While there has been a reduction in the number of discretionary medical cards, I wish to assure the Deputy that there is no policy to reduce the number of medical cards issued where discretion is involved in the assessment process. The fact is that many people who used to hold discretionary cards have been granted medical cards on income grounds because they now fall within the means thresholds. Only a very small proportion of people with discretionary medical cards who have been reviewed recently have been found to be ineligible for a medical card. Of the discretionary cards in circulation in 2011, less than one tenth have been found to be ineligible on review. On the other hand, even where medical expenses have been taken into account, some people have been found to be ineligible because their net income is in excess of the means thresholds, sometimes by hundreds of euro per week.
In accordance with the legislation, medical cards are awarded to persons who suffer undue financial hardship in the arranging of GP services including where this arises as a result of a disease or an illness. The HSE established a panel of community medical officers to assist in the processing of applications for medical cards where the income guidelines are exceeded but where there are difficult personal circumstances, such as an illness or physical disability. The medical officer reviews evidence of necessary medical expenses provided by the applicant. As appropriate, he or she liaises with general practitioners, hospital consultants and other health professionals so that costs relating to the health circumstances of the applicant can be taken fully into account.
The Minister for Health and I are conscious of the difficulties faced by the relatively small number of people who have been found to be ineligible. At his request, the HSE is currently examining how individuals who are not entitled to a medical card could still receive services that meet their needs. This examination relates to all of the services and supports provided by the HSE and with regard to as much flexibility as is available at a local level. Additional information will be provided and local information points will be established at major health centres around the country where members of the public can obtain comprehensive information and support in accessing the full range of supports from the health services. The objective is to maximise the supports available for patients and families.
Appropriate notice is also being considered as part of the review for existing medical card holders who may no longer be eligible on renewal, but where serious medical conditions or profound disability continues to exist in the household. The clear intention is to maximise the supports that can be provided in each case to the fullest extent possible. The HSE is seeking to find the best way to achieve this in order to ensure families will receive the support they need.