In a document obtained by Trinity News of a correspondence made to the HSE by a woman with motor neuron disease, the patient, who is extremely impaired by her ailment, is told that failure to gather and submit documents already in the possession of the HSE is her choice, and will result in the expiration of her medical card.
The patient initially contacted the HSE to inquire about her medical card application.
She had been granted a temporary card in May after her GP contacted the HSE making the case that she urgently needed access to services and equipment. After a month without correspondence from the HSE, the patient contacted them and was told that they required additional financial information in order to be able to process the application.
The patient responded that her application was made on discretionary grounds based on her motor neuron disease diagnosis supported by her GP and occupational therapist. She was told that all applications have to be assessed on financial grounds before they can be considered on medical grounds.
By July the patient had submitted the relevant financial documentation, and received no further correspondence until August, when she received a letter requesting the submission of the same financial information, and the same form filled out again.
“After a month without correspondence from the HSE, the patient contacted them and was told that they required additional financial information in order to be able to process the application.”
In November, the patient contacted the HSE and was told “they only gave you a card for a short period of time because they felt that that was just applicable. So they must have felt that your circumstances were going to change.”
The resubmission is not due to the forms and information being incomplete or improper, the HSE representative tells the patient that the resubmission is part of a review process, but cannot tell the patient the result of the initial application. The representative instead consistently maintains the right of the HSE to conduct reviews and says “unfortunately if you don’t fill it out again, your card will be suspended, so that is your own decision.” The patient replies that she is not in a position to resubmit the documents, and outlines the difficulty she had in collecting the documents in the first place, due to the severity of her impairment and the fact that she does not have the use of her hands. The patient asks to confirm that they need “the information you already have on my file,” and the HSE representative replies “it is being requested again, yes.”
They continue; “unfortunately anybody’s medical circumstances are being reviewed, so that’s blind people, its deaf people, its old people, we’re reviewing people that are a hundred years of age. Absolutely everybody, and a lot of people aren’t able to do things for themselves anymore. And that’s very misfortunate and I do sympathise sincerely with you. But unfortunately it is going to be the case now that everybody regardless of any medical condition will be reviewed and they will be expected to get the information into ourselves.”
Speaking to Trinity News, one Irish medical expert said that there was no one event signalling policy change regarding medical cards, but they started noticing the application of means testing to discretionary medical cards over the summer. They had been given out on a discretionary basis in the case of terminal illness, but now cards are being withdrawn or under review if the card holder is still alive after six months. This is problematic for people holding these cards, because they will most likely be in a worse state of health than they were when they were given the card in the first place, and they are being asked to gather and submit financial documents to prove that they are still terminally ill.
The HSE does not disclose the formula by which it calculates the application of means testing for those over the statutory limit for medical cards. The implication of a more rigid approach to means testing is that the HSE believes that there are people who hold medical cards who do not deserve them; however cuts to medical cards are not based on publicly available research into the medical card-holding population.
“The resubmission is not due to the forms and information being incomplete or improper, the HSE representative tells the patient that the resubmission is part of a review process, but cannot tell the patient the result of the initial application.”
Speaking before the Oireachtas Health Committee, Minister for Health James Reilly said that “people who are entitled to their medical card have nothing to fear.” He asserted that eligibility for a medical card “never operated on the basis of a medical condition or an illness. It operates on the basis of undue financial hardship” and he said that eligibility is based on a person’s finances.
Under the 1970 Health Act though, income is not the only factor to be considered when deciding medical card eligibility, as Dr. Muiris Houston pointed out in an Irish times opinion article on the 30th of October. According to the act, a person is entitled to a medical card if they are “unable, without undue hardship, to arrange general practitioner medical and surgical services for themselves and their dependents.” Dr. Houston has argued that “undue hardship” in the act can therefore be interpreted in terms of severity of illness, rather than on income.
One reason for this approach is that medical cards don’t just grant access to GPs and medication, but also access to services that are not well provided for in the private sector. Community based clinical professional services like occupational and speech therapy are not well provided in the private sector. There are very few private occupational therapists and almost no private community nursing.
Commenting on the case, the Irish Motor Neurone Disease Association (IMNDA) said that “this case is reflective of a larger trend we have been witnessing. The majority of our members do not have medical cards and many times even if a patient receives a medical card in the first instance they are then refused it on renewal even though their condition has become progressively worse. The Irish Motor Neurone Disease Association strongly advocates that all patients in Ireland with a terminal illness are treated equally and fairly, and we would urgently call on the Minister of Health to clarify the situation and that the MND community are granted a fast track and automatic access to the emergency medical card”.