Written answers

Thursday, 8 October 2015

Department of Health

Medical Card Eligibility

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Independent)
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174. To ask the Minister for Health given the Irish Cancer Society report on the cost of cancer, if he will firstly ensure that primary care reimbursement service revises its means assessment to take the real costs into consideration; if he will ensure that all persons diagnosed with cancer, regardless of age, will be granted a medical card; and if he will make a statement on the matter. [35150/15]

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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Under the Health Act, 1970, eligibility for a medical card is founded primarily on the undue financial hardship test and every application must be assessed on that basis.In accordance with the Act, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they who face difficult financial circumstances, such as extra costs arising from an illness.

Where a person does not qualify for a medical card, they may be provided with a GP Visit Card, appropriate therapy or other community supports or drugs and appliances under the Long Term Illness scheme, where the qualification criteria are met.

The Report of the Expert Panel on Medical Need for Medical Card Eligibility was published by the HSE on 25 November 2014. A key recommendation of the "Keane" Expert Panel was that a person’s means should remain the main qualifier for a medical card. It also recommended that it is neither feasible nor desirable to list conditions in priority order for medical card eligibility.

On foot of the Keane Report, the HSE has also established a Clinical Advisory Group (CAG). The CAG's interim report included a recommendation to extend medical card eligibility to all children under the age of 18 years with a diagnosis of cancer, for a period of five years in each case. The Director General of the HSE accepted this interim recommendation and agreed to it being incorporated in the guidelines for deciding officers in respect of discretionary awarding of eligibility. The CAG is continuing its work to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system.

It is clear that there are people with medical needs and it is important that they should be able to access necessary assistance in a straight forward manner. Greater discretion is being exercised by the HSE because the number of discretionary medical cards in circulation has increased from about 52,000 in mid-2014 to nearly 93,000 at the beginning of September this year. While the HSE makes every effort to apply discretion whenever possible, in a small number of cases, given the financial means assessment, it is not always possible for those in higher income brackets to qualify for a medical card.

Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.

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