Parliamentary Question addressed to the Minister for Health

To ask the Minister for Health the circumstances and their relative weighting, other than income, which are taken into consideration in awarding a medical card; and if he will make a statement on the matter?

Reply:

The 1970 Health Act states that persons who are unable, without undue hardship, to arrange GP services for themselves and family qualify for a medical card, having regard to the overall financial situation of the applicant and his/her dependants. Applications are, in the first instance, subject to a means assessment to determine   if assessable income declared is within the set income limits to qualify for a medical card or a GP visit card.   Medical card and GP visit card applications are considered in accordance with the Medical Card and GP Visit Card National Assessment Guidelines.

If an application is assessed over the qualifying financial thresholds for both a medical card and GP visit card or assessed as under the qualifying thresholds for a GP visit card only, and the application also includes other medical, social or financial details that do not form part of the means assessment, the application will then be considered on discretionary grounds for a grant of a card under the provisions relating to “undue hardship”/”unduly burdensome’ to arrange GP services for the medical card scheme of assessment. The assessment to be made in this instance is whether it is considered that ‘undue hardship’ will occur or an ‘undue burden’ be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs in the absence of medical card or GP visit card eligibility.

The National Assessment Guidelines provide guidance to a decision maker as to the relevant factors to have regard to in making an assessment as to whether the ‘undue hardship’/’undue burden’ provisions apply to the circumstances presented on an application. In particular, the guidelines state that the ‘exercise of discretion by the HSE, in favour of the applicant, should be considered where meeting the costs of services covered by a Medical Card or a GP Visit Card compromises the applicant’s or his/her family’s ability to meet the essential costs associated with:

–         maintenance of employment

–         provision of reasonable housing

–         provision of appropriate nurturing and care for children or dependants

–         provision of adequate heating, nutrition and clothing, or

–         coping with exceptional personal and financial burdens arising from medical or social circumstances.

In conducting this assessment, the Guidelines state that the following issues be taken account of on an application:

–         Illness or medical circumstances which results in financial hardship.

–         The cost of providing general medical and surgical services.

–         The cost associated with the provision of medical, nursing and dental treatment.

–         The cost of physiotherapy and speech and language therapy.

–         Transport cost to hospitals and clinics.

–         Addictions such as drink, drugs and gambling.

–         Poor money management.

–         Social deprivation €“ including poor home management.

–         The cost of medical aids and appliances.

The HSE will give equal consideration to each of the above factors that present on an application in deciding whether to approve that application for grant of a medical card on grounds of ‘undue hardship’/’undue burden’.

The decision maker may make appropriate inquires or seek advice from other sources to assist with coming to a decision on ‘undue hardship’/’undue burden’; these sources may include:

–         The Applicant’s Doctor(s).

–         The HSE’s Medical Officers.

–         The Public Health Nurse.

–         The Community Welfare Officer.

–         Social Worker.

–         Therapy Services.

–         Money Advice and Budgeting Service (MABS).

I trust the above clarifies the circumstances, in addition to income, taken into account in deciding whether to approve medical card eligibility on discretionary grounds.