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.
Domiciliary Care Allowance (DCA) is a monthly allowance payable to a parent/guardian in respect of a child aged under 16, who has a severe disability or condition and requires continual or continuous care and attention in the home, substantially and above the care and attention normally required by a child of the same age and the child must be likely to require this level of care and attention for at least 12 months.
Since 1st June, 2017, all children for whom a Domiciliary Care Allowance is paid qualify automatically for a medical card without the requirement of a financial assessment.
DCA ceases to be payable when a child reaches 16. A child may transition to Disability Allowance (DA) from age 16, even if still attending full-time education, subject to satisfying all qualifying conditions for that scheme, including certain medical criteria and a means test.
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.
Furthermore, people who have been on a disability payment for at least a year can retain a Medical Card for a further three years on return to work, provided they were in receipt of the payment for a period of at least 12 months prior to commencing employment.
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.
I can assure the Deputy that my Department keeps medical card issues under review in order to ensure the medical card system is responsive and sensitive to people's needs. Over the course of 2024 and 2025, we will review the existing eligibility framework to clearly assess what is working well and to inform policy proposals to enhance eligibility and access to services based on robust evidence. This is an important step towards delivering on universal healthcare in Ireland.
