Alex White (Dublin South, Labour) | Oireachtas source

I thank Senator Moran for raising this issue.

By the end of October last, there were over 1,860,000 medical cards issued by the Health Service Executive, HSE. This represents an increase of over 60% in the number of medical cards, or 700,000 individuals, since the end of 2005. Over 40% of the national population now holds a medical card, compared to 27% at the end of 2005.

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. The 1970 Health Act provides that medical cards are awarded to people who are unable, without undue hardship, to arrange general practitioner services for themselves and their family. The HSE gives effect to this legislation through its medical card national assessment guidelines.

If an applicant's means are above the financial thresholds set out in the national guidelines, the HSE examines for any indication of circumstances, medical or social, which might result in undue financial hardship. 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 considered when determining whether or not undue financial hardship exists for the individual in accessing general practitioner or other medical services.

Discretion will be assessed automatically during the processing of an application where the applicant has provided additional information, which can be considered for discretion by staff or a medical officer, where appropriate. However, even in the event that additional information was not provided initially with an application, families can still provide other additional information for consideration on a discretionary basis following receipt of the correspondence indicating an unsuccessful decision. The HSE has a clinical panel of specialist medical professionals to assist in the processing of applications for discretionary medical cards, where a person exceeds the income guidelines but there are difficult personal circumstances, such as an illness.

With regard to the specific case to which the Senator refers, I have been advised by the HSE that, on 29 August 2013, a review notice was sent to the parents in respect of the medical card held by their son which was due to expire on 30 November 2013. An application was received from the family on 22 October 2013 which was incomplete and which required additional information on the family's weekly income and outgoings. In this regard, a letter requesting this information issued to the family on 25 October 2013.

The assessment found that the family's weekly income was above the national guidelines threshold for a medical card and a general practitioner visit card. The application was then referred to a medical officer for review under the processes I outlined above for consideration on a discretionary basis. Following this review, there was no recommendation to change the unsuccessful status of the application.

I am advised that the family was so informed by letter dated 25 November 2013. This letter included a financial statement and also outlined the options open to the family, namely to submit additional information to the HSE for a reassessment or to appeal the decision to the HSE appeals office.

I understand that an appeal has not been received by the appeals office. That may be explained by what Senator Moran outlined. The family concerned has 21 days to submit an appeal to the decision not to renew the medical card. Once the HSE primary care reimbursement service is informed of the appeal by the appeals office, the card previously held is reactivated pending the outcome of the appeal.