Medical Card Scandal

Mr. Incognito

1.

I happened to have my first professional experience with a Form MC1 Form today or in English a Medical Card Application Form. As a tax head the following caught my eye that is outlined on the Form. You’ll have to bear with me if I get a bit technical for a little while but I’ll explain it all jargon free in a bit.

Who may apply? “Anyone who is ordinarily resident in Ireland can apply. Ordinarily Resident means that you have been living here for at least one year or intend to live here for at least one year”

Now that might sound fair enough, except that is not what ordinarily resident means. Ordinary Residence is defined by S820 of the Tax consolidation Act as

“For the purposes of this Act an individual shall be ordinarily resident in the State for a year of assessment if the Individual has been resident in the State for each of the 3 years of assessment preceding that year”

For the purpose of this article it is important to note that it takes three years to lose ordinary residence also- you have to be non resident for three years- this will become important.
Big difference. Since 1991 Millions if not Billions in the difference.

As the tax acts definition covers tax legislation and is to be confined to such I did a bit of research.

Medical card eligibility is covered by the Health Act 1970 as amended by the Health Act 1991.

It is the 1991 Act that introduced the concept of ordinary residence as a condition for a medical card. It is not definded but rather the Minister may issue guidelines

Guidelines on "Ordinarily resident in the State".
4.—The Act of 1970 is hereby amended by the insertion of the following section after section 47:
"47A. The Minister may issue guidelines to—
( a ) the chief executive officers of health boards, and
( b ) persons appointed or designated by him under section 47 (1),
to assist each of them in deciding whether or not a person is ordinarily resident in the State for the purposes of sections 45 and 46".

http://www.irishstatutebook.ie/1991/en/act/pub/0015/index.html#zza15y1991

In the HSE’s own guide to the Medical card application procedure it outlines what those guidelines issued were:

http://www.hse.ie/eng/services/Find_a_Service/entitlements/Medical_Cards/mcgpvcguidelines.pdf

Following consultation between the Department of Health and the Health Areas, the Minister for
Health is, under Section 47A of the Health Act, 1970 (as amended by the Health (Amendment) Act, 1991) issuing the following guidelines on the interpretation of the criterion of ordinary residence.

The guidelines deal with the interpretation of ordinary residence under the following headings:
• nationals of non-EC countries;
• nationals of EC countries other than Ireland;
• Irish nationals who have been resident outside Ireland

References in the guidelines to “satisfying the Health Area” imply satisfying the Chief Executive
Officer or any officer to whom the function of determining eligibility for health services had been
delegated by the Chief Executive Officer. In all cases the Health Area is entitled to seek such
evidence as it may require in order to reach its decision.

1 Nationals of non-EC countries
1.1. An non-EC national should be regarded as “ordinarily resident” in Ireland if s/he satisfies the
Health Area that it is his/her intention to remain in Ireland for a minimum period of one year.
Examples of the evidence which may be sought in this context include

• proof of property purchase or rental, including evidence that the property in question is the
applicant’s principal residence;
• evidence of transfer of funds, bank accounts, pensions;
• Alien’s Registration Book (“Green Book”), residence permit as stamped on passport;
• work permits or visas, statements from employers etc;
• where necessary, the signing of the affidavit by the applicant

1.2. A non –EC national who is in Ireland as a student should be regarded as “ordinarily resident”
if s/he is attending a registered course of study of at least one academic year’s duration.
1.3. A dependant of a non-EC national must also satisfy that criterion of “ordinary residence” in
order to establish eligibility for health services here i.e. the fact that a non-EC national has
established his/her eligibility does not imply that non-resident dependants are also eligible.
1.4. A non-EC national may have established an entitlement to cover under EC regulations as a
result of residence or employment in an EC country. In such cases, the arrangements set out in
Paragraphs 2.1 and 2.2. apply.

