Child With Special Needs: Excessive Demand and H&C in Canada
Updated: Oct 26
The short answer: Under section 38(1)(c) of the Immigration and Refugee Protection Act (IRPA), a foreign national is inadmissible on health grounds if their health condition "might reasonably be expected to cause excessive demand on health or social services." This can apply to a child. In an H&C request for permanent residence, a medical assessment is part of the later process, and an officer may have to consider excessive demand. IRCC's H&C guide says exemptions from inadmissibility are given only in exceptional circumstances. Exactly how this applies depends on the child and the file, so raise it early with a representative.
This article is part of our humanitarian and compassionate (H&C) application guide.
What does section 38 say?
Section 38(1) says a foreign national is inadmissible on health grounds if their health condition:
(a) is likely to be a danger to public health;
(b) is likely to be a danger to public safety; or
(c) might reasonably be expected to cause excessive demand on health or social services.
Section 38(2) lists people to whom paragraph (c) does not apply. These include some family-class members who are the spouse, common-law partner or child of a sponsor, people who applied as Convention refugees or persons in similar circumstances, and protected persons. A child in an H&C request is not automatically in one of those groups. Check your own category with a representative.
How does IRCC describe excessive demand?
IRCC's help centre says there is no specific health condition that automatically leads to inadmissibility, and that each applicant is assessed individually. Officers consider the current state of the condition, the likely prognosis, the cost of health and social services over the next 5 to 10 years, and the effect on wait lists. (IRCC's operational instructions describe the cost assessment over five consecutive years, so check which period applies to your file.)
IRCC's migration health materials also describe a cost threshold based on a multiple of the average Canadian per capita cost. The amounts change over time, so this article does not give figures. Check IRCC's current instructions or ask a representative.
IRCC's operational instructions say certain services are not included when costs are calculated, and these include special education related services, such as the preparation of an individualized education plan and educational assistants. A representative can tell you how that applies to your child.
How can this interact with an H&C request?
IRCC's H&C guide says a person must not have a health condition that would cause excessive demand, and it "strongly" suggests resolving inadmissibility before applying where possible. It also says that if you are asking for an exemption from inadmissibility, you must clearly state the specific exemption you are requesting, and that these exemptions are given only in exceptional circumstances.
IRCC's operational instructions on excessive demand discuss H&C grounds for permanent residence applications and indicate that the authority to grant an H&C exemption from section 38 rests with a more senior delegated officer. We were not able to confirm every detail of how that works, or when in the process it is considered. Please treat it as a general description only.
In practice, that means a child's special needs can matter in two ways:
As a factor in the H&C request itself, through the best interests of the child. See H&C and a child with autism.
As a possible admissibility issue later in the process, when medical results are reviewed.
What happens if IRCC has a concern?
IRCC's instructions say that if a medical officer finds a condition may cause excessive demand, a procedural fairness letter specific to the findings is prepared. It gives you a chance to respond. The instructions refer to a "credible and viable mitigation plan" addressing the inadmissibility elements. Deadlines are stated in the letter you receive, so read it carefully and act quickly. See procedural fairness letters.
What should I do now?
Raise it early. If your child has a diagnosed condition, discuss it with a qualified representative before you file, not after a letter arrives.
Keep medical records organized. Current reports from the child's doctors and therapists help describe the condition, treatment and prognosis. See H&C medical evidence.
Know what is not certain. A child's needs may strengthen the H&C request while also raising an admissibility question. IRCC makes the decision.
Keep the whole family in view. Medical inadmissibility can affect how a family is assessed. A representative can explain how, for your case.
Frequently asked questions
Does a child's autism or other condition make them automatically inadmissible?
No. IRCC says no specific condition automatically leads to inadmissibility, and each applicant is assessed individually.
Can I get an H&C exemption from medical inadmissibility?
IRCC's guide says exemptions from inadmissibility are possible only in exceptional circumstances and must be clearly requested. Whether one is appropriate for your child is a legal assessment. Raise it early with a representative.
Is a medical exam needed when I file?
IRCC's H&C guide says you do not need one before submitting. Instructions come later, and results are valid for 12 months.
Next steps
If your child has a health or developmental condition, talk with a representative before you file. Every H&C situation is different. E-Pathway Immigration can help you assess whether H&C considerations may be relevant, identify the evidence and questions that need attention, and understand your options. A decision remains with IRCC.
. Domonic Cheung has over a decade of experience working with special-needs matters.
Related guides: H&C and a child with autism · Special-needs evidence · H&C medical evidence · H&C and criminal inadmissibility · Procedural fairness letters · H&C guide index
Last reviewed: October 2026
Sources: IRPA s. 38 · IRPA s. 25 · IRCC Guide 5291 · IRCC help centre: excessive demand · IRCC: Excessive demand on health services and social services · IRCC Migration Health transition binder
This article provides general information only and is not legal advice. Immigration options and outcomes depend on individual circumstances. Consult a qualified representative for advice about your situation.
About the author
Domonic Cheung is a Regulated Canadian Immigration Consultant (RCIC), licence R711344, with E-Pathway Immigration in Vancouver, BC. You can verify his licence on the College of Immigration and Citizenship Consultants (CICC) public register.
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