John Deasy (Waterford, Fine Gael)
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1022. To ask the Minister for Health if applicants for the over 70's medical card are subject to the same discretionary conditions as those under 70 whereby financial hardship as a result of medical need may be assessed; and if he will make a statement on the matter. [45606/13]

Alex White (Dublin South, Labour)
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Medical Card and GP Visit Card eligibility under the scheme for persons aged 70 or older is solely based on an assessment of gross income.

For persons person aged 70 or older who are assessed as ineligible under the gross income thresholds that apply, they may also have their eligibility assessed under the means tested medical card scheme. This assessment is based on net income and assessable outgoing expenses and the qualifying income thresholds under this scheme are lower than over -70s gross income thresholds. If a person is means assessed ineligible for a medical card under the general scheme and that person has other social, medical or financial circumstances relevant to an assessment of their ability to provide for their medical needs or the medical needs of any dependants they may have, these factors will be considered to decide if a medical card or GP visit card should be approved on discretionary grounds under the ‘undue hardship’ or ‘undue burden’ provision of the medical card scheme.

Pearse Doherty (Donegal South West, Sinn Fein)
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1023. To ask the Minister for Health the number of persons in County Donegal that are currently eligible for a medical card; and if he will make a statement on the matter. [45619/13]

Alex White (Dublin South, Labour)
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The HSE collates medical card data by Local Health Area. According to statistics at 1 October 2013, there are currently 91,091 persons holding medical card eligibility in the Donegal Local Health Area.

Billy Kelleher (Cork North Central, Fianna Fail)
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1024. To ask the Minister for Health with regard to the clinic panel that has been set up to assess discretionary medical cards, if financial officers form part of the panel whereby they can accurately value the financial burden on persons and families where no medical card is awarded and a specific costing is placed on the patients needs that would have been covered under the medical card on such needs as therapy, medical equipment, medical supplies, hospital fees, General Practitioner visits as well as consultant visits and so on if not; if he will consider putting such assessors on the panel; and if he will make a statement on the matter. [45639/13]

Alex White (Dublin South, Labour)
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The 1970 Health Act provides that persons who are unable, without undue hardship, to arrange GP services for themselves and family qualify for a medical card, having regard to the overall financial situation of the applicant and his/her dependants. Applications are, in the first instance, subject to a means assessment to determine if assessable income declared is within the set income limits to qualify for a medical card or a GP visit card. Medical card and GP visit card applications are considered in accordance with the Medical Card and GP Visit Card National Assessment Guidelines.

I am advised by the HSE that, if an application is assessed over the qualifying financial thresholds for both a medical card and GP visit card or assessed as under the qualifying thresholds for a GP visit card only, and the application also includes other medical, social or financial details that do not form part of the means assessment, the application will then be considered on discretionary grounds for a grant of a card under the ‘undue hardship’/unduly burdensome’ arranging of a GP service provisions of the medical card scheme of assessment. The assessment to be made in this instance is whether it is considered that "undue hardship"/"unduly burdensome" will occur or an ‘undue burden’ be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs in the absence of medical card or GP visit card eligibility. Deciding Officers appointed from within the staff of the HSE Primary Care Reimbursement Service take decisions in relation to the consideration of applications to approve or decline the grant of a medical card/GP visit card on discretionary grounds.

The National Assessment Guidelines give guidance to a decision maker as to the relevant factors to have regard to in making an assessment as to whether the ‘undue hardship’/’undue burden’ provisions apply to the circumstances presented on an application. In particular, the guidelines state that the "exercise of discretion by the HSE, in favour of the applicant, should be considered where meeting the costs of services covered by a medical card or a GP visit card compromises the applicant’s or his/her family’s ability to meet the essential costs". In conducting this assessment, medical and social circumstances are taken into account. The decision maker may make appropriate inquires or seek advice from other sources to assist with coming to a decision on ‘undue hardship’/’undue burden’, e.g. the applicant’s Doctor(s), the HSE’s Medical Officers, Social Worker, etc.

In the case of an application that includes evidence as to an individual(s) medical condition, the HSE’s assigned medical officers are consulted for their professional advice and expertise and asked to make a recommendation on an application as to whether ‘undue hardship’ will occur or an ‘undue burden’ be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs, having regard to the medical condition(s) presenting. This assessment necessarily involves the medical officers exercising their professional judgment and expertise to evaluate the cost of providing for a particular medical condition, as described on an application, and making a determination having regard to the assessed income and circumstances on an application whether ‘undue hardship’/’undue burden’ will occur in the absence of a medical card/GP visit card eligibility. The HSE is satisfied with the current operating procedures in this regard and satisfied that the panel of Medical Officers have the necessary professional expertise and judgment to effectively discharge this function.