John Halligan (Waterford, Independent)
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5. To ask the Minister for Health if he will clarify the situation whereby in assessing income for eligibility of a medical card, persons over 70s are assessed on gross income but under 70s are assessed on net income; his plans to rectify same and assess income based on net income for all applicants; and if he will make a statement on the matter. [48353/13]

John Halligan (Waterford, Independent)
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I ask the Minister for Health if he will clarify the situation whereby in assessing income for eligibility of a medical card, persons over 70s are assessed on gross income but under 70s are assessed on net income. Does he have any plans to rectify this and assess income based on net income for all applicants? I ask him to make a statement on the matter.

Alex White (Dublin South, Labour)
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Under the Health Act 2008, automatic entitlement to a medical card for persons aged 70 and over ended on 31 December 2008. Under the arrangements effected by the Act, a revised system of assessment for eligibility was introduced for those 70 years of age and over, based on the significantly higher gross income limits rather than the standard net income thresholds. This advantageous arrangement for persons aged over 70 years has facilitated a much greater share of this cohort qualifying for a medical card compared with the population as a whole.

In the main, persons in the over 70 age cohort do not have the same outlays and expenses as those under 70 who are assessed on a means basis. Under the standard means tested medical card scheme, allowance may be made for rent or mortgage, travel to work and child care costs. Generally, for the over 70s, mortgages have been cleared, children have been catered for and they would not have costs for travel to work.

However, persons aged 70 or older who are assessed as ineligible under the gross income thresholds may also have their eligibility assessed under the means tested medical card scheme where they face particularly high expenses, for example, nursing home or medication costs. As I have outlined, this assessment is based on net income and assessable outgoing expenses and the qualifying income thresholds under this scheme are lower than the gross income thresholds for those over 70.

Furthermore, persons aged over 70 years may still be eligible for a medical card on a discretionary basis where they face undue hardship in arranging medical services as a result of medical or social circumstances. There are no proposals to change the assessment from a gross income basis to a net income basis for the over 70 age cohort.

John Halligan (Waterford, Independent)
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In recent weeks I have come across three people aged over 70 who have been refused medical cards. They discovered the reason was that gross income is assessed in their cases. This is an issue of equality. One would imagine that those aged over 70 should be treated the same as those aged under 70 in the assessment of income and net income should be used for everyone. The HSE has launched an information campaign about the medical card system in recent weeks. One of its reasons for doing so was the widespread confusion about medical cards. Does this situation not add to the confusion and distrust citizens have in the operation of the system? There should be equity in the system regardless of how we assess the medical cards. The age of the applicant does not matter and the same criteria should be set for all. This is confusing for those who work within the health service, given the number of Deputies and local authority members contacting them on the issue of inequality in the assessment of medical cards.

Alex White (Dublin South, Labour)
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This was a particular scheme introduced some time ago for the over 70s, as the Deputy will be aware and it is tailored to that age group. As I indicated in my reply, given that it is predicated on gross income, the arrangement facilitates a much greater share of that group of people being able to qualify for a medical card compared with the population as a whole. While I do not have the figure before me, I believe this is correct. Even after the changes announced in the budget - the legislation is to be introduced today or tomorrow - approximately 93% of those aged over 70 will still have either a full card or a GP-only card. It is a scheme specific to the over 70s and it is of advantage to those over 70. The rationale for having an assessment on gross income for the over 70s is based on that.

I agree with the Deputy on the need for more information and clarity, and the HSE has made great strides in recent weeks in doing that. We will listen carefully to any proposals Deputies have on how best to communicate the HSE's administrative scheme.

John Halligan (Waterford, Independent)
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Could the Minister of State propose an amendment to the Bill going through the House this week to provide for equality of treatment thereby making the system fair? Like other Deputies, I have spoken to people in the health service who say making an application and assessment for people over or under 70 is confusing. An amendment to the Bill would clarify the situation.

Alex White (Dublin South, Labour)
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There is no proposal to amend the Bill we propose to bring before the House. Does the Deputy think it should based on net income for all or gross income for all? There is no proposal to do either but I am curious as to which one the Deputy is proposing.

John Halligan (Waterford, Independent)
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One way or the other. One cannot have it every way. The Minister of State accepts that people are confused.

Alex White (Dublin South, Labour)
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I do not think people are confused when we explain that there is a different way of assessing income. It is net income for the general population and gross income for the specific group of over-70s. There may be some confusion on the part of people regarding forms and how the thing is managed and that is what we are trying to deal with and I think the HSE is doing a good job on that.