Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the Deputy for raising this matter. Under the provisions of the Health Act 1970, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. There is no automatic entitlement to a medical card for persons with a specific illness, including cancer. The income thresholds apply to all applications and there are no variations on these where an applicant or family member has a specific illness. The net weekly income limits for a married couple for a standard medical card are €266.50 and €298.00 for persons aged up to 65 years and aged 66 years or over, respectively. The net income limits apply after tax, PRSI, rent or mortgage payments, child care costs and travel to work costs are taken into account. A different system operates for persons aged 70 years and older. Assessment for a medical card is based on gross weekly income, which is €1,200 in the case of a married couple, well above the limit for people aged 66 years or under.

Under the legislation, there is provision for discretion by the HSE to grant a medical card where a person's income exceeds the income guidelines. The HSE takes a person's social and medical issues into account in determining whether "undue hardship" exists for a person in providing a health service for himself or herself or his or her dependants. The HSE set up a clinical panel to assist in the processing of applications for such discretionary medical cards where there are difficult personal circumstances. This approach recognises the need to have in place a standard process for considering applications in respect of people who, while over the income guidelines, require discretionary assessments on the basis of illness, such as cancer, or undue financial hardship.

The HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill or are seriously ill and in urgent need of medical care that they cannot afford. These are issued within 24 hours of receipt of the required patient details and the letters of confirmation of the condition from their doctors or medical consultants. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on grounds of means or undue hardship and will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual with a limited eligibility period of six months, which is what the Deputy is seeking.

For persons with a terminal illness, no means test applies. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible.

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