Under the provisions of the Health Act 1970, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. There is no automatic entitlement to a medical card for persons with a specific illness, such as cancer. The income thresholds apply to all applications and there are no variations on these where an applicant - or family member - has a specific illness.
However, under the legislation, there is provision for discretion by the HSE to grant a medical card where a person's income exceeds the income guidelines. The HSE takes a person's social and medical issues into account in determining whether or not "undue hardship" exists for a person in providing a health service for themselves or his or her dependents.
The HSE set up a clinical panel to assist in the processing of applications for such discretionary medical cards, where there are difficult personal circumstances. This approach recognises the need to have in place a standard process for considering applications in respect of people who, while over the income guidelines, require a discretionary assessment on the basis of illness, such as cancer, or undue financial hardship.