Pregnant Alberta nurse loses public health coverage as she waits for work permit renewal

As of Wednesday, nurse Charity Mackrell is no longer covered by Alberta's public health care because she's an American citizen waiting for her Canadian work permit to be renewed. Pregnant, she's worried about big bills to pay if the renewal doesn't come before the baby arrives.

Charity Mackrell may have to pay bills to hospital she works at

Charity Mackrell, a licensed practical nurse at Olds Hospital, says she lost her access to Alberta health care on Wednesday due to a delay in renewing her work permit. A U.S. citizen, she is still allowed to work for Alberta Health Services while being uninsured. (Charity Mackrell)

UPDATE: On Thursday afternoon, Alberta Health Minister Tyler Shandro said he extended Alberta health insurance to all foreign residents waiting for work permit renewals, including Charity Mackrell.

A licensed practical nurse in Olds, Alta., got some exciting news recently. Charity Mackrell and her husband are going to be parents.

But as of Thursday, the 26-year-old is no longer covered by Alberta's public health insurance because she's an American citizen waiting for her Canadian work permit to be renewed.

That means if she needs to see a doctor, even in the hospital where she works, she'll likely be handed a bill.

"It's been pretty anxiety-inducing," said Mackrell, whose baby is due in November.

Mackrell is from Texas originally. She met her husband, a Calgary Police Service officer, years ago on a volunteer trip. They married and she studied in Alberta. 

For the past several years, she's worked for Alberta Health Services on a work permit. That permit expired in January.

Saving for a baby, worried about COVID-19

She applied for an extension, and received what's called "implied status," allowing her to continue working legally in Canada.

Alberta Health, however, gave her only a standard three-month health coverage extension, which ran out Wednesday.

"I understand everyone has jobs and policies they have to look after," Mackrell said.

"But I doubt any of them would want to switch places with me and be pregnant and be worrying about getting COVID or worrying about having to pay for hospital bills — while I'm also trying to save up for this child that we're expecting."

Mackrell and her family members have been calling Alberta Health officials, representatives with Immigration Canada and their local politicians. No one has found a way to help keep her on public health care during her pregnancy.

"I'm normally a pretty practical. You know, proactive, let's just deal with this," Mackrell said. "But with this situation, it doesn't really seem like I'm getting anywhere with anyone."

Covered for COVID-19, not other care

In the meantime, she said she will continue working for Olds Hospital, including potentially caring for those who might have COVID-19.

If she becomes infected herself, Alberta Health will cover costs specific to COVID-19 treatment, as they've offered to do for any uninsured foreigner in Alberta. But she won't be covered for anything else.

When contacted by CBC, Alberta Ministry of Health spokesperson Steve Buick said foreign nationals without access to public health coverage must pay out of pocket. But, he said, if they save their receipts, they can apply to have those expenses covered once approved again.

Jean Munn, an immigration lawyer and member of the Alberta Human Rights Commission, pictured left, says Alberta Health should extend health coverage to nurse Charity Mackrell, right. (Caron & Partners, Charity Mackrell)

Jean Munn, an experienced immigration lawyer in Calgary, said she's had clients save receipts only to have their expenses denied.

She also said she is working with another family expecting a baby in Calgary whose refugee claim is delayed due to the COVID-19 pandemic. She said they've been quoted upward of $24,000 for delivery.

"There are large numbers of people in this country at different stages of doing something entirely lawful, who have no health coverage at all. I think her case is very, it's very sympathetic," Munn said. "If they're paying taxes, just like you and me … it's ridiculous that Alberta Health Care [Insurance Plan] doesn't cover them."

'Very shocked' when asked to pay

Mackrell said she and her husband don't have thousands of dollars available for medical bills, even with steady employment. She also noted she's at no risk of losing her job, especially during a pandemic, when health-care workers are highly valued.

"I'm not looking for a handout by any means, and I don't think I'm special, but I do think I deserve just to be looked after, to have coverage," Mackrell said.

She said she first learned she would be without public health coverage when her prenatal clinic called and asked her how she'd be paying for her appointments.

"I was very shocked and not expecting that," she said.

Delays due to pandemic crisis

Since then, Mackrell has been contacting the federal government, Alberta Health and even her MLA and MP looking for help, but no one has been able to find an exception for her. Mackrell has provided emails documenting this to CBC News.

Munn said that if the work permit renewal process is running on time, Mackrell may see her permit, and health-care access, approved in May.

A spokesperson for Immigration, Refugees and Citizenship Canada said that processing times for applications may be delayed due to the COVID-19 pandemic.

Charity Mackrell says she's excited to grow her family with her Canadian husband but wishes it didn't come with the stress of being without health care. (Supplied by Charity Mackrell)

In a statement, Immigration Canada said that to account for permit approval delays averaging around four months in normal circumstances, anyone who has applied is allowed to continue working legally. However, the department noted that health coverage for foreign workers remains under the control of the provinces.

Her husband also applied to sponsor her as a permanent resident, but that application is expected to take months longer.

Lawyer worries many in same situation

Lethbridge immigration lawyer Mark Holthe said he's been hearing from many people in Mackrell's situation who are wondering when their permits will be approved and when they'll regain access to Alberta's health-care system.

He said he's especially worried for people who will lose their jobs due to the pandemic, and as their work permits expire, will no longer have employment to keep them in Canada.

"Where does that leave that foreign worker? I guess, happy trails and go home," Holthe said. "It's cruel and harsh, and as an immigration lawyer, I fight it every day. But those are realities."

Mark Holthe is an immigration lawyer in Lethbridge, Alta. (Holthe Law)

He said the Canadian government could extend all work permits automatically during the COVID-19 pandemic to remove that uncertainly until public servants can catch up with processing applications. 

Immigration Canada did not respond when asked about that suggestion.

As for Mackrell, she and her husband are still hoping something will be done.

"We both put ourselves at risk every day," she said. "So yeah, we're definitely both frustrated."


Rachel Ward


Rachel Ward is a journalist with The Fifth Estate. You can reach her with questions or story ideas at


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