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British Columbia’s top court has upheld a decision to revoke almost a decade of medicare coverage for an immigrant couple, confirming in a rare judgment that provinces have every right to deny health funding to people who spend too much time living abroad.

B.C., like most provinces, requires that patients spend at least six months annually in the jurisdiction to benefit from medicare, and alleged Sayed Geissah and Souad Khalaf had lived most of the past several years in the Middle East.

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The pair had argued that the Canadian citizenship they obtained gave them the right to reside wherever they wanted, and that B.C.’s medicare agency could not force them to live in Canada when it was too expensive for them to do so.

The Court of Appeal said in a judgment this month that the province had acted legally when it retroactively stripped them of coverage for a nine-year period.

It may be the first time the courts have ruled on medicare residency laws, and has potentially broad ramifications given that millions of Canadians live in other countries, said Sergio Karas, a Toronto immigration lawyer. People residing most of the year outside Canada usually do not pay income taxes here.