Eligibility for health services in Ireland is primarily based on residency and means. Under the Health Act 1970, determination of eligibility for medical cards is the responsibility of the Health Service Executive (HSE) other than for persons over 70 who are automatically entitled to a medical card.
Medical cards are issued to persons, who in the opinion of the HSE are unable to provide general practitioner, medical and surgical services for themselves and their dependants without undue hardship. It is open to all persons, including those with a disability, to apply to the chief officer of the relevant HSE area for health services if they are unable to provide these services for themselves or their dependents without hardship.
The setting of income guidelines for medical cards is a matter for the HSE which has discretion in issuing of medical cards, and a range of income sources are excluded when assessing medical card eligibility. Despite someone having an income that exceeds the guidelines, a medical card may still be awarded if the HSE considers a person's needs or other circumstances justify this.
Persons aged 16-25, including students, who are financially dependent on their parents are entitled to a medical card if their parents are medical card holders. Those who are dependants of non-medical card holders are not normally entitled to a medical card except where they have an entitlement under EU regulations or where they are in receipt of a disability allowance.
For those who do not qualify for a medical card there are a number of schemes which provide assistance towards the cost of medication. Under the long term illness scheme, the relevant area of the HSE may arrange for the supply, without charge, of drugs, medicines and surgical appliances to people with a specified condition for the treatment of that condition. These conditions are mental disability, mental illness — for persons under sixteen -, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, diabetes mellitus, diabetes insipidus, haemophilia, cerebral palsy, epilepsy, multiple sclerosis, muscular dystrophies, parkinsonism, conditions arising from thalidomide and acute leukaemia.
Non-medical card holders can also avail of the drugs payment scheme, which protects individuals from excessive drug costs. Under this scheme, no individual or family unit pays more than €85 per calendar month towards the cost of approved prescribed medicines.
The health strategy includes a whole series of initiatives to clarify and expand the existing arrangements for eligibility for health services including recommendations arising from the review of the medical card scheme carried out by the health board CEOs under the Programme for Prosperity and Fairness.
The Programme for Prosperity and Fairness also contained a commitment that a working group be established to examine the feasibility of introducing a cost of disability payment. This working group is to conduct a review of medical card entitlements for people with disabilities.