The Government is finalising plans which will allow families to write off childcare costs when being assessed for eligibility for medical cards.
The Irish Times has learned that plans under consideration by the Tánaiste and Minister for Health Mary Harney would see qualification for a medical card determined in future by the disposable income of the applicant.
A spokesman for Ms Harney said last night that the childcare proposal was one of a number of possible reforms that were being examined.
He said the childcare issue was being "seriously considered" within the Department of Health, and a final decision would be taken within a week or so.
It is understood that under the plans childcare expenses would be added to other existing allowable expenses, such as mortgage and rent, when calculating an applicant's income.
It is unclear at present whether all childcare costs or just part of the expenses incurred would be allowable under the Tánaiste's proposals for reform of the medical card eligibility criteria.
The Department of Health believes that the current income guidelines for medical cards, which were increased by 7.5 per cent or twice the rate of inflation last November, are continuing to fall behind rises in wages.
This has meant that despite Government promises to provide 30,000 additional medical cards this year as part of a €60 million initiative, the numbers covered by the free GP and drugs scheme are actually continuing to fall.
A separate Government plan to provide an additional 200,000 "doctor-only" medical cards this year, which would cover GP visits but not drug costs, has become bogged down in a row with the Irish Medical Organisation (IMO).
The doctors' union is to hold further talks with the Department of Health on this issue this week.
The Tánaiste told the Dáil in answer to a parliamentary question last week that the the existing income guidelines for medical cards were "way out", and that "clearly people's incomes are much higher than the increases provided for".
"We need to move to a position where disposable income is taken into account.
"For example, childcare costs should be allowable when calculating a person's income for the purpose of receiving a medical card," Ms Harney said.
The Tánaiste said she was determined the 30,000 additional full medical cards and the 200,000 doctor-only cards, which the Government promised last November, would be allocated.
A spokesman for the Tánaiste told The Irish Times last night that a decision on the new eligibility criteria would be taken within days.
The Department of Health and the Health Service Executive is to launch a public information campaign this month on how to apply and be assessed for the additional full medical cards and the doctor-only scheme.
It is understood that a change in eligibility guidelines to allow applicants to write off childcare and other costs would not need Cabinet or Department of Finance approval. The Government provided €60 million to the Department of Health in this year's financial estimates to increase medical card eligibility.
According to official Department of Health figures, there are now nearly 100,000 fewer people covered by the medical card scheme than there were in 1997 even though the population has grown by around 400,000 in the interim.
"In 1997, there were 1,244,459 medical cards, or 34.37 per cent of the population of 3,621,035. In September 2004, 1,151,106 persons were covered by the medical card, or 29.39 per cent of the population of 3,917,203. In April 2005, there were 1,145,331 medical cards, or 28.32 per cent of the population of 4,043,800," the Tánaiste told the Dáil last week.
