Joy SpearChief-Morris is the recipient of the 2025 CJF-CBC Indigenous Journalism Fellowship, established to encourage Indigenous voices and better understanding of Indigenous issues in Canada’s major media and community outlets.
Janine Manning needed a root canal.
While a fairly common procedure, Manning’s dentist recommended her to a specialist because of the specific injury to her tooth.
Manning is a member of the Chippewas of Nawash Unceded First Nation in southern Ontario, and uses the federal Non-Insured Health Benefits program (NIHB) that covers things like dental care for First Nations people and Inuit.
But when it came to pay the bill, Manning was told the federal program would cover only $159 of the nearly $2,200 procedure.
Manning was able to get about $1,400 covered by her private insurance, but still had to pay nearly $600 out of pocket.
“It just seems like such a frustrating system that is really not supportive of Indigenous folks who are just simply trying to access dental services,” Manning said.
The NIHB program covers things not insured by medicare, like vision and dental care, mental health counselling, prescriptions, travel for medical services and medical supplies and equipment. It’s positioned as a payer of last resort, meaning clients who have benefits from provincial/territorial or private insurance must first use those.
Dentists and users of the program, like Manning, say the program is not keeping up with modern costs and procedures. Administrative burdens are causing dentists to opt out of the program, creating accessibility issues for First Nations and Inuit clients who can’t afford to pay up front.
The Non-Insured Health Benefits program pays for things not covered under medicare, like prescription drugs or glasses, for eligible First Nations people and Inuit but the program is criticized for being outdated and complicated.
A program stuck in the 1970s
According to the NIHB program’s 2023-2024 annual review, about 344,898 clients used dental benefits. Dental benefits were the program’s third largest expenditure that fiscal year, with over $379 million spent.
But barriers to accessing dental care is the number one complaint when it comes to NIHB, according to Caroline Lidstone-Jones, chief executive officer of the Indigenous Primary Healthcare Council.
“Many NIHB eligible First Nations people face long wait times, partial approvals, providers who won’t take NIHB and major travel barriers,” she said.
“These challenges often turn treatable dental issues into preventable tooth loss.”
Lidstone-Jones, a member of Batchewana First Nation, had to get a root canal recently herself.
She said it took four rounds of paperwork between NIHB and her dentist over six months just to be denied in her predetermination for the procedure.
Her private insurance paid for a crown on her tooth and she ended up paying about $1,000 out of pocket, while NIHB paid zero.
“Because it’s so costly, there is so many people then who are just not able to participate in that level of care,” Lidstone-Jones said.
Manning said she submitted an appeal for coverage of her root canal, but was denied after waiting over eight weeks for an answer.
Dr. Aaron Burry, chief executive officer of the Canadian Dental Association, said the NIHB program needs to move into the 21st century.
Burry, who has been a dentist in Ontario for nearly 40 years, said more modern dental procedures can require “long, laborious processes” to get approved by NIHB, “if it’s approved at all.”
“Many of the concepts that are in the NIHB program are really from the 1970s and 1980s,” Burry said.
“Certainly the issues that we hear about, the dentists that we deal with at CDA, are providing care that’s on a higher level.”
How did we get from the medicine chest treaty clause to the Non-Insured Health Benefits program? Joy SpearChief-Morris unpacks its history.
Burry said a major issue with NIHB is the predetermination or pre-authorization process when it comes to certain dental procedures, which he said is not only lengthy but creates uncertainty.
“To put in all that effort and then have the answer still be no is typically a frustration for the patient, but it’s also a frustration for the dentist and the dental office,” he said.
Burry said issues like these and other negative experiences with NIHB, such as delayed payments, are why many dentists “don’t view this program very positively” and have chosen to opt out of it.
As a result, finding dental providers who will bill to NIHB is an ongoing issue for clients.
David McLaren, president of the First Nations Health Managers Association, said some members of his community in Kebaowek First Nation in Quebec have to travel longer distances to find a dentist that will direct bill NIHB. But then NIHB, which covers travel for medical procedures, does not always pay for the travel if there are other dentists closer.
“We call service providers and say, do you accept the NIHB program in its entirety? Are you going to charge our clients?” McLaren said.
“I don’t think people who are on Sun Life have to do that.”
Resolutions but no solutions
In 2022 a parliamentary report conducted by the Standing Committee on Indigenous and Northern Affairs on NIHB noted administrative issues with the dental program – such as the need for modernizing approvals processes – and the impact on First Nations and Inuit overall oral health.
The report issued 18 recommendations, but when asked by CBC Indigenous, the federal government did not answer whether there has been action on these recommendations.
Indigenous Services spokesperson Eric Head said in a statement to CBC Indigenous that the NIHB’s approach to setting maximum dental fees is “dynamic.” Fees are reviewed on an annual basis and adjusted for “a variety of factors, including inflationary pressures.”
Head said dental associations and providers can establish or adjust their own fee rates as part of their business models.
Head said “the number of providers enrolled with the NIHB program increases every year in each benefit area” with dental seeing a 10 per cent enrolment increase between 2021 and 2025.
First Nations and Inuit who use the NIHB program are also eligible for the new Canadian Dental Care Plan (CDCP), if they meet its income requirements.
But while NIHB is usually considered the payer of last resort with other public or private insurance, NIHB must be billed first before clients can try to access the CDCP.
Head said, “There will be no service stacking or duplication of coverage between the CDCP and NIHB program.
“It is expected that the NIHB program will cover all eligible services with limited to no gaps between the two plans.”
From red tape to win-win-win
Dr. Scott Leckie, who has been a dentist in Winnipeg for 35 years and an advocate of the program, said sometimes offices have to dedicate a full-time clerk just to NIHB paperwork.
The CDCP and NIHB use similar fee structures, which Burry said are “somewhere between very close to substantially less” than the fee structures established by each provincial dental association.
Both dentists agreed matching the dental associations’ fee structures, like most private insurers, would be an improvement.
Leckie said there needs to be a comprehensive review of the administration of the NIHB dental program to ensure that its predetermination requirements are in line with other public and private dental programs.
Burry said for NIHB to be successful at what it does, it needs to be a “win-win-win” program for patients, providers and the government, which it is not achieving now.
Burry said many First Nations clients have higher care needs when it comes to dental than the average Canadian and the NIHB is not designed to deliver that.
“It is primarily set to cost containment, so in that respect, the government meets its objectives,” he said.
“But when you meet that objective, does this work for the dentist in terms of being able to provide the care they want to provide? Not necessarily. Does this work for the patient? No, because they don’t … get the care,” he said.
Lidstone-Jones said the “red tape” associated with the NIHB program makes it difficult to access preventable dental care, particularly for elders and children, which leads to greater impacts on quality life, self-esteem and mental health.
“Sometimes people don’t understand that these are actual, real life people going through this system trying to access care.”
