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 to arrange GP services for themselves and family without undue hardship, having regard to their overall financial situation, can qualify for a medical card. The HSE can only award medical cards in accordance with the Health Act and, therefore, it must assess the means and reasonable expenditure of the applicant, and his or her spouse or partner.
While there is no automatic entitlement to a medical card for persons with specific illnesses, or with a disability, the HSE has discretion to award a medical card to avoid undue hardship, having regard to person's or the family’s overall financial situation, even where the person's income exceeds the income guidelines. 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. As I have outlined, the 1970 Act established a financial means assessment and medical card eligibility is granted on the basis of the financial situation of the applicant. The nature of a disease or illness an applicant may have is not the basis for granting eligibility and, therefore, is not an indicator on the HSE's clients’ registers.
All medical card and GP visit card holders, regardless of the card having been awarded on the basis of means or where discretion was involved, 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. In order to have all of the circumstances of the applicant taken into account, it is necessary to have these reviews supported by 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.
The Long Term Illness Scheme is an illness/condition based scheme under which Downs Syndrome is covered and for which entitlement applies, irrespective of means. Where persons with Down's Syndrome are not eligible for a medical card following an assessment of their means, the HSE can provide their full requirements in respect of prescribed medicines and appliances free of charge through this statutory entitlement. Public dental, ophthalmic and aural treatment and appliances are also available free of charge to children and in respect of any difficulties identified at child health or school health examinations.