I propose to take Questions Nos. 24 and 30 together.
Under the Health Act, 1970, eligibility for a medical card is based on whether a person is unable, without undue hardship, to arrange GP services for themselves and their family, having regard to their overall financial situation and reasonable expenditure. Under the legislation, having a particular illness or disability, in itself, does not establish eligibility for a medical card.
All applications or reviews concerning medical and GP visit cards must be supported with a range of documentation. This requirement is clearly outlined on the relevant forms and where such supporting documentation is not supplied, or is incomplete, the HSE will issue correspondence to the applicant, specifying the additional information required.
All medical card and GP visit card holders are subject to a periodic review to determine continuing eligibility. The HSE has a very structured review process and makes every effort to ensure on-going engagement with clients during this process. If the HSE is made aware that a person has special needs, assistance will be afforded to help that person complete the application whether at application stage or at review stage. The local health office can be contacted or LoCall 1890 252 919 to request this assistance.
The HSE also makes every effort to provide a person with sufficient time to renew their eligibility. Each month, the HSE identifies those medical/GP visit cards that are scheduled for review within three months. The HSE has increased this notification time to four months in respect of those clients who were granted eligibility on the basis of discretion. This is to allow an additional month to ensure that all pertinent medical and other data is provided for inclusion in the assessment process.
Persons are requested to return their completed review forms at least one month in advance of the due expiry date of their existing card. This is to allow the HSE sufficient time to carry out the review and/or to get back to the individuals, if the application is incomplete or requires any further details to be furnished.
Where a review form is returned, but not fully completed by the expiry date, it is HSE policy to extend the eligibility of the client for a reasonable period of time until the review is carried out. Medical card holders who genuinely engage with the HSE will not have their eligibility withdrawn before that review is complete.
Where an applicant indicates on their review application that medical evidence has been previously submitted relating to a life-long medical condition, and this has been confirmed by the HSE, the HSE will not request further medical evidence in this regard. The applicant will, however, be required to submit all other up-to-date information material to a review assessment.
Eligibility for a medical card only exists for so long as a person continues to meet the criteria set out in the Health Act. The HSE has an obligation to take measures to ensure that the medical card register is as accurate as possible. One recognised auditing practice, which the HSE now carries out, is to undertake random reviews. The selection criteria on which such random reviews occur varies from time-to-time.
All card holders - irrespective of the basis on which the card was awarded – may be subject to a periodic review of eligibility. Each medical card or a GP visit card includes a “valid to” date. Notwithstanding the date printed on the card, the HSE reserves the right to review eligibility, at any time.
GPs are advised three months in advance of the review dates of their patients’ GP visit cards/medical cards and, subsequently, the following month and the month after that, if the patient has not returned the review form by that time. GPs have full electronic visibility of their medical card panel of patients and have the facility to allow temporary extension of eligibility for expiring cards where a sensitive renewal is appropriate. The temporary extension may also be allowed where they are aware that a person is still availing of services but there may be something that prevents them from carrying out a standard review.
Given that over 40% of the population, or about 2 million people, qualify for a medical card or GP visit card, the scale of the administration of the GMS scheme is significant. Over 700,000 individuals were assessed by the HSE in 2013. Well in excess of 95% of applications were processed within the target of 15 working days.