Gerry Adams (Louth, Sinn Fein)
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585. To ask the Minister for Health the medical and social factors that present on an application for medical cards that are considered when deciding upon whether to approve a medical card on grounds of undue hardship; and if he will make a statement on the matter. [17493/14]

Alex White (Dublin South, Labour)
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The medical card system is founded on the undue hardship test and the Health Act 1970 provides for medical cards on the basis of means. Eligibility for a medical card is assessed first and, if unsuccessful, there is an automatic assessment for a GP visit card. If an application is assessed to be ineligible on the basis of means for a medical card/GP visit card 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. This provides for consideration for a grant of a card under the "undue hardship" (medical card) and "unduly burdensome" (GP visit card) provisions of the medical card scheme of assessment. Undue hardship can only be ascertained through an assessment of financial means, with the extra discretionary effect where somebody's condition or illness is affecting their financial situation. The HSE's National Assessment Guidelines provide 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 associated with: maintenance of employment; provision of reasonable housing; provision of appropriate nurturing and care for children or dependants; provision of adequate heating, nutrition and clothing, or coping with exceptional personal and financial burdens arising from medical or social circumstances.

In conducting this assessment, the Guidelines state that the following issues be taken account of on an application: illness or medical circumstances which results in financial hardship; the cost of providing general medical and surgical services; the cost associated with the provision of medical, nursing and dental treatment; the cost of physiotherapy and speech and language therapy; transport cost to hospitals and clinics; addictions such as drink, drugs and gambling; poor money management; social deprivation, including poor home management and the cost of medical aids and appliances. The HSE will give equal consideration to each of the above factors that present on an application in deciding whether to approve that application for grant of a medical card on grounds of undue hardship/undue burden. 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 and these sources may include the Applicant's Doctor(s); the HSE's Medical Officers; the Public Health Nurse; the Community Welfare Officer; Social Worker; Therapy Services and/or the Money Advice and Budgeting Service (MABS).