Jimmy Harte (Labour)
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I thank the Minister of State for taking the time to attend the House. A practical problem is arising in the north west over medical cards, particularly in County Donegal.

In other parts of the north west the review letters have gone out. I have been contacted in many cases by people with family members in nursing homes, sometimes over 90 years of age, who are being asked to resubmit the review. Through no fault of their own, they had not been reviewed for ten years. Some families are getting frustrated because some of the information being requested cannot be ascertained and they feel that they are forced to fill in the forms incorrectly. Are allowances being made in cases where information cannot be garnered from individuals? In one case a son asked his father about money and assets because the mother had died some years earlier and she had looked after the family's financial affairs and the father, who is now at an age where he suffers from dementia, did not know. The family do not know the information and feel they are compromising the medical card application. Could the HSE or the Department issue direction for such extreme cases? Others have come to me and the process for replying has been quite straightforward but when a person finds it difficult to reply, there should be some sort of provision for that.

Alex White (Dublin South, Labour)
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I thank the Senator for raising this issue. The Health Service Executive operates under the legislative framework of the Health Act of 1970 as subsequently amended. In the interest of probity, the HSE is obliged, irrespective of the age of the person, to ensure that a person's eligibility is correctly recorded in line with the eligibility legislation and the national guidelines. The HSE aims to ensure that every person who is entitled to the medical card schemes is given the opportunity to avail of their entitlement. The Senator may be aware that the HSE spends in the region of ¤750 million on medical cards for persons aged over 70 years of age, mainly on prescription drugs and GP care. The HSE is legally obliged by legislation to have regard to the need to secure the most beneficial, effective and efficient use of its resources. However, where an individual requires help or has any questions or difficulties in completing a medical card application or review form, he or she, or a member the family, should contact their local health office, where the staff continue to provide assistance.

Medical cards are provided to persons who, under the provisions of the Health Act 1970, are in the opinion of the HSE unable without undue hardship to arrange GP services for themselves and their dependants. Under the legislation, determination of eligibility for a medical card is the responsibility of the HSE. The assessment tor a medical card is determined primarily by reference to the means, including the income and reasonable expenditure, of the applicant and his or her partner and dependants.

A new medical card scheme for persons aged 70 years or over was introduced with effect from 1 January 2009. Under this scheme, a person who is ordinarily resident in the State qualifies for a medical card when he has attained the age of 70 years as long as his gross income does not exceed the means test income limit. The income limit for a single person is ¤700 per week and the relevant income limit for a couple is ¤1,400 per week.

Reviews for medical card holders who are 66 years or over now operate on a sell-assessment basis. The length of validity for all standard medical cards for people under 66 is now three years. However, the length of validity for people aged 66 years and over is four years.

Any medical card holder undergoing a review to renew a medical card who genuinely engages with the HSE in that review will not have his entitlement withdrawn before the review is complete, regardless of the expiry date shown on the medical card. In cases where a decision is made not to grant a medical card, the applicant is informed of the decision and is notified of his right to appeal this decision. Contact details for the appeals office are provided to him. Where a person submits an appeal to a decision not to renew a medical card within 21 days of that decision, he retains his medical card or GP visit card until the appeal is decided.

All efforts are made by the HSE to deal with the individuals properly, fairly and impartially. The circumstances outlined by the Senator where it is not possible to ascertain the existence of assets, if that relatively unusual situation is communicated in the course of this exercise, I am sure the HSE and those dealing with the area will deal with the situation in a sensitive and pragmatic way. There is a legal responsibility on the HSE to ensure that people are properly entitled to a medical card get one. As far as information about assets or means is concerned, it is usually ascertainable but I accept there may be circumstances where there are difficulties in that regard. I emphasise that the HSE will exercise sensitivity and will be pragmatic but people must engage in the fullest possible with the HSE rather than, as was suggested by the Senator, feeling reluctant to give information. They should give the information as best they can and if there is a lack of certainty about the information, that should also be outlined. People will deal with this with their eyes wide open on both sides.

Jimmy Harte (Labour)
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I thank the Minister of State for that reply. The fact it seems to be geographically specific, perhaps there are more medical card reviews in Donegal because of the population profile and unemployment but the local office should contact the families of those in nursing homes. People have to ask their relations in nursing homes about their assets and they are not perhaps compos mentis. The local office should contact the nursing home to inquire about particular difficulties. I know a family who were normally on top of their affairs but in this instance they felt constrained and did not want to put down information that they were not sure about. Families are not always aware of the help that is available because this might be only happening for the first time.