Income threshold for medical card eligibility has stayed same for two decades, committee told

Paul Flanagan, Principal Officer with the Department of Health, acknowledged that the income threshold for younger people has not changed for “something in the region of 20 years”.

It is “extraordinary” that the “shockingly low” financial threshold for medical card eligibility has not been adjusted for over 20 years, the Oireachtas Health Committee heard on Wednesday.

The Department of Health was before the committee discussing two areas under the General Scheme of the Health (Miscellaneous Provisions) Bill 2023.

Paul Flanagan, Principal Officer with the department, said talks are taking place with Revenue, HSE and Department of Finance around changes to how people on medical cards can earn extra income without losing their eligibility to the means-tested cards. This is focused on the Rent a Room Scheme which allows householders to rent out a room for up to €14,000 a year tax-free.

It is not yet agreed how this will work. Proposals include offering a tax credit or allowing people on medical cards to self-declare. Green Party spokeswoman Neasa Hourigan pointed out this scheme offers no rights to the tenants.

Mr Flanagan said the income threshold for over-70s was adjusted recently. However, he acknowledged that the threshold for younger people has not changed for “something in the region of 20 years”.

This is just €184 a week, assistant principal Adedolapo Odukoya said. Sinn Féin Health spokesman David Cullinane said this is “shockingly low” and prohibits people even on very low incomes from availing of the package.

Social Democrats health spokeswoman Roisin Shortall agreed, saying medical cards give patients access to a range of supports.

“It is extraordinary that the income limits have not increased for 20 years, at a time when we are supposed to be extending access for people,” she said.

Medicine supplies

Meanwhile, the committee also heard that medicines shortages were of huge concern to patients last winter, particularly around respiratory illnesses.

Anne Marie Seymour, principal officer at the Department of Health, said pharmacists can already offer generic substitutions for out-of-supply products.

“What’s proposed here is specific expansion where it is therapeutically different, so the main ingredient is different but you get the same result for the patient,” she said. “So it’s to manage that piece, and that is where we would see the use of this medicine substitution protocol.” 

Antibiotics would be a good example, she said: “It would enable a pharmacist to change the antibiotic without sending somebody back to their prescriber to get a new prescription.”  The changes would enable pharmacists to sell and supply approved medicines without the need for a prescription.

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“Another piece of work going on in the department is the emergency supply of controlled drugs,” she said. Gino Kenny TD said a pharmacist could offer a short-term supply of medication for palliative care or methadone, for example.

She also said pharmaceutical companies are required to give the State notice of two months before a product becomes out-of-stock. 

Asked if there have been failures of that, she said yes. “There have been cases where if we had known earlier, or the Health Products Regulatory Authority had been informed earlier, that there was a shortage coming, that things could have been done better,” she said.