Medical Cards

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Under the provisions of the Health Act 1970 (as amended), eligibility for health services in Ireland is based primarily on residency and means. The Act provides that persons who are unable, without undue hardship, to arrange GP services for themselves and family can qualify for a medical card. The HSE can only award medical cards in accordance with the Health Act and, therefore, it must assess applicants on the overall financial situation of the applicant and his or her spouse or partner. The HSE gives effect to this legislation through its Medical Card National Assessment Guidelines. Persons who are not subject to the means test are those with EU entitlement, people affected by the drug Thalidomide and women who have had a symphysiotomy.

The HSE is obliged to operate within the legal parameters as set out in the Health Act, while also responding to the variety of circumstances and complexities faced by individuals who apply for a medical card. Under the legislation, there is no entitlement to a medical card based on having a particular disease or illness (nor has there been previously). However, if an applicant’s means are above the financial thresholds as set out in the national guidelines, the HSE routinely examines for indications of medical or social circumstances which might result in undue financial hardship in arranging medical services and, in such circumstances, the HSE, exercising its discretion, may grant eligibility for a medical card on this basis. Where persons submit an application, as a new applicant or a renewal/review, without additional medical documentation and are refused, they will receive a letter giving a calculation of the guideline thresholds and where these have been exceeded. Also, at this stage, they are informed of the option to furnish further medical documentation, to demonstrate medical expenditure related to an illness or disease, in support of their application.

Where discretion is exercised with regard to an applicant with an illness or disease, it is the effect of the medical expenditure related to that condition on a person’s financial situation that is relevant to the assessment for a medical card. In accordance with the legislation, it is not possible to award a medical card by virtue of an illness or a disease.

The HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill in palliative care or who are seriously ill and in urgent need of medical care that they cannot afford. They are issued within twenty-four hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. For persons with a terminal illness in palliative care, no means test applies. Once the terminal illness is verified by a GP or Consultant, patients are given an emergency medical card for a period of 18 months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible.