ANALYSIS:The debacle regarding over-70s' medical cards recalls the period when they were introduced, writes Eithne Donnellan
THERE HAS been utter confusion over which criteria would be used to determine which over-70s who currently have medical cards without ever having been means-tested would retain them come January 1st next year.
Minister for Health Mary Harney seemed very clear last Tuesday on who, apart from doctors, would take the hit and who would not, as a result of the abolition of an automatic entitlement to medical cards by those over 70.
She said there were 350,000 people in the State over 70 with medical cards and about 140,000 of these had never been means-tested, and they would therefore have to reapply for their cards.
Of this 140,000, she indicated that she expected 14,000 to still qualify for medical cards after a means test, another 35,000 to get doctor-only cards, 70,000 to get an annual grant of €400 to help offset their medical bills, and that 20,000, those who were better off, would get nothing.
Many older people, as well as their families, were outraged. Worried about the consequences of the plan, drawn up in a bid to save €100 million a year, they began to look up the income thresholds which would now allow an older person to qualify for a medical card.
The Department of Health said on Wednesday the income thresholds for medical cards were the same after Tuesday's Budget as before, and were on the HSE website. These said a single person over 65 would qualify for a medical card if their income after rent and other ongoing costs wasn't more than €201.50 a week, while a couple would qualify if their net weekly income wasn't over €298.
Consternation followed in the Dáil and elsewhere over these income limits, particularly at the low income threshold which would allow a couple to qualify for the benefit, and yesterday the HSE issued a statement just before lunchtime saying the income threshold for a single person remained the same but for a couple it had been raised to €596.50 a week.
It also said the weekly income threshold which would allow older people to qualify for a doctor-only card, which had been given as €447 a week for a couple on Wednesday, had been upped to €895 a week. The upper qualifying threshold for a single person over 70 who lived alone remained unchanged at €302 a week, it said.
Less than an hour after the new figures were issued by the HSE, one of its press officers sent another e-mail recalling the earlier statement.
Why? Well it appears nobody was clear on the figures. As Roisin Shortall, Labour's spokeswoman on social and family affairs, put it, those behind the changes seemed to be making them up as they went along.
The entire debacle mirrors what happened back in 2001 when free medical cards for all over-70s were first introduced. The rush decision was announced in Budget 2000 without those in government having a clue of how many people would qualify and how much the change would actually cost. No deal had been reached with GPs on how much they would get paid for treating all the extra medical card holders. The result: it cost millions more than anyone ever expected.
One would have thought lessons would have been learnED about embarking on an announcement without being well prepared. This time round another rush decision was made, given the economic downturn. It seems the HSE hadn't been told to get itself ready for the change and no real consideration had been given to what eligibility criteria would apply when the over-70s would now be trying to win back their medical cards.
By yesterday afternoon, answers to queries put to the Department of Health and the HSE seeking the definitive income limits for older people seeking to retain their medical cards were put on hold. An urgent meeting had been convened between the Department of Health, HSE officials and Ms Harney to work out the definitive position, we were told.
Then finally the position became clear. Shortly before 6pm a statement was issued by the Department of Health outlining brand new and higher income thresholds for the over-70s. The qualifying thresholds for couples were higher than they had been on Wednesday, but lower than those set out by the HSE early yesterday.
So what are they? As of now a single person over 70 will qualify for a medical card if their net weekly income after expenses such as rent and medicines is not more than €240.30 a week. For a couple over 70, the income limit after expenses is €480.60 a week.
While assets are taken into account as part of the means test, the family home is not counted and neither are the first €36,000 a single person has in savings or the first €72,000 a couple has in savings. Furthermore, social welfare payments like the fuel allowance or the living alone allowance are not counted as income for the purposes of the medical card means test.
Meanwhile, the new income limits to be applied when over-70s apply for doctor only/GP visit cards will be €360.45 a week for a single person and €720.90 for a couple. Again, when applications are made for this card, one's net income after expenses is the one which will be used in making a determination on eligibility. And again the same amounts in savings are disregarded in the case of single people and couples when they are being means tested for these cards.
Individuals over 70 not qualifying for a medical card or GP visit card on income grounds may qualify for a new annual grant of €400 to help defray medical expenses if their gross weekly income is less than €650. Medical receipts do not have to be produced to get this payment, which will not be taxable.
The Department of Health has stressed that people on the old age pension automatically qualify for a medical card. However, for older people with private pensions, their income from these pensions will be counted as part of their means when they are being assessed for medical card/GP card eligibility.
Now to the next hurdle. The HSE has pledged to write before November 14th to the 140,000 people who need to be means-tested if they are to have any chance of retaining their medical cards. Recipients of these letters will then have two weeks to fill out a form detailing their income and expenditure. The HSE hopes to have all of the forms processed and all the means tests completed by December 31st.
This is a tall order, one would suspect, in terms of the HSE getting all the forms out to all relevant people at their correct addresses within one month, not to mind having all the returned forms processed and new cards issued to those who qualify for them within 10 weeks from now.