Janine Manning, a member of the Chippewas of Nawash Unceded First Nation in southern Ontario, needed a root canal—a routine procedure, but one her dentist referred to a specialist due to the specific injury.
Manning uses the federal Non-Insured Health Benefits (NIHB) program, which covers dental, vision, mental health, prescription drugs, and medical equipment for First Nations and Inuit. However, the program covered only $159 of her nearly $2,200 procedure. Her private insurance paid about $1,400, leaving her to cover 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 is intended as a payer of last resort, meaning clients must first use provincial or private insurance before NIHB coverage applies. Critics say the program’s rates and approval processes are outdated and slow, forcing some dentists to opt out.
Caroline Lidstone-Jones, CEO of the Indigenous Primary Healthcare Council and a member of Batchewana First Nation, said the administrative hurdles often prevent timely care. She shared her own experience, in which a predetermination request for a root canal took six months and four rounds of paperwork, ultimately resulting in no NIHB coverage. Her private insurance covered the crown, but she still paid about $1,000 herself.
“Because it’s so costly, many people cannot participate in that level of care,” Lidstone-Jones said.
Dr. Aaron Burry, CEO of the Canadian Dental Association, said the program’s approval process is cumbersome and outdated, with procedures and concepts dating back to the 1970s and 1980s. Dentists face uncertainty when submitting predetermination requests, which can lead to frustration for both providers and patients.
David McLaren, president of the First Nations Health Managers Association, said some community members in Quebec must travel long distances to find dentists who bill NIHB. Even then, the program does not always cover travel expenses if other providers are closer.
A 2022 parliamentary report highlighted the need to modernize NIHB dental services and reduce administrative barriers, issuing 18 recommendations. The federal government has not confirmed whether these recommendations have been implemented.
Indigenous Services spokesperson Eric Head said NIHB reviews fees annually and adjusts for inflation, and that the number of enrolled dental providers has increased 10% between 2021 and 2025. Eligible clients can also access the Canadian Dental Care Plan (CDCP), though NIHB must be billed first.
Dr. Scott Leckie, a Winnipeg dentist, noted that offices sometimes dedicate a full-time staff member just to handle NIHB paperwork. He said a review of administration and predetermination processes is needed to align the program with other dental coverage.
“NIHB needs to be a win-win-win for patients, providers, and government,” Burry said. “Right now, it’s primarily a cost-containment program, and that means patients often don’t get the care they need.”
Lidstone-Jones said excessive red tape prevents timely dental care, especially for elders and children, impacting quality of life, self-esteem, and mental health.
“Sometimes people don’t understand these are real people struggling to access basic care,” she said.