1322. Deputy Peadar Tóibín asked the Minister for Health whether the HSE, when considering an application for a medical card on discretionary grounds, can take into account the exceptional and lifelong medical needs of a child with an extremely rare genetic syndrome, including the requirement for specialist therapies, orthotics, medical equipment, medications and frequent medical appointments; whether she considers that the current medical card assessment adequately recognises the significant additional financial burden placed on families caring for children with complex disabilities and rare conditions, particularly where both parents are working. [65177/26]

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. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.

People under 70 are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after deduction of tax, PRSI and Universal Social Charge. Certain expenses are also taken into account. Detailed guidelines are available at: Assessment for a medical card - HSE.ie. (www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/) People aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, those aged over 70 can also be assessed under the general means tested scheme where there are particularly high medical costs. Details are available at: Medical card for over 70s. (www2.hse.ie/services/schemes-allowances/medical-cards/other-types-of-medical-card/over-70s/)

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.

Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card - in particular, to take full account of difficult circumstances in the case of applicants who may be in excess of the income guidelines. In such circumstances, the HSE may exercise discretion and grant a medical card, for example:

• Discretionary medical cards issued to patients with significant medical expenses, but who do not satisfy the means test.

• Emergency medical cards are issued to patients that are terminally ill, or are seriously ill, and in urgent need of medical care that they cannot afford.

Furthermore, it should be noted that 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. Information on Domiciliary Care Allowance is available from the Department of Social Protection. www.gov.ie/en/department-of-social-protection/services/domiciliary-care-allowance/

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