Under the provisions of the Health Act 1970 (as amended), eligibility for health services in Ireland is based primarily on residency and means. The Act provides that persons who are unable, without undue hardship, to arrange GP services for themselves and family qualify for a medical card. The HSE can only award medical cards in accordance with the Act and, therefore, it must assess applicants on the overall financial situation of the applicant and his or her dependants. The HSE gives effect to this legislation through its Medical Card National Assessment Guidelines.
Under the legislation, there is no (and has never been an) automatic entitlement to a medical card for persons with any specific condition or illness. While there is no legal basis for the HSE to award medical cards on the basis of a specific medical condition, the HSE has, however, discretion to grant a medical card in certain circumstances. If an applicant's means are above the financial thresholds, set out in the national guidelines, the HSE examines for any indication of circumstances (medical or social), which might result in undue financial hardship in the arranging of medical services. Eligibility may be granted on a discretionary basis if these circumstances are such that a person cannot arrange GP services for themselves and their family without undue financial hardship.
Discretion must be exercised by the HSE but the fundamental provision in the 1970 Act is that a person is assessed on the basis of undue hardship in arranging a GP service, having regard to his or her means. Undue hardship can only be ascertained through an assessment of financial means, with the extra discretionary effect where a person's condition or illness is affecting his/her financial situation. The HSE must operate within the legal parameters as set out in the Act, while also responding to the variety of circumstances and complexities faced by individuals who apply for a medical card.