Thursday, 5 December 2013
Medical Card Appeals
I welcome the Minister of State, Deputy Alex White, and thank him for taking the Adjournment debate. A few days ago I was contacted by a mother who recently learned that her son's medical card was to be removed with effect from 30 November 2013. We have had many debates on medical cards but this case is important to highlight as it is affecting many other families with children who have special needs.
The boy in question is two years of age and has had a medical card since he was three months old. He was born in 2011. The medical card was up for review last month and the family's means were deemed too great to be granted the continuation of their son's medical card. This family has yet to receive the letter withdrawing the medical card but I contacted the Department of Health and was told their son's medical card has been withdrawn and that a letter was sent to the family on 25 November.
The child in question has a very serious condition, hydrocephalus, for which he has a shunt. He cannot walk, talk or feed himself. He attends numerous doctors and specialists including neurosurgeons, specialists in eye clinics, paediatricians, dietician, physiotherapist, occupational therapist and speech and language therapist. As evidenced by this list, this child's level of care and intervention needs are very high and would be a substantial financial burden on this family were it not for the medical card. For example, last May he needed his shunt reviewed and it was discovered that he required immediate brain surgery which cost thousands of euro. Additional costs include medication such as the anti-seizure medication he needs to take regularly, the specialist shoes and splints that cost hundreds of euro and the specialist equipment required to aid him in sitting and standing and encourage him to walk.
On paper this family might appear to be able to cope with the financial burden of a chid with substantial special needs but reality tends to be much different from what is assessed on paper. In the coming months this family will welcome a new little brother or sister to their family, which will add to the pressures they already experience. I cannot help but believe this young child will regress without the appropriate level of support provided by the medical card. It is because the State has provided a medical card for this young boy that he has achieved all he has to date. If the medical card is taken from him we would do him a major disservice and send the wrong message to the family. The boy's mother is distraught at the thought of losing the medical card. While she understands the family might be above the financial threshold, the cost they would pay for services for their son greatly outweighs their income.
This opens up the wider area of medical card discretion for children with significant special needs. I have addressed the Minister on this before. This mother, like other mothers of children with special needs, must fight to get the services she needs for her child. The withdrawal of the medical card is an added burden. She said she would be better off leaving her job and going on social protection because she would then be eligible for the medical card. I cannot understand that logic when we want people working and being able to provide the best for their children.
I plead with the Minister to examine this particular case and the wider issue of discretionary medical cards.
Every case is completely separate. The expenses I have outlined do not take into consideration other child care costs if there is a new addition to the family. This child and family desperately need the medical card to provide the best outcome for the child in question.
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.
I thank the Minister of State for his reply but I am disappointed when one examines the individual circumstances of this case. To date, the family has not received a letter from the HSE. I will pass this information on to them. I understand the family is above the financial threshold but the costs of services and needs of the child in question greatly outweigh the family’s income. If the mother in question were to give up work tomorrow, she would have a medical card reinstated. Instead, she loses her medical card because she is working. I hope everything that can be done will be done for this family to have its medical card reinstated.
I understand the Senator’s points. I do not know the individual specific circumstances of the case. There is a process in place for an appeal. It is a matter for the appeals officer to make a decision. I can only advise the House on what the processes are and how they should be invoked in these circumstances. The Minister does not have a role in this.
There are clear processes in place. If the process is not working in the way I have advised then, of course, I would have a role in ensuring the process is properly and correctly followed. As for the individual case in question, that is matter for appeal.