Entitlement to health services in Ireland is primarily based on residency and means. Under the Health Act 1970, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board. Other than for persons aged seventy years and over who are automatically entitled to a medical card, medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner medical and surgical services for themselves and their dependants without undue hardship.
Income guidelines are drawn up each year by the health board and authority chief executive officers to assist in the determination of a person's eligibility for a medical card and these are revised annually in line with the consumer price index, CPI. However, it should be noted that the guidelines are not statutorily binding and even though a person's income exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that his or her medical needs or other circumstances would justify this. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.
It should be remembered that health board chief executive officers have discretion in relation to the issuing of medical cards and also that a range of income sources are excluded by the health boards when assessing medical card eligibility. Many allowances such as carers' allowance, child benefit, domiciliary care allowance, family income supplement and foster care allowance are all disregarded when determining a person's eligibility. Given these factors and the discretionary powers of the CEOs, having an income that exceeds the guidelines does not mean that a person will not be eligible for a medical card, and a medical card may still be awarded if the chief executive officer considers that a person's medical needs or other circumstances would justify this.
I am conscious that increases in social welfare rates in recent years have given rise to a situation where such rates may exceed the income guidelines for a medical card. Because of this situation, my Department has written to the chairman of the chief executive officers' group on a number of occasions, most recently on 5 November 2003, asking that he advise the CEOs of my concern that medical card holders should not be disadvantaged by virtue of increases in social welfare payments which may be announced in the forthcoming budget. They were asked to ensure that increases in social welfare payments do not lead to medical card holders losing their medical cards by reference to the income guidelines and to make every effort to ensure that both medical card holders and applicants are made fully aware that increases in social welfare payments will not disadvantage them when applying to hold or retain a medical card.
My Department has asked the chief executive officer of the Eastern Regional Health Authority to examine the issue raised by you and to reply directly to you in the matter.