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Medical Cards

Dáil Éireann Debate, Tuesday - 12 July 2022

Tuesday, 12 July 2022

Questions (87)

Michael Moynihan


87. Deputy Michael Moynihan asked the Minister for Health if he intends to review the medical card assessment process for persons with disabilities; and if he will make a statement on the matter. [37502/22]

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Oral answers (6 contributions) (Question to Health)

Does the Minister intend to carry out a review of the medical card assessment process for people with disabilities? What shape would such a review take?

Eligibility for a medical card is primarily based on a financial assessment in accordance with the Act of 1970. The issue of granting medical cards on the basis of illness or a disability was previously examined in 2014 by an expert panel on medical need and medical card eligibility. The panel concluded that it was not feasible, desirable or ethically justifiable to list medical conditions in priority order for medical card eligibility.

An example was where there was discussion around medical cards for cancer patients. The answer we got back was not to create a hierarchy of diseases, such as a cancer patient versus someone with motor neurone disease and so forth. That was not recommended in the 2014 report. However, since December 2018, the medical card earnings disregard for people in receipt of disability allowance was substantially increased from €120 to €427 per week. It applies to the assessment process for single people and to family assessments. This very significant policy change gave effect to the important recommendation of the Make Work Pay for People with Disabilities report. This substantial increase in allowable earnings acknowledges that a medical card is a particularly significant support and ensures that people with disabilities can continue to be supported to access care where needed. Furthermore people who have been on a disability payment for at least a year can retain a medical card for a further three years on return to work provided they were in receipt of the payment for a period of at least 12 months prior to commencing employment.

Week after week at the Joint Committee on Disability Matters, disability advocacy groups and people with disabilities come in. They constantly say that the medical card is gold for a person with a disability. It is hugely important that it is maintained. In some instances people with disabilities can get therapeutic work. They can earn extra income on top of the disability allowance. There is a stop in the system whereby people lose their disability benefits if they are able to get part-time work, which would have a huge impact on their lives and how they live their lives. The previous review was eight years ago. It is important that a review now takes place and we look at ensuring that someone who has a disability continues to have the medical card rather than lose it.

I fully agree that we should not have a situation where somebody with a disability can and wants to go to work, but if he or she does, he or she will go over the income threshold and thereby lose the medical card. We all appreciate how important it is, as the Deputy pointed out, particularly for people with disabilities to retain the medical card. In that regard, I will be happy to discuss it further with the Minister of State, Deputy Rabbitte. No doubt Deputy Moynihan will continue to do so as well. If there is a review and if there are specific barriers catching people in what traditionally would be viewed as a poverty trap, when going to work leaves them worse off, we need to make sure that going to work leaves them better off. Everybody, whether they have a disability or not, needs to be able to lead the fullest life possible. If there are such perverse incentives, we should certainly undertake a review.

In regard to the medical card, there is one other issue on disabilities. I do not wish to list the disabilities, but I refer to a person with a diagnosis of a lifelong disability and who got a medical card in his or her younger years. At some point, there is a review. The person's income has not changed as he or she is on disability, and probably will be for life. Documentation comes back and the person must submit again a letter from his or her GP or consultant outlining the specific diagnosis. The diagnosis is not going to change. There should be an in-built mechanism within the medical card system whereby if a person has a disability or a chronic illness that is life-changing and for life, that should be noted. Families should not be asked whether the person is still disabled or whether he or she still has a specific diagnosis. This happens and it is completely unjust.

I am reminded of a session I was at a few years ago in the audiovisual room where this was brought up. Parents of children gave testimony. They had been through awful things. One mother said she had been asked whether her child still had autism. We all understand that is not an appropriate question. It is quite a ridiculous question to ask. My understanding is that some of this arises when a child transitions to adult schemes. When the child turns 16, there is another process regarding adult payments and supports. Some of it may be linked to that. It is an issue of which the Minister of State, Deputy Rabbitte, is aware. No doubt she will be happy to engage further. If we can find ways to alleviate that, we should do so.