Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The Deputy may be aware of the key recommendation of the Report of the Expert Panel on Medical Need for Medical Card Eligibility that a person’s means should remain the main qualifier for a medical card. The Expert Panel Report also concluded that it is neither feasible nor desirable to list conditions in priority order for medical card eligibility. Therefore, medical card provision is based on financial assessment. Under the legislation, having a particular illness, in itself, does not establish eligibility for a medical card and therefore, the medical conditions of applicants for this scheme are not monitored on that basis. Accordingly, a patient suffering from either MS or MND will not have automatic eligibility for a medical card.
Where the applicant's income is within the income guidelines, a medical card or GP visit card will be awarded. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. The Act obliges the HSE to assess whether a person is unable, without due hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure and every application must be assessed on that basis.
Within the application process, the HSE endeavours to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The legislation allows the HSE, in certain circumstances, to exercise discretion and grant a medical card, even though an applicant exceeds the income threshold, where he or she faces difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.
The HSE is required to undertake reviews of eligibility in order to ensure that a person continues to meet the qualifying criteria required to continue holding eligibility. Where a medical card is due to expire, these cards are reviewed and a renewal notice is sent out to the medical card holder three months in advance of the expiry date. It is important to note that the person under review maintains eligibility for the card while the review is being conducted, including any period where additional information is requested. It should be noted that no reviews of discretionary medical cards are taking place at this time.