Under the Health Act 1970, eligibility for a medical card is based primarily on means. The Act does not provide for automatic eligibility based on having a particular disease or illness.
The issue of granting medical cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.
However, the HSE does have a compassionate system in place for the provision of medical cards when it is informed that a patient is receiving end of life treatment – that is when patients’ unfortunately have a prognosis of less than 12 months. These applications do not require a means assessment nor are they reassessed.
Individuals may also qualify for a medical card through the means assessment process. Where such individuals might be in excess of the income guidelines every effort is made by the HSE, within the framework of the Health Act 1970, to support applicants in applying to take full account of the difficult circumstances, such as extra costs arising from an illness. In such circumstances the HSE may exercise discretion and grant a medical card.
Furthermore, since 2015 medical cards are awarded without the need of a financial assessment to all children under 18 years of age with a diagnosis of cancer.
It should also be noted that the HSE Clinical Advisory Group (CAG) was established in December 2019 to review eligibility for medical cards in cases of terminal illness. The work of the CAG group has concluded and a Report was submitted recently to my Department and is currently under active consideration.