I propose to take Questions Nos. 796 and 865 together.
Under the Health Act 1970, eligibility for a medical card is based primarily on means. The issue of granting medical cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.
The HSE has however a compassionate system in place for the provision of medical cards when it is informed that a patient is receiving end of life treatment – that is when patients’ unfortunately have a prognosis of less than 12 months. These applications do not require a means assessment nor are they reassessed. There are currently almost 1,800 such medical cards awarded. Separately, terminally ill patients who do not meet the end of life criteria may also qualify for a medical card under the general assessment processes. Every effort is made by the HSE, within the framework of the Health Act 1970, to support applicants in applying for a medical card and to take full account of the difficult circumstances, such as extra costs arising from an illness.
Furthermore, since 2015 medical cards are awarded without the need of a financial assessment to all children under 18 years of age with a diagnosis of cancer.
It should also be noted that the Programme for Government ‘Our Shared Future’ contains a commitment to extend discretionary medical cards to those with a terminal illness. A HSE Clinical Advisory Group (CAG) was established in December 2019 to review eligibility for medical cards in cases of terminal illness. The final Report of the CAG was recently submitted to my Department and has been published. The Report notes that there are practical and legal challenges with extending eligibility for medical cards for terminally ill patients within the framework of the current process. However, I wish to assure the Deputy that I am committed to ensuring that terminally ill patients have access to the services they need. In that regard, my Department has devised a work programme which has been initiated and which will look to address the policy and legal findings of the Report and deliver on the Programme for Government commitment.