Government approves method for the return of medical cards lost in discretionary review
The Government has today approved the method by which medical cards awarded by way of discretion can be returned to persons with serious medical conditions who lost them having completed an eligibility review. The decision covers the period from the 1st of July 2011 till the 31st of May 2014.
At its meeting today the Cabinet has agreed a method which paves the way for the return of cards by the Health Service Executive which does not involve changing the law. Accordingly the return of such cards can be implemented within a matter of weeks through actions taken by the HSE.
The Government has accepted that the review of the cards – which took place in the context of the centralisation of the medical card system – produced unintended consequences. Much anecdotal evidence points to the fact that some persons with an acute medical condition, or a lifelong condition (including a disability) have lost their medical cards, an outcome that the Government could not stand over.
In recent weeks the Government decided to take remedial action to repair the unintended consequences and also decided to formulate a new policy whereby eligibility for health services can take account of medical conditions, in addition to the existing basis of financial means.
The HSE has already established an expert panel to advise on the broader issue by September. Today’s decision will see an expeditious reinstatement of cards.
Today’s decision has come in the wake of considerable interaction with the Office of the Attorney General. While Medical Cards are provided to persons under the 1970 Health Act, the Director General of the HSE is satisfied that today’s Government decision will allow him to return cards to persons with an acute medical condition or a person with a lifelong condition (including disability).
The Cabinet decisions have been made in the context of the move to introduce Universal Health Insurance and Universal Primary Care. The move to Universal Health Insurance will mean that everyone is covered for the health services that they need, and where community rating will ensure that premiums will be the same for everyone – regardless of how great their medical need is. Government will subsidise the cost of premiums on the basis of ability to pay.
A policy paper on Universal Primary Care will be completed by the Autumn. It will reflect the Government decision that it wants to provide access to appropriate health services on the basis of medical need, and has put in place the mechanisms required to provide the sound evidence base required to legislate for that.
Note for Editors
Restoring medical and GP visit cards
Who will get a card back?
The HSE will restore cards to people who held a medical or GP visit card, issued on a discretionary basis to a person with a serious medical condition, and who lost that card having completed an eligibility review between 1st July 2011 to 31st May 2014.
- A person must have held a medical or GP visit card issued on a discretionary basis during that period, but had it withdrawn on foot of a completed eligibility review;
- They must have completed the review process during that period i.e. provided the information and documentation required to assess their eligibility;
- They must have a serious medical condition which required that their case was referred to a Medical Officer as a part of the review process.
It is anticipated that over 15,000 cards will be restored to people with serious medical conditions as part of this process
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Information points on the re-instatement of discretionary medical
- Government has decided that it wishes to provide for eligibility for appropriate health services on the basis of medical need (in addition to the existing financial hardship ground). This is in line with its Programme for Government commitments, and will be the most significant reform to eligibility in over 40 years.
- The HSE has established an Expert Panel to make recommendations in this regard. The HSE has also put in place a public consultation process, and over 1,000 submissions have been received to date.
- The Department of Health is preparing a policy paper on the further roll out of GP care without fees at point of use, and this will reflect the recommendations of the Expert Group
- ◦This work will be completed in time for consideration during the estimates process.
- Government will make decisions with regard to entitlement to appropriate health services on the basis of medical need in the autumn, with a view to legislation being in place early in 2015.
- In the context of that policy decision, the Government has decided that medical cards and GP visit cards awarded by way of discretion can be re-instated to persons with a serious medical condition (or disability) who lost them on foot of completing an eligibility review during the period from 1st July 2011 to 31st May 2014.
- The reinstatement applies to people who:
- Had a medical or GP visit card during that period, which was withdrawn following a completed eligibility review.
- Completed the eligibility review, that is they provided the information and documentation required to assess eligibility
- Have a serious medical condition, which required that their case was referred to a Medical Officer as part of the review process.
- It is anticipated that over 15,000 cards will be restored to people with serious medical conditions as part of this process.
- 5,288 people will have their discretionary medical cards re-instated.
- 2,899 people will have their discretionary GP visit cards re-instated.
- 7,118 people will move from GP visit card (back) to a discretionary medical card.
- People do not need to make an application to avail of this reinstatement – the HSE will work expeditiously through its database to contact the people concerned and let them know that their card has been re-instated.
- It is expected that everyone will have been contacted within 3 weeks.
- The HSE has a local contact number: 1890 25 29 19
- The reinstated cards will be valid for a year – as by that time government will have made decisions to provide a robust and sustainable solution in relation to access to appropriate health services for people with specific medical conditions.
- These cards are being reinstated in the context of government decisions in relation to future eligibility policy. The eligibility reviews conducted during that period were in accordance with legislation as it stands. Accordingly, there is no basis for the HSE to reimburse expenditure incurred prior to reinstatement
- The Drugs Payment Scheme means that a household only has to pay a maximum of €144 each month for approved prescribed drugs, medicines and certain appliances.
- This scheme is aimed at those who don’t have a Medical Card and normally have to pay the full cost of their medication. It also applies to those who have a GP Visit Card.
- Anyone ordinarily resident in Ireland can apply to join the scheme, regardless of family, financial circumstances or nationality.
- Anyone who has incurred costs higher than that in a month can apply for a refund, going back to March 2011.
- A small number of individuals may not have been able to complete their review during this period due to circumstances relating to their medical condition e.g. hospitalisation during treatment.
- The Director General of the HSE has, on his own initiative, indicated that he will put in place a specific appeals process to consider such cases – referred to as an ad misericordiam appeal.
- An ad misericordiam appeal is a broad administrative concept.
- The ad misericordiam process is being used now to provide a mechanism to enable restoration of cards in exceptional circumstances where individuals were not in a position to complete the eligibility review. It is an appeal process specific to the decision to reinstate cards, applications will be considered on a case-by-case basis.
- This type of mechanism has been used previously in relation to matters such as staff discipline, but it has not previously been used in relation to medical and GP visit cards – as there are already appeals processes in place in relation to the award of cards on the basis of means or discretion i.e.
- The current legal basis for the award of medical and GP visit cards is in relation to financial hardship, and there is an existing appeals process in this regard.
- People who had additional costs in relation to medical conditions had their cases considered by a Medical Panel, which could result in the award of a card on the basis of discretion.
- The suspension of eligibility reviews in relation to cards issued on the basis of discretion in respect of medical conditions is already in place, and applies from the 1st June – these cards remain valid.
- In relation to people who had commenced engagement with a review, but where the review was subsequently suspended by the HSE, those cards remain valid.