Alex White (Dublin South, Labour) | Oireachtas source

I thank the Senator for raising this issue. 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. As set out in the Act, medical cards are awarded to people who are unable without undue hardship to arrange general practitioner, GP, services for themselves and their family, typically where their means are below the HSE's income thresholds.

Discretionary medical cards are awarded to people who are unable without undue hardship to arrange GP services for themselves and their family even though their means exceed the HSE's income thresholds. In these cases, social and medical issues are taken into account when considering whether undue hardship exists for the applicant. However, the HSE can provide medical cards in emergency circumstances to patients who are in urgent need of medical care that they cannot afford. Medical cards can be issued in emergency circumstances within 24 hours of receipt of the required patient details and letter of confirmation of condition from a doctor or consultant. Medical cards issued due to an emergency are generally requested by a manager in a local health office or a social worker. A medical card can be requested in response to an emergency from the central office in respect of a person in palliative care, who is terminally ill; a homeless person in need of urgent or ongoing medical care; a person with a serious medical condition in need of urgent or ongoing medical care; a foster child in need of urgent or ongoing medical care; or an asylum seeker with a serious medical condition in need of urgent or ongoing medical care. An emergency medical card can only be issued to an individual named person - that is, no dependants will be included, unless a case is made separately for any other member of the family on medical emergency grounds. With the exception of those for terminally ill patients in palliative care, all emergency medical cards are issued for six months on the grounds that the patient is eligible for a medical card on the basis of means or undue hardship and will follow up with a full application, along with all the normal documentary evidence required to assess eligibility, within four weeks of receiving the emergency card.

It can take a day to physically produce the plastic card and a further day in the post, but the medical card number can be provided to the local office or social worker within 24 hours if requested. Once approved, any primary care contractor can validate the entitlement of a customer through the online system.

Where a doctor or consultant certifies that there is a terminal illness, the nature of the terminal illness is not a deciding factor in the issue of a medical card and no means test applies. The HSE monitors such cases and can renew a client's eligibility, if necessary. In such circumstances, again, there is no assessment of means.

I am satisfied that, given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure a person receives a medical card as quickly as possible. In addition, the individual is afforded time to furnish the requisite follow-up documentation, as required. As the HSE ensures the system responds to the variety of circumstances and complexities faced by individuals in these circumstances, there are no proposals to extend the six month period to 12 months. However, I have listened carefully to what the Senator has said and as he and the House will be aware, there has been much discussion recently about this entire area and observations or insights Senators have in respect of the operation generally of the medical card scheme, including the discretionary and emergency aspects of it, will be taken carefully into account by me in the discussions, contacts and deliberations we will continue to have with the HSE on the administration of the schemes. There is considerable interest in and some concern on the part of colleagues about certain aspects of the schemes. The insights of Senators, including Senator Colm Burke, will be taken on board and considered by me in the discussions. There is no intention or proposal to extend the period, as suggested by the Senator.