A woman in her seventies mentions it almost in passing, the way people mention the weather. She was born in a county home. She was there for the first two years of her life, and then she wasn’t, and nobody in the family has ever made much of it. She is on a non-contributory pension. She pays for her physiotherapy out of her own pocket, puts off the dentist another year, and counts out the prescription charges at the till.
There is, in all probability, a lifelong medical card waiting for her. It is not means tested. It does not expire. It carries entitlements an ordinary medical card does not. Nobody in her life has ever told her it exists, and the scheme that issues it closes in March 2029.
TL;DR
- The Mother and Baby Institutions Payment Scheme provides a lifelong, non-means-tested enhanced medical card to anyone who spent 180 days or more in one of the 44 institutions named in Schedule 1 of the Mother and Baby Institutions Payment Scheme Act 2023.
- It covers GP care, prescriptions with no prescription charges at all, public hospital care, dental, ophthalmic and aural services, home nursing, home support, counselling, chiropody and physiotherapy.
- You do not have to sign a legal waiver to accept the card. The waiver applies to the cash payments, not the health supports.
- Payments under the scheme are disregarded for social welfare means tests, for the medical card means test and under Fair Deal, and are exempt from income tax and capital gains tax.
- Government estimated 19,000 people would qualify for the card. By September 2026, fewer than 7,600 people had applied to the scheme for anything at all.
- Applications close in March 2029. Freephone 1800 843 354.
What the enhanced medical card actually is
It is not a separate scheme with its own office and its own paperwork. When the Payment Scheme Office decides you are eligible and you accept the offer, it notifies the HSE, and the HSE posts you a medical card. It looks exactly like any other medical card. Nothing on it indicates where it came from, which was a deliberate design choice and a decent one.
What sits behind it is different. The Department of Children, Disability and Equality sets out the entitlement in plain terms: GP services, approved prescribed drugs, medicines, aids and appliances, all inpatient and outpatient public hospital services in a public ward including consultant services, maternity and infant care, certain dental, ophthalmic and aural services, home nursing, home support, counselling on referral, chiropody or podiatry on referral, and physiotherapy on referral.
Two things in that list are not standard. The first is that there are no prescription charges for the person named on the card. An ordinary medical card holder still pays a charge per item up to a monthly cap. This card does not. The second is that it is lifelong and not subject to ongoing means testing, so there is no annual review letter and no anxiety about an income change taking it away. The HSE reissues it automatically every ten years.
One practical consequence catches people out. If you already hold a general medical card, the HSE cancels it in favour of the new one. You are not meant to hold both, and the Department’s own guidance says to apply anyway, because the new card is the better of the two.
The 180-day rule, and who it tends to reach
Section 22(4) of the 2023 Act is the line that decides it. A person who was resident in a relevant institution for not less than 180 days is eligible for the health services listed in section 34(3). Not “about six months”. One hundred and eighty days.
That threshold quietly determines who the card reaches. Mothers were often in these institutions for weeks rather than months, which is why many women qualify for a payment but not for the card. Children stayed. A great many of the people who now meet the 180-day test were infants and toddlers there, which means they are in their sixties, seventies and eighties today, at precisely the stage of life when GP visits, physiotherapy, chiropody and home support stop being hypothetical.
Schedule 1 of the Act names 44 institutions in two parts. Part 1 lists 31, including 29 county homes from Carlow to Wicklow, the Tuam Children’s Home and Sean Ross Abbey. Part 2 lists 13, including St Patrick’s at Pelletstown, Bessborough in Cork, Manor House in Castlepollard, Árd Mhuire in Dunboyne, Bethany Home, Denny House, the Regina Coeli Hostel and St Kevin’s Institution in Dublin. Each entry has a concluding year, and several of them run to 1998. This is not only a story about the 1940s and 1950s.
If you are unsure whether the place you are thinking of is on the list, or what it was called, or when exactly you were there, that is not a barrier. The scheme states plainly that applicants do not need to provide institutional records, exact dates, or any account of what happened to them. You give your contact details, any other names you were known by, your date of birth, whatever you know about the institution, and certified photo identification. That is the standard application.
You do not have to sign a waiver to take the card
This is the point that stops people, and it is worth being precise about. Accepting a general payment or a work-related payment requires signing a legal waiver, under which you agree not to take further action against the State in relation to your time in the institution. That is a serious decision and people are right to weigh it.
The waiver attaches to the payments. The health supports are assessed and offered separately, and an applicant can apply for one benefit, two, or all three. If the cash is what gives you pause, the card is still on the table.
