The 1970 Health Act provides that persons who are unable, without undue hardship, to arrange GP services for themselves and family qualify for a medical card, having regard to the overall financial situation of the applicant and his/her dependants. Applications are, in the first instance, subject to a means assessment to determine if assessable income declared is within the set income limits to qualify for a medical card or a GP visit card. Medical card and GP visit card applications are considered in accordance with the Medical Card and GP Visit Card National Assessment Guidelines.
I am advised by the HSE that, if an application is assessed over the qualifying financial thresholds for both a medical card and GP visit card or assessed as under the qualifying thresholds for a GP visit card only, and the application also includes other medical, social or financial details that do not form part of the means assessment, the application will then be considered on discretionary grounds for a grant of a card under the ‘undue hardship’/unduly burdensome’ arranging of a GP service provisions of the medical card scheme of assessment. The assessment to be made in this instance is whether it is considered that "undue hardship"/"unduly burdensome" will occur or an ‘undue burden’ be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs in the absence of medical card or GP visit card eligibility. Deciding Officers appointed from within the staff of the HSE Primary Care Reimbursement Service take decisions in relation to the consideration of applications to approve or decline the grant of a medical card/GP visit card on discretionary grounds.
The National Assessment Guidelines give guidance to a decision maker as to the relevant factors to have regard to in making an assessment as to whether the ‘undue hardship’/’undue burden’ provisions apply to the circumstances presented on an application. In particular, the guidelines state that the "exercise of discretion by the HSE, in favour of the applicant, should be considered where meeting the costs of services covered by a medical card or a GP visit card compromises the applicant’s or his/her family’s ability to meet the essential costs". In conducting this assessment, medical and social circumstances are taken into account. The decision maker may make appropriate inquires or seek advice from other sources to assist with coming to a decision on ‘undue hardship’/’undue burden’, e.g. the applicant’s Doctor(s), the HSE’s Medical Officers, Social Worker, etc.
In the case of an application that includes evidence as to an individual(s) medical condition, the HSE’s assigned medical officers are consulted for their professional advice and expertise and asked to make a recommendation on an application as to whether ‘undue hardship’ will occur or an ‘undue burden’ be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs, having regard to the medical condition(s) presenting. This assessment necessarily involves the medical officers exercising their professional judgment and expertise to evaluate the cost of providing for a particular medical condition, as described on an application, and making a determination having regard to the assessed income and circumstances on an application whether ‘undue hardship’/’undue burden’ will occur in the absence of a medical card/GP visit card eligibility. The HSE is satisfied with the current operating procedures in this regard and satisfied that the panel of Medical Officers have the necessary professional expertise and judgment to effectively discharge this function.
