Seanad debates
Wednesday, 21 February 2024
Nithe i dtosach suíonna - Commencement Matters
Departmental Reviews
10:30 am
John Cummins (Fine Gael)
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I thank the Cathaoirleach. I thank the Minister of State for taking this Commencement matter this morning. It is disappointing that a line Minister is not here. If there are outstanding items, I would appreciate if I could get a response in writing. This issue will not be a new one for the Minister of State. I am sure his office deals with queries about medical cards in the same way my offices in Waterford city and Dungarvan do on a regular basis. He will also know the stress and strain periodic reviews of medical cards for those aged over 70 can cause. Generally, that generation is not as tech-savvy as the Minister of State or myself. There are some who are, of course, very tech savvy, but in general they need assistance from family members. Often, they do not have family members there to assist them with downloading and printing off statements and so on. The stress and strain it causes are significant. The fear of losing a medical card is very real, even though numbers indicate that the number of over-70s in receipt of medical cards has increased every year from 2020. The data, which I reviewed in the HSE publications, showed that in February 2020, 359,722 persons aged 70 and over were in receipt of a medical card. This accounted for 23% of all medical cards issued. Data from this month showed that 390,676 persons aged 70 and over are in receipt of a medical card. This accounts for 24% of all medical cards currently held. That data shows that despite periodic reviews of this cohort, generally every three to four years, the number of over-70s with medical cards has not dropped. The reason is simple; this age cohort, generally, is on a fixed income, in retirement and, barring taking up employment or winning the lotto, its income and means are not going to change. Despite this, the HSE is paying significant amounts for reviews of this cohort. It is a pointless exercise. How much money is being spent by the HSE on reviews of medical card eligibility? Whatever that figure is, if it is multiplied by 24%, that is the saving that could be made by ceasing this practice. If someone over 70 goes through the assessment process and is deemed to have an entitlement to a medical card, he or she should not have to go through a periodic review process every few years, save where they take up employment. That could be stipulated in the regulations. I can only think of a handful of cases in my 15 years as a politician in which, on review, a medical was removed. To park the hardship, stress and strain it causes for older persons, on a cost-benefit basis alone, there are significant savings to be made by ceasing the practice of reviews of medical cards for over-70s. I stress that it is over-70s. I am not saying that reviews should be ceased for all cohorts but this cohort is generally on a fixed income.
James Browne (Wexford, Fianna Fail)
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I thank the Senator for raising this important matter of what annual savings are made from periodic reviews of medical cards for over-70s versus the cost of carrying out those reviews in light of the increased income and means test thresholds. I have experienced the same situation in my office. Often, even those who have them removed get them back on review or appeal. I welcome the opportunity to update the House on this matter. Eligibility for a medical card is primarily based on a financial assessment conducted by the HSE in accordance with the Health Act 1970, as amended.The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn in a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means-tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the universal social charge. Certain expenses are also taken into account.
Persons aged 70 or older are assessed under the over 70s medical card income threshold, which is based on gross income. In November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1,050 for a couple. Since 2015, every individual aged 70 and over has automatic eligibility for a GP-visit card.
The HSE is required to ensure that all applications for new medical cards and all renewals of existing medical cards are issued in accordance with the Health Act 1970, as amended. For the majority of individuals this involves ensuring that the relevant financial thresholds are satisfied. It is important to note that the implementation of a review of medical cards upon reaching their expiry dates is not undertaken to deliver savings, rather it is carried out with a view to ensuring that the HSE is complying with Government policy and legislation on medical card provision. The granting of eligibility through means-testing is considered an objective, fair and equitable approach to providing eligibility to persons with lower incomes. The qualifying threshold calculation takes into consideration the applicant’s particular expenses as well as their income as information regarding these is necessary to validate the applicant’s eligibility for medical card or GP-visit card.
The HSE has given the Department of Health the following information regarding medical cards for people over 70. Any medical card approved for an individual over 70 is usually provided for four years. A total of 194,770 of such cards for individuals over 70 were due to expire in 2023. Of those expiring cards, 89% were extended for people based on information available to the HSE without the need to contact those people directly and only 11% of expiring cards required direct client engagement. Of the 19,347 full applications assessed fewer than 1,000 did not retain medical cards. Any individual not retaining a medical card would retain a right to an over 70s GP-visit card.
Insofar as it can, the HSE seeks to limit the number of people over 70 who are asked to formally engage with the application process. It does this based on a data-driven approach, while also ensuring that it complies appropriately with its statutory responsibilities regarding financial assessments.
To ensure the medical card system is responsive and sensitive to people's needs, the Department of Health keeps medical card issues, including the current medical card income thresholds under review. Any changes are considered in the context of Government policy, the annual budgetary Estimates process and other issues which may be relevant.
John Cummins (Fine Gael)
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I thank the Minister of State. I note that only 20,000 of the 194,000 medical cards for those age 70 and over that expired in 2023 were reviewed. However, as he can see from the data, fewer than 1,000 were ruled ineligible, which is 1,000 out of 194,770 persons over 70. I specifically asked for the cost of carrying out those 20,000 reviews and the Minister of State did not provide that information in his reply. I know it is not done on a cost-saving basis. I am sure that the Minister of State will agree with me that common sense should prevail. Where fewer than 1,000 are deemed ineligible following a review out of 194,000, we need to consider the cost savings that could be made let alone the stress and strain caused to individuals and families. The Government needs to review this. The policy needs to reflect common sense. I feel that common sense is not being applied in this area.
James Browne (Wexford, Fianna Fail)
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I again thank Senator Cummins for raising this important issue. He is correct in saying that the actual cost was not provided by the HSE. As I have said, eligibility for the medical card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970, as amended. In this regard, the HSE is required to ensure applications for a new medical cards and renewals of existing medical cards are issued in accordance with the Act. However, insofar as it can, the HSE seeks to limit the number of clients over 70 who are asked to engage with the application process.
Any medical card approved for an individual over 70 is usually provided for four years. According to the HSE, based on the 2023 figures, 89% were extended for people based on information available to the HSE without contacting the client. Of the remaining 11%, the 19,347 with full applications assessed, fewer than 1,000 did not retain the medical card. To ensure the medical card system is responsive and sensitive to people's needs, the Department of Health keeps medical card issues, including the current medical card income thresholds, under review. I will certainly bring to the Minister's attention that in the response, the HSE has not provided the specific answer to the question the Senator raised.
John Cummins (Fine Gael)
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I would appreciate getting that in writing.
Fintan Warfield (Sinn Fein)
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I welcome our guests the Public Gallery.