Joanna Tuffy (Labour)
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My question to the Minister of State concerns a particular case of a married couple. The husband is in receipt of an old age contributory pension, and claims qualifying adult allowance for his wife. Their joint income is €298.80. In October they qualified for the medical card, under the medical card income guidelines. It has come to my attention that because of the budget increases, that couple may be over the income limit for the medical card as they are now in receipt of a total income of €322.10. Will the Minister of State clarify the position? Does he analyse the situation in the same way? It is a matter of concern. A few months ago, when the income guidelines were announced, the couple qualified for the medical card. However, the social welfare increase made a couple of months later means they are outside the income limits.

Since formulating the question, I examined this issue and found other incidents where people qualified for the medical card or the GP visit card on a social welfare income in October 2005 but, following budget increases, are now outside the income guidelines. A married couple aged under 65 years, where the husband is in receipt of an invalidity pension and claims qualifying adult allowance for his wife, had a total income of €264.30 before Christmas. That brought them within the medical card income guidelines limit of €266.50 for a married couple up to 65 years. The new social welfare rates introduced in the budget mean their income is more than the medical card income limits as they are in receipt of €293.50. That is made up of €171.30 for the claimant and €122.20 for the qualifying adult.

Another example is a married couple aged between 66 and 69 years where the husband was in receipt of the old age non-contributory pension and claiming qualified adult allowance for his wife. That is made of €166 for the claimant and €109.70 for the qualifying adult totalling €275.70. That would leave them under the medical card income guidelines of €298 for a married couple aged between 66 and 69 years. However, with the new social welfare rates following the budget, the claimant will have an income €182 and the qualifying adult will have an income of €120 totalling €302. That brings the couple over the medical card income limit.

I am concerned, although some people might be within the guidelines because they might have receipts which they could include in their application for the card. However, some people might not have those receipts and within two months, they will find themselves outside the income limits for the medical card. Surely the Government should now increase the income limits as a matter of urgency. Am I correct in my analysis of the position or am I missing something? Is there any way around this?

Seán Power (Kildare South, Fianna Fail)
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I thank Senator Tuffy for raising this matter. The determination of eligibility of applicants to medical cards is a matter for the Health Service Executive, HSE, as provided for under the provisions of the Health Act 1970. Since 2001, persons aged 70 and over have an automatic statutory entitlement to a medical card. In all other cases, medical cards are issued to persons for whom, in the opinion of the executive, the provision of general practitioner medical and surgical services for themselves and their dependants would prove unduly burdensome. In assessing applications, the HSE has regard to the financial circumstances and medical needs of the applicant.

Income guidelines are used by the executive in determining eligibility. They are not statutorily binding and in cases where a person's income exceeds the guidelines, a medical card may still be awarded if the executive considers that his or her medical needs or other circumstances would justify this. In the past, the Department of Health and Children has requested that increases in social welfare payments would not adversely affect the eligibility to medical cards of people in receipt of such payments. I understand from the HSE that it has been established practice for many years that anyone whose income was solely derived from social welfare sources would qualify for a medical card.

Furthermore, in December 2005, the Department asked the HSE to take account of the welfare, taxation and other changes announced in the budget in the operation of the income guidelines and to identify any changes which may be required in order to ensure that medical cards and GP visit cards will continue to be available to those who need them. In this regard, the HSE has indicated it is completing a review of the guidelines and expects to be in a position to make a recommendation in the near future.

The Senator will be aware the Tánaiste and Minister for Health and Children has made significant improvements to the way in which an applicant's eligibility for medical cards and GP visit cards is assessed. From 1 January 2005, the income guidelines were increased by 7.5% and significant rises were also made in the allowances provided for dependent children.

In June 2005, the Tánaiste simplified the means test for both medical cards and GP visit cards. It is now based on an applicant's and spouse's income after income tax and PRSI and takes account of reasonable expenses incurred in respect of rent or mortgage payments, child care and travel to work. On 13 October 2005, the income guidelines for both medical cards and GP visit cards were further increased by 20%. This means the income guidelines are now 29% higher than at the end of 2004. It will also be noted that income guidelines used for the assessment for GP visit cards are 25% higher than those used for medical cards.

The Health Act 2004 provided that the HSE has responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Given this, I would be happy to request the executive, on provision of the relevant details as outlined by Senator Tuffy to investigate and report directly to the Senator in respect of any specific cases which she raised.