As the Deputy will be aware, eligibility for medical cards is set out in the Health Act 1970 (as amended). The Act provides that persons, unable without undue hardship having regard to their overall financial situation to arrange GP services for themselves and family, qualify for a medical card. There is no, nor has there ever been, an entitlement to a medical card for a person with a particular illness or medical condition and, therefore, in accordance with the legislation, it is not possible for the HSE to award a medical card.
The HSE has discretion to grant a medical card where a person's income exceeds the income guidelines. This discretion must be exercised by the HSE in accordance with the legislation. However, 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. The HSE is obliged to operate within the legal parameters as set out in the Health Act, while also responding to the variety of circumstances and complexities faced by individuals who apply for a medical card. Where discretion is exercised with regard to an applicant with an illness or disease, it is the medical costs of that condition on a person's financial situation that is relevant to the assessment for a medical card.
All medical card and GP visit card holders are subject to a periodic review of eligibility to determine continuing eligibility. Changes in card numbers is dependent on the level of ineligibility detected. However, it is important to note that where a medical card is withdrawn, irrespective of its having been awarded based solely on means or where the HSE has exercised discretion, it is not withdrawn due to the cost implications for the HSE. In accordance with the Health Acts, a medical card can only be withdrawn due to eligibility not having been established.