2 Nationals of EC countries other than Ireland
2.1. Arrangements under EC regulations supercede the provisions of the Irish eligibility system is
respect of certain categories of nationals of other EC countries:
• social security pensioners of other EC countries who are not covered by an Irish social
welfare pension (as recipient of dependant), and who are not employed or self-employed
here, receive a Medical Card;
• persons resident here who are insured workers in the territory of another EC country receive
a Medical Card;

3 Irish Nationals who have been resident outside Ireland
3.1 Where an Irish national who returns to Ireland following residence in another EC country is
covered by any of the arrangements made under EC regulations, the same approach as that set out in Paragraph 2.1 should be taken.
3.2 Where and Irish national returns to Ireland and is not covered by any of the arrangements
made under EC regulations, s/he should be regarded as “ordinarily resident” here if s/he

• is employed or self-employed here; or
• satisfies the Health Area that it is his/her intention to remain in Ireland for a minimum period
of one year.
56
3.3 Where an Irish national is working abroad on a short-term contract but satisfies the Health
Area that it is not his/her intention to take up residence outside of Ireland on an indefinite basis, the status of “ordinarily resident” and eligibility for Irish health services may be retained. The Health Area may take account of the nature and duration of the contract as well as evidence such as the examples in Paragraph 1.1 in arriving at its decision.
Health Area is satisfied that the person did not establish an entitlement to health services in any other country, the Health Area should (if Paragraph 3.2 does not apply) regard the person as “ordinarily resident” in Ireland if s/he requires treatment on returning to Ireland. This guideline is intended to ensure, in particular, that persons who emigrate do not lose their health services eligibility on residence grounds before they have been able to establish eligibility elsewhere. It would not apply where a person is covered by EC Regulations and, in particular, it would not entitle a person temporarily resident in another EC country to have the Health Area extend the Form E111 beyond the normal period.

4 Persons deemed not to be “ordinarily resident”
4.1. Where a person is deemed not to be “ordinarily resident” in Ireland, and where none of the
other provisions set out above apply, the Health Area may either
- apply the full economic charge for any services provided;
Or - provide urgent necessary treatment at a reduced charge or without charge
(as deemed appropriate by the board) where application of the full economic charge
would cause undue hardship.

5 “Urgent necessary treatment”
5.1. The references to the provision of urgent necessary treatment free of charge to temporary
visitors from another EC country (Paragraph 2.1) and to persons deemed not to be “ordinarily
resident” here (Paragraph 4.1) do not cover
• non-urgent or elective treatment which can reasonably be postponed until the person’s return
to his/her own country;
• any case in which a person travels to Ireland for the specific purpose of obtaining treatment.
Department of Health
7 July 1992

What the hell was the Department of Health thinking. And how has this thinking (if you could call it that) been allowed to exist for almost 20 years. By incorporating the meaning of ordinary residence as it is outline by the tax acts this country could have saved billions in Medical expenditure on people that have turned up in Ireland, paid for a mickey mouse English course and allowed to have free medical treatment and then up sticks and went home. The department had to issue guidelines to cover Irish nationals that may have spent a year abroad and suddenly would not be entitled to medical treatment. Incorporating the tax legislation definition would guarantee them treatment for up to three years. There is provision in the Guidelines for urgent necessary treatment for those that need it free of charge. Why are we opening the door for those that do not require urgent medical treatment free of charge just because they are resident for part of the year? One year. Free medical card. This sort of thinking is the reason that A&E is overcrowded and we are propping up medical treatment for those that in my opinion should not be entitled to it and wasting millions in taxpayers money for those that have made little or no contributions to the Tax system to subsidise their treatment. It is nothing short of a scandal.

starbelgrade

Mr. Incognito wrote: »

From my bog:

Did you find all that when you were cutting turf?

mikom

Mr. Incognito wrote: »

From my bog:

How many hoppers did you cut this summer?

bleg

tldr

monkeypants

Mr. Incognito wrote: »

From my bog:

That's impressive. You'd be lucky to find a TV magazine in mine.

Gummy Panda

Mr. Incognito wrote: »

From my bog:

That's where I stopped reading

pow wow

Go to Northern Ireland and get some treatment for free on the NHS, it might make you feel better.

marco_polo

Numbers and Figures?

Feeona

That's some serious sh*t

Sykk

Your whole blog is ruined because you said "From my bog"

bonerm

bleg wrote: »

From my bog:

This is how Biffo and Lenihan should deliver all bad news on the current state of the economy. Bad press avoided.

28064212

Mr. Incognito wrote: »

By incorporating the meaning of ordinary residence as it is outline by the tax acts this country could have saved billions in Medical expenditure on people that have turned up in Ireland, paid for a mickey mouse English course and allowed to have free medical treatment and then up sticks and went home.

Any indication that situation has ever happened, much less that it has cost billions? Also, from section 1.2: ...registered course of study.... I somehow doubt there are huge swathes of 3 week courses masquerading as year-long ones to be registered with the HSE

Mr. Incognito wrote: »

The department had to issue guidelines to cover Irish nationals that may have spent a year abroad and suddenly would not be entitled to medical treatment. Incorporating the tax legislation definition would guarantee them treatment for up to three years. There is provision in the Guidelines for urgent necessary treatment for those that need it free of charge.

