Tuesday, 4 November 2014
Medical Card Applications
I also thank the Minister for staying on to take this Adjournment matter.
In the past number of months, taking a holistic view on it, our experience in dealing with the medical card primary care reimbursement service, PCRS, staff has improved. However, this case is an example of how matters were and how they should not be. I would not normally put a medical card application down as an Adjournment matter, but the applicant is suffering from considerable anxiety because of being moved from Billy to Jack and told one thing by one group and something else by another. Ultimately, the message from different staff within the PCRS system is conflicting. My office has been dealing with this application on a daily basis. My secretary would speak to one person and get one set of recommendations in terms of what is required, and having put the necessary paperwork together, then would be told that something else entirely is required.
There seems to be a breakdown in communications between the PCRS and the Revenue Commissioners, particularly when it comes to the Revenue website and for the self-employed who submit self-assessment. Apparently, when one makes a self-assessment, one is issued with a letter of acknowledgement which is considered a receipt but for some reason, the PCRS is of the view that a completely different documentation is required. Even the Revenue staff are baffled because such a document, for which we have been asked on behalf of these clients, does not exist.
Ultimately, I need somebody senior in the PCRS to take this file and resolve it for me. In my view - the financial statements are there to back it up - the person is entitled to a medical card but is being delayed because of bureaucratic non-engagement and, perhaps, through no fault of anybody, misunderstanding. It is merely one of these cases that is going on for months and it needs to be resolved.
The Senator will be aware that in accordance with the relevant health legislation, full eligibility for a medical card is awarded where a person cannot arrange GP services for himself or herself and his or her family without undue hardship, having regard to his or her financial circumstances.
It is important to clarify that, under the Health Act 1970, as amended, the determination of an individual's eligibility for a medical card is the statutory responsibility of the HSE. Under the legislation, it is clear that there is no role for the Minister for Health in assessing an individual's medical card eligibility. Furthermore, under the Health Act 2004, as amended by the Health Service Executive (Governance) Act 2013, the Minister for Health may not give a direction to the HSE relating to a decision concerning the eligibility of an individual.
By way of assistance, Senators may be aware that there is a dedicated PCRS contact service for Members of the Oireachtas. This service deals specifically with queries about medical cards and GP visit card. The details of the contact service have been issued to all Members of the Oireachtas and I would be happy to forward the details to Senators, if they so wish.
On the case to which the Senator refers, I believe it would be inappropriate to discuss the family circumstances and their financial details in public in the Seanad. However, I can advise the Senator that medical card applications are considered by the HSE in a fair and equitable manner on the basis of an assessment of the applicants' means, by reference to the HSE's national assessment guidelines and in accordance with the health legislation.
The HSE has, however, discretion to grant a medical card in circumstances where there is undue hardship in the arranging of medical services. For example, if an applicant's means are above the financial thresholds set out in the national guidelines, the HSE examines for any indication of medical or social circumstances, which might result in undue hardship in the arranging of medical services. In order to fully take account of all the relevant circumstances that may benefit an applicant in the assessment, a range of information and documentation must be provided, as outlined on the application form.
The HSE makes every effort to provide a person with sufficient time to renew his or her eligibility. Where a review form is returned, but not fully completed by the expiry date, it is HSE policy to extend the eligibility for a reasonable period of time until the review is carried out and a final decision made. I understand from the HSE that in this case some information is outstanding.
Finally, I can advise the Senator that medical card holders who engage with the review of their medical card eligibility will not have their eligibility withdrawn before the review is complete.
I note the reply. Of course, one would not discuss a specific case particulars on the floor of the House. This is an example of where the system still is not working. The information requested has been provided but yet it is deemed not acceptable, although Revenue cannot understand what is acceptable because what is deemed to be acceptable by the PCRS does not exist in the eyes of Revenue. That has also been backed up by the client's accountants.
I like to deal with matters in a positive manner. I would be happy if the Minister gave a commitment that he would request a senior person in the PCRS to deal with this file - not direct him or her as to what to do - and to iron out the crinkles that exist.
If the Senator contacts my private office later in the week I can undertake to have a senior person examine the file. As the Senator accepts, I cannot direct him or her to provide a medical card.