THE Health Service Executive (HSE) has insisted that a "medical card is not for life" as it grapples with the public outcry that followed Budget Day cuts.
It also rejected claims it was trying to "blackguard" people who needed medical cards – but said 37,733 holders whose cases were reviewed this year did not reply or provide sufficient information.
An information campaign will get under way to make the process of applying or retaining a medical card clearer – but there will be no relaxing of the rules.
The campaign – in the wake of the ongoing public outrage over the loss of discretionary medical cards – includes an online video on how to fill out the application form.
It will also involve clearer, more "sensitively-written" letters and newspaper advertisements.
Staff are to receive more training; there will be a new information leaflet – and a helpline for members of the public who want to make a query on medical cards will be operational from 8am to 8pm.
Paddy Burke, who runs the medical card section of the HSE, said there were no internal caps put on the numbers who can qualify for a card.
But he insisted: "A medical card is not for life."
He likened it to a credit card which can "run up €50,000 spending" which must be paid for by the State.
He said that there was more surveillance this year to identify people who no longer needed the benefit or were defrauding the system.
So far this year, 428,000 medical cards have been reviewed and of these 9,891 were found to be no longer eligible – with another 3,992 holders now deceased.
Another 35,733 people who were contacted by the HSE did not respond to the letter or provide enough information to review their application.
Basic mistakes in application forms can involve failure to include an address or a PPS number.
So far this year, 106,000 new medical cards have been issued – but overall, the numbers with the benefit increased by only 2,400 because of the disqualifications and downgrading to a GP card.
Last year, there was a surplus of cards issued after a huge backlog built up, due to centralising the system in Dublin, and a need to fast-track and eliminate delays which had arisen.
A specific illness is not an automatic entitlement to a medical card or GP card – assessment is based on income threshold and some outgoings.
Discretionary cards are for those who are over the income threshold but face financial hardship because of medical bills.
An assessment of income and hardship is made by officials and HSE doctors before a decision is made.
Some leading hospital consultants such as neurologist Dr Orla Hardiman have recently criticised medical cards being taken from their patients.
The more difficult applications are discussed by the HSE doctors on a case-by-case basis, she added.
Health Minister James Reilly said he had asked for the HSE information campaign and nobody who was entitled to a medical card need worry about losing it.
"Despite the significant savings to be made by the HSE in the year ahead, nobody who is entitled to a medical card will lose it or be refused one," he said.
Dr Johanne Cooney, a HSE medical officer who is one of 13 doctors who reviews the medical needs of people applying for a discretionary card, said doctors were entitled to advocate for their patients but "we must be objective".
"If people have a card for a number of years they can feel they should hold on to it," she added.
The HSE's medical card helpline number is Locall 1890 252 919.