Ruairí Ó Murchú (Louth, Sinn Fein)
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2471. To ask the Minister for Health if she will review and revise the medical card means-testing system to assess income after deduction of essential disability-related expenses, in order to more accurately reflect disposable income and improve fairness in eligibility decisions; and if she will make a statement on the matter. [21215/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Medical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold.

Persons aged 70 or older are assessed under medical card income thresholds which are based on gross income. The weekly gross medical card income thresholds for people aged 70 and over are currently €550 per week for a single person and €1050 for a couple.

Persons under 70 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. Examples of allowable expenses include rent, mortgage, certain insurance costs, childcare, maintenance, nursing home net costs which help to increase the amount a person can earn and still qualify for a medical card. Detailed guidelines are available at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/).

The issue of granting medical cards on the basis of illness or a disability was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.

However, 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. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

Since December 2018, the medical card earnings disregard for people in receipt of Disability Allowance was increased from €120 to €427 per week and applies to the assessment process for single people and to family assessments. This significant policy change gave effect to an important recommendation of the Make Work Pay for People with Disabilities report. This substantial increase in allowable earnings acknowledges that a Medical Card is a particularly significant support and ensures that people with disabilities can continue to be supported to access care when needed.

I can assure the Deputy that, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.