Wednesday, 14 May 2014

Questions (186, 195, 196, 197)

Michael Healy-Rae

Question:

186. Deputy Michael Healy-Rae asked the Minister for Health his views on the situation where persons with profound disabilities and serious illness have had their medical cards removed. [21730/14]

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Bernard Durkan

Question:

195. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the review of eligibility for medical cards continues to be monitored with a view to alleviating hardship, stress and concerns for applicants; and if he will make a statement on the matter. [21773/14]

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Bernard Durkan

Question:

196. Deputy Bernard J. Durkan asked the Minister for Health the measures he will put in place to ensure the minimisation of concerns arising from the review of eligibility for medical cards with particular reference to older persons and children and adults with special needs or particular medical conditions which might seriously impact on their quality of life and resources; and if he will make a statement on the matter. [21774/14]

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Bernard Durkan

Question:

197. Deputy Bernard J. Durkan asked the Minister for Health the extent to which his attention has been drawn to the concern of persons affected by the review of eligibility of medical cards resulting in stress and trauma for families; if he will put in place provision to deal with this issue; and if he will make a statement on the matter. [21775/14]

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Written answers (Question to Health)

I propose to take Questions Nos. 186, and 195 to 197, inclusive, together.

Under the Health Act, 1970, eligibility for a medical card is founded primarily on the undue financial hardship test and every application must be assessed on that basis. Under the legislation, determination of an individual’s eligibility for a medical card is the responsibility of the HSE. The 1970 Health Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange GP services for themselves and their family, having regard to their overall financial situation and reasonable expenditure. The legislation is clear that qualification for a medical card is means-tested. Medical cards are not awarded - nor have they ever been - on the basis of a particular illness or disease. Medical cards are issued 'automatically' - or irrespective of means - even if an applicant is suffering from a serious medical condition or a life long condition.

All medical card and GP visit card holders are subject to a periodic review of eligibility to determine continuing eligibility and the HSE has a very structured protocol in place for the review process and makes every effort to ensure on-going engagement with clients during this process. These reviews must be supported with a range of documentation and this requirement is clearly outlined on the application forms. As a result, where such supporting documentation is not supplied, or is incomplete, to enable the assessment of an application, in accordance with the National Assessment Guidelines, the HSE will issue correspondence to the applicant, specifying the additional information required to progress the assessment of their application.

Persons who have been granted a medical card under the ‘financial hardship’ provisions of the medical card scheme are required, when the subject of a review assessment, to submit all relevant and up-to-date details. This is necessary so that the HSE can make a correct determination of continuing eligibility. If the HSE is made aware that a person has a disability or special needs, assistance will be afforded to help that person complete the application and explain the support documentation they need to send, whether at application stage or at review stage. The local health office can be contacted on LoCall 1890 252 919 to request this assistance.

The HSE also makes every effort to provide a person with sufficient time to renew their eligibility. Each month, the HSE analyses the Medical Card Register to identify those medical/GP visit cards that are scheduled for review within three months. A review notification will indicate the card holder should complete a self-assessment or request the card holder to return evidence of household income, assessable outgoings and medical circumstances to enable a full review assessment be conducted by the HSE. The HSE has increased this notification time to four months in respect of those clients who were granted eligibility on the basis of discretion. This is to allow an additional month to ensure that all pertinent medical and other data is provided for inclusion in the assessment process.

A reminder letter is issued a month later if the requested review form details have not been returned at that point. If a person does not return the review form within the time specified, continuing eligibility cannot be confirmed and the medical card cannot be reissued. In these circumstances, or where the review process establishes that a person no longer holds eligibility, the eligibility ceases.

Persons are requested to return their completed review forms at least one month in advance of the due expiry date of their existing eligibility. This is to allow the HSE sufficient time to carry out the review and/or to get back to the individuals, if the application is incomplete or requires any further details to be furnished.

Where a review form is returned, but not fully completed by the expiry date, it is HSE policy to extend the eligibility of the client for a reasonable period of time until the review is carried out and a final decision made on the person's continuing eligibility, once there is appropriate communication from the client. Medical card holders who genuinely engage with the review of their medical card eligibility will not have their eligibility withdrawn before that review is complete.

Where an applicant indicates on their review application that medical evidence has been previously submitted relating to a life-long medical condition, and this has been confirmed by the HSE, the HSE will not request further medical evidence in this regard. The applicant will, however, be required to submit all other up-to-date information material to a review assessment.

Eligibility for a medical card only exists for so long as a person continues to meet the criteria set out in the Health Act. The legislation requires a person to notify the HSE of any change in their circumstances, such as income, expenditure, medical or social issues, which disentitles them to a medical card. In practice, very few people do so. As a result, the HSE has an obligation to take measures to ensure that the medical card register is as accurate as possible and that its voted budget is being spent appropriately in the medical card scheme. One recognised auditing practice, which the HSE now carries out, is to undertake random reviews. The selection criteria on which such random reviews occur varies from time to time.

Therefore, all card holders - irrespective of the basis on which the card was awarded – may be subject to a periodic review of eligibility to determine continuing eligibility. The Deputies will be aware, each person who has eligibility to a medical card or a GP visit card receives a plastic card on which a “valid to” date is printed. This is the latest date that a review may be conducted in respect of that person. Notwithstanding the “valid to” date printed on the card, the HSE reserves the right to review eligibility, at any time, and take appropriate action in circumstances where the cardholder does not establish that he/she continues to fulfil the criteria for eligibility under the Medical Card / GP Visit Card National Assessment Guidelines.

A person’s GP is also kept informed of any review notifications of their patients. GPs are advised three months in advance of the review dates of their patients’ GP visit cards/medical cards and, subsequently, the following month and the month after that, if the patient has not returned the review form by that time.

GPs have full electronic visibility of the medical card panel of patients available to them and have the facility to electronically allow temporary extension of eligibility for expiring cards where a sensitive renewal is appropriate. The temporary extension may also be allowed where they are aware that a person is still availing of services but there may be something that prevents them from carrying out a standard review, e.g. a blind person with little family support.

Given that over 40% of the population, or about 2 million people, qualify for a medical card or GP visit card, the scale of the administration of the GMS scheme is significant. Over 700,000 individuals were assessed by the HSE in 2013. Well in excess of 95% of applications were processed within the target of 15 working days. I am satisfied that both applications and reviews are undertaken in a facilitative manner and that every support is afforded by the HSE.

The HSE is currently examining how individuals, who are not entitled to a medical card, could still receive services that meet their needs. This issue is being addressed in a manner that includes all of the services and supports provided by the HSE with as much flexibility as is available and at a local level.