal years (2023-24 to 2026-27).
A further $3 billion was proposed in Budget 2021 for Health Canada to help provinces and territories ensure standards for long-term care are applied and permanent changes are made. This funding will be available to provinces and territories over five fiscal years (2023-24 to 2027-28).

Budget 2023 lays out the federal government’s plan, “Working Together to Improve Health Care for Canadians,” to provide nearly $200 billion in additional funding over ten years to provinces and territories.