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Care providers say Ottawa is taking far too long to pay for health services for First Nations children

Some health care providers say bureaucratic red tape at the federal level is delaying life-saving therapies for First Nations children, causing some children to experience further developmental delays and leaving their businesses in financial difficulty.

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

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

Speech-language pathologists told CBC News that the department may take even longer to pay for their services. Some say they have been waiting for payment for more than a year.

They said most other third-party payers approve funding within 10 to 30 business days and pay 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 that she was not paid by the ministry for the sessions and that she has to pay her employees.

“It’s been an incredibly stressful year so I’ve had to consider laying off staff,” Passover said. “I had to consider closing my business because of the delays.”

Rachel Pessah, owner of Bright Spot Therapy Services in Timmins, Ont., is concerned about the impact that long delays in accessing services through Jordan’s Principle are having on First Nations children. (Rachel Passover/provided)

Gail Tippeneskum’s six-year-old daughter, Olivia, one of the Passover clients, cannot access speech therapy sessions until ISC pays for light point therapy services.

“I’m worried about my daughter now…what if she’s not learning or speaking as well now because she doesn’t have that one-on-one time with the workers?” said Tippeneskum.

Service providers say the delays are pushing many independent operations to the brink of bankruptcy, while forcing children to deal with other developmental issues and fall behind in school.

“I love the program and what it was designed to do… But I feel like it really falls short of its main goal of not slipping kids through the cracks,” said Passover.

“The longer children wait for these services, the bigger the gap between where they are and where they need to be for their age.”

Minister of Indigenous Services commits to review

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

In 2017, the Canadian Human Rights Tribunal ordered Canada to process applications for First Nations children within 12 to 48 hours and to stop imposing service delays before funding is granted.

But service providers and families say the policy is failing.

Crystal Jacobs, a member of the Moose Cree First Nation, tries to access speech therapy for her 6-year-old daughter Mercy, who is non-verbal, has a rare and undiagnosed genetic condition and requires 24-hour care out of 24.

Jacobs said she had received assistance from the federal government in the past to cover the cost of an adapted stroller and a temporary hotel stay.

But over the past year, Jacob said, she had to wait months to hear from Indigenous Services telling her that her applications had been denied.

“I’ve been told… a few times they’ve helped me in the past and I should just be grateful for that,” Jacobs said.

“I just feel like my daughter is being discriminated against because she’s disabled.”

Care providers say Ottawa is taking far too long to pay for health services for First Nations children
Crystal Jacobs has waited months for federal funding for speech therapy for her six-year-old daughter Mercy, who is nonverbal and has an undiagnosed rare genetic condition. His request was denied. (Crystal Jacobs/Supplied)

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

“If there are delays in children’s access to services, I absolutely want to know about it and I will absolutely commit to looking into why that is the case,” Hajdu said. “Vendors must be paid in a timely manner.”

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

“Our goal is to pay invoices within 15 working days of receipt,” said ISC spokeswoman Megan MacLean.

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

Calls to eliminate bureaucracy

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

“When a child and a family need service, you better be there,” Angus said.

“For a government to delay and refuse to pay for children to be denied services – they are playing with the lives and the future of this generation of children.”

Care providers say Ottawa is taking far too long to pay for health services for First Nations children
Timmins-James Bay NDP 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)

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

“It’s really sad for me because I know that means a child has been without this service for a year, and that’s inexcusable,” she said.

Blackstock said he heard about similar issues from other clinicians. She says she raised the issue with the Canadian Human Rights Tribunal last September.

Now, she says, it is high time for the federal government to act.

“We want to see them sort of untangle the bureaucracy around Jordan’s Principle,” Blackstock said.

“They need to go back to basics. What we need is a professional letter and consent from the guardian. That should be enough to process an application. They also need to reinforce their staff, if the staff is a problem. “

Care providers say Ottawa is taking far too long to pay for health services for First Nations children
Cindy Blackstock, executive director of the First Nation Child and Family Caring Society, calls on the federal government to “untie the red tape” around Jordan’s Principle. (CBC News)

Carla Willock, clinical director and owner of the Victoria Speech and Language Center in Victoria, British Columbia, said the federal government’s interpretation of Jordan’s Principle requires a family to submit more documents than any of its other customers, and leaves them in limbo for months.

“It’s almost like they’re trying to create a barrier for families to access this funding,” Willock said.

Companies refusing to work with Jordan’s Principle

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

The federal government only pays service providers for services it approves. Clinicians say that if they are only paid to give a child one session a week and that child suddenly needs a second session, it can be very difficult to convince the service to pay more.

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

They are asking the ministry to relax the rules to allow them to adapt the programming as they see fit.

“A lot of companies are refusing to work with JP (Jordan’s Principle) because we’re not being paid or are considering the possibility of going out of business,” said Alana MacIntyre, speech pathologist and owner of Spark Rehabilitation in Sault Ste. . Marie, Ont.

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

“When the processes work, they work great for kids,” MacIntyre said.

“But when they don’t work it really impacts the kids and the providers because financially we can’t handle it.”

LISTEN | Care providers grapple with delayed federal payments under Jordan’s Principle:

Morning North9:58Northern Ontario Families and Caregivers Face Delays Despite Jordan’s Principle

Federal bureaucratic processes are delaying essential therapies for First Nations children, despite the 2017 enactment of Jordan’s Principle. This law states that the care of First Nations children must take priority over disputes over which government should pay them, in order to avoid situations like this. A family and a caregiver share their thoughts. 9:58

The problem also affects waiting lists for other children.

Chelsey Chichak, a licensed speech therapist based in Langley, B.C., said she often has to reserve spots for children seeking therapy under Jordan’s Principle while waiting for the federal government to make a decision.

“My biggest fear is that someone comes to us and says, ‘I would like your services, but I can only use Jordan’s Principle’, and we have to say, ‘I’m sorry. We cannot accept this program because of delays in applications and reimbursements, as it impacts our businesses across Canada,” she said.