Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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47. To ask the Minister for Health in view of the fact that discretionary medical cards are provided for persons whose income or assets exceed the threshold but for whom purchase of care, services and equipment relating to the illness would create undue financial hardship; that the Health Service Executive has stated that a panel of clinicians examine each case and apply an adjustment for those above the income threshold to determine whether the illness will lead to financial hardship in the absence of availability of a medical card; that this is a form of health economic analysis and requires detailed information relating to the cost of illness, if he will provide details of the precise nature of this analysis for persons with motor neurone disease, which determines whether they are likely to incur undue financial hardship as a result of the progressive and terminal illness; and if he will make a statement on the matter. [21287/14]

Alex White (Dublin South, Labour)
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Medical cards are provided to persons who are in the opinion of the HSE unable without undue hardship to arrange GP services for themselves and their dependants.

Under the legislation, assessment for a medical card is determined primarily by reference to the means, including the income and reasonable expenditure, of the applicant and his or her partner and dependants. Determination of eligibility is the responsibility of the HSE.

While there is no automatic entitlement to a medical card for persons with a specific illness or a disability, the HSE has discretion to award a medical card to avoid undue financial hardship, having regard to person’s or the family’s overall financial situation, even where the person’s means exceed the means assessment thresholds set out in the HSE's National Assessment Guidelines.

The HSE has established panel of Community Medical Officers to assist in the processing of applications for medical cards on a discretionary basis, where the income guidelines are exceeded but where there are difficult personal circumstances, such as an illness or physical disability.

The Community Medical Officer reviews the evidence of necessary medical expenses provided by the applicant to the HSE. As appropriate, he or she liaises with general practitioners, hospital consultants and other health professionals so that costs relating to the health circumstances of the applicant can be fully taken into account. Based on this full information the HSE is in a position to determine if the applicant is experiencing undue hardship in arranging medical services having regard to person’s overall financial situation.

This consistent process of assessment, which is not a form of health economic analysis, ensures that medical cards are issued to applicants whose income is above the guidelines thresholds but where illness or disability would lead to undue financial hardship for them in arranging GP services for themselves and their dependants.