Under the provisions of the Health Act 1970 (as amended), eligibility for health services in Ireland is based primarily on residency and means. The Act provides that persons who are unable, without undue hardship, to arrange GP services for themselves and family can qualify for full eligibility (a medical card). The HSE can only award medical cards in accordance with the Health Act and, therefore, it must assess applicants on the overall financial situation of the applicant and his or her spouse or partner.
The HSE is obliged to operate within the legal parameters as set out in the Health Act, while also responding to the variety of circumstances and complexities faced by individuals who apply for a medical card. Under the legislation, there has never been an entitlement to a medical card based on having a particular disease or illness. The HSE gives effect to this legislation through its Medical Card National Assessment Guidelines.
The HSE's Expert Group on Medical Need and Medical Card Eligibility examined the issue of awarding medical cards on the basis of illness and concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. The Expert Group also concluded that a person’s means should remain the main qualifier for a medical card. This position remains unchanged.
Nevertheless, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face 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 also has a system in place for the provision of medical cards in response to emergency situations i.e. in circumstances where persons are in need of urgent or on-going medical care that they cannot afford and also for persons in palliative care who are terminally ill.