And what about immigrants who have now gone home? The tax legislation definition would allow them to return here for three years to get medical card treatment, even though they are no longer resident and have no intention of returning. That is as likely to cost the state 'billions' as the "one year" definition

marco_polo

Also FYI

http://www.inis.gov.ie/en/INIS/Pages/Student_Visa_Guidelines

•You have immediate access to at least €7,000. This is the estimated cost of living in Ireland for a student for one academic year. (Having also paid full college fees, Good luck with passing the medical card means test in that case)
•You must also demonstrate that you or your sponsor has ready access to an amount of at least €7,000 for each subsequent year of your studies, in addition to the course fees for each of those years.
•You have private medical insurance.

Mr. Incognito

And what about immigrants who have now gone home? The tax legislation definition would allow them to return here for three years to get medical card treatment, even though they are no longer resident and have no intention of returning. That is as likely to cost the state 'billions' as the "one year" definition

Very easy to fix- just insert that in the case of non residents that qualify under the ordinary residence rules they need to be Irish citizens or irish domiciled.

Also FYI

Quote:
http://www.inis.gov.ie/en/INIS/Pages...isa_Guidelines

•You have immediate access to at least €7,000. This is the estimated cost of living in Ireland for a student for one academic year. (Having also paid full college fees, Good luck with passing the medical card means test in that case)
•You must also demonstrate that you or your sponsor has ready access to an amount of at least €7,000 for each subsequent year of your studies, in addition to the course fees for each of those years.
•You have private medical insurance.

Thanks for that info. Wasn't aware of that.

Look I'd defend social welfare all day as it is funded on PRSI contributions but giving out free health care because you just turned up and happen to be resident for part of the year is a joke.

As for the person asking for numbers and figures, I'm not sure where you would get a breakdown of medical card holders but its pretty easy to dig out how much was expended by medical card holders since 1991. I'll dig out the overall figure and get back to you

marco_polo

Mr. Incognito wrote: »

Very easy to fix- just insert that in the case of non residents that qualify under the ordinary residence rules they need to be Irish citizens or irish domiciled.



Thanks for that info. Wasn't aware of that.

Look I'd defend social welfare all day as it is funded on PRSI contributions but giving out free health care because you just turned up and happen to be resident for part of the year is a joke.

As for the person asking for numbers and figures, I'm not sure where you would get a breakdown of medical card holders but its pretty easy to dig out how much was expended by medical card holders since 1991. I'll dig out the overall figure and get back to you

Granted the HSE defination does not appear to be as tight as the Department of Social Welfare Defination of Habitually Resident for example.

However I cannot think of many ways that one could legally be in the country for a year and still pass the means test for a medical card be that work permit holders, foreign students etc.

galah

seriously, I can't see this being abused too much, to be honest (Ireland would not be in my top 5 countries where to sponge free healthcare, judging by the state of it...).

If you wanna whinge about free medical cards, look at the over 70s, who can have a WEEKLY income of up to 700 Euros and still receive free healthcare through the medical card.

Sorry, but if you're earning that much, you can afford private healthcare.

ynul31f47k6b59

You completely lost me at bog.

Mind you, well done - all I found down mine this summer were frogs.

ejmaztec

Amina Dry Sarsaparilla wrote: »

Mind you, well done - all I found down mine this summer were frogs.

Mon Dieu!:eek:

monkeypants

bonerm wrote: »

This is how Biffo and Lenihan should deliver all bad news on the current state of the economy. Bad press avoided.

Wasn't there once a picture of Biffo doing that?

Mr Benevolent

Bog. Haha. Also, TL;DR. Anyway, I just got my medical card yesterday. Can't wait to see what free drugs I can get.

biko

TLDR - what's your point OP?

bleg

Confab wrote: »

Bog. Haha. Also, TL;DR. Anyway, I just got my medical card yesterday. Can't wait to see what free drugs I can get.

Sucks to be be you, getting your medical card 1 month before they bring in prescription charges.

Mr Benevolent

bleg wrote: »

Sucks to be be you, getting your medical card 1 month before they bring in prescription charges.

Meh, I'll just stock up before it starts. No biggie.

Shopping list:

Viagra
Methadone
Oxycodone
Demerol

Anyone care to add anything they want?