James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the Deputy for raising this issue.

Under the Health Act 1970, eligibility for a medical card is founded primarily on the undue financial hardship test. Under the legislation, determination of an individual's eligibility for a medical card is the responsibility of the Health Service Executive. The 1970 Health Act obliges the HSE to assess whether a person is unable, without undue 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. If an applicant's means are above the financial thresholds for eligibility for a medical card or a GP visit card, as set out in the national guidelines, the HSE examines for any indication of medical or social circumstances, which could result in undue financial hardship. However, even where a person exceeds these financial thresholds, eligibility may be granted on a discretionary basis if these circumstances are such that a person cannot access general practitioner or other medical services without undue financial hardship. In these cases, social and medical issues are taken into consideration by the HSE when making a decision on eligibility.

It is important to note that discretion is not a stand-alone exercise. Exercising discretion remains an integral part of the assessment process for a medical card.

Eligibility for a medical card continues for as long as a person meets the criteria set out in the Health Act. The legislation requires a person to notify the HSE of any change in their circumstances, including income, expenditure, medical or social issues, which renders them no longer entitled to a medical card. In practice, few people do so. As a result, the HSE has an obligation to ensure that the medical card register is as accurate as possible and that its voted budget is being spent appropriately in the medical card scheme. One recognised auditing practice now carried out by the HSE is random reviews.

All card holders, irrespective of the basis on which the card was awarded, may be subject to a periodic review of eligibility to determine continuing eligibility. As Deputies will be aware, each person eligible to a medical or GP visit card receives a plastic card on which a "valid to" date is printed. This is the latest date that a review may be conducted in respect of that person. Notwithstanding the "valid to" date printed on the card, the HSE reserves the right to review eligibility at any time and to take appropriate action in circumstances where the cardholder no longer fulfils the criteria for eligibility under the medical card-GP visit card national assessment guidelines.

Persons who have been granted a medical card under the financial hardship provisions of the medical card scheme are required, when the subject of a review assessment, to submit all relevant and up-to-date details. This is necessary so that the HSE can make a correct determination of continuing eligibility. Where an applicant indicates on a review application that medical evidence has been previously submitted relating to a life-long medical condition, and this has been confirmed by the HSE, the HSE will not request further medical evidence in this regard. The applicant will, however, be required to submit all other information material to a review assessment.

A critical element of probity in the medical card scheme is the ongoing review of client eligibility by the HSE. Overall, the HSE assessed the eligibility of more than 700,000 individuals in 2013. More than 95% of complete applications were processed within the 15 working days target. I am satisfied that all reviews undertaken are appropriate and carried out in an appropriate and a facilitative manner.

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