The scheme will also reimburse up to €500 excluding VAT for independent legal advice before you decide, paid back by bank transfer on production of a solicitor’s invoice or receipt. If you are weighing a waiver, use it. Nothing in this article is legal advice, and a solicitor who reads your particular determination is worth considerably more than a general guide.
What the card does not do
Being straight about the limits is part of being useful. It does not move you up a waiting list. The Department says so in terms: the card carries no advantage regarding waiting times, because HSE services are prioritised on clinical need and resource availability. Anyone who has watched a relative wait eighteen months for an orthopaedic appointment will want to hear that before they build any hope on it.
It does not guarantee free hearing aids and glasses. The dental, ophthalmic and aural services are those specified in section 67 of the Health Act 1970, and there may be costs beyond what the card covers. Your HSE Local Health Office is the place to establish what you will and will not pay.
And it cannot be used outside Ireland. For people living abroad the scheme offers a once-off health support payment of €3,000 instead, which is the sensible choice for most. If you live abroad but expect to return, you can still take the card, but you will need a PPS number, an address in Ireland and registration with an Irish GP before it is any use to you.
The money does not count against you
This is the part that tends to settle nerves in a kitchen, and it is written into the legislation rather than left to administrative goodwill.
Section 46 of the 2023 Act amends the Nursing Homes Support Scheme Act 2009 so that a general payment or a work-related payment is a “relevant payment” to be disregarded in the Fair Deal financial assessment. It sits in the list immediately after Thalidomide payments. Section 41 inserts a new section 205B into the Taxes Consolidation Act 1997, exempting the payment from income tax, exempting income arising from investing it, and taking gains on assets bought with it out of capital gains tax.
Citizens Information states the position across the board: for people living in Ireland, payments awarded through the scheme are not included when means are assessed for social welfare means-tested payments, for a medical card or GP visit card, or under Fair Deal.
So a payment does not reduce a non-contributory State Pension, and it does not get eaten later by a nursing home assessment. For someone in their eighties who has spent years quietly assuming any windfall would simply be clawed back, that is the single most important paragraph here.
The list the 2023 Act borrowed word for word
There is a detail in the drafting that tells you something about how Ireland builds these entitlements.
Section 34(3) of the 2023 Act lists eight services, lettered (a) to (h). Section 2(1) of the Redress for Women Resident in Certain Institutions Act 2015, which provides health services to women who accepted an offer under the Magdalen Restorative Justice Ex-Gratia Scheme, lists eight services, lettered (a) to (h). They are identical: the same GP medical and surgical service, the same reference to the Reimbursement List, the same nursing service under section 60 of the Health Act 1970, the same home help under section 61, the same dental, ophthalmic and aural services under section 67, the same counselling, chiropody and physiotherapy on referral.
Eight years apart, the second scheme simply reused the first. That has a practical consequence: section 22(7) of the 2023 Act says you are not eligible for these health services if you are already a relevant participant under the 2015 Act. One card, not two, and the application form asks you directly whether you hold a Magdalen scheme medical card.
It also leaves one small wrinkle worth knowing. The statutory text requires a referral from a registered medical practitioner for counselling and for physiotherapy, while the Department’s published guidance describes those referrals as coming from a medical practitioner or a registered nurse. If you are relying on a public health nurse to open one of those doors, ask the question rather than assume the answer.
The clocks you need to know about
Four deadlines matter, and none of them are advertised loudly.
Six months to accept. Under section 34(1), once a Notice of Determination containing an offer of health services is sent to you, you have six months to accept or reject it. For the cash payments, section 31(5) goes further: an applicant who says nothing within the six months is deemed to have rejected the offer. People put these envelopes on the mantelpiece. Six months passes.
Sixty days to seek a review of a determination you disagree with, and sixty days again to appeal the review outcome to an independent appeals officer. An appeals officer’s decision is final, save for an appeal to the High Court on a point of law within 28 days.
March 2029. Section 6 provides that the scheme ceases to operate on the fifth anniversary of its establishment day, and the Department confirms the closing date as March 2029. An application received before that date is still processed afterwards, but one received on or after it cannot be considered at all.
Two pieces of good news sit alongside the clocks. Applications are prioritised by the applicant’s age, and anyone who is terminally ill goes into a separate priority queue on production of a short letter from their doctor. And where a person died on or after 13 January 2021, the date of the State apology, their personal representative may apply on behalf of the estate for the general and work-related payments. The health supports, by their nature, do not survive the person.
The gap nobody has finished counting
In November 2021 the Department estimated that 34,000 survivors would qualify for a financial payment under the scheme, and that 19,000 of them would also qualify for an enhanced medical card. Those figures were set out again in the Oireachtas Library and Research Service Bill Digest in December 2022, with a total projected cost of around €800 million.
The scheme opened on 20 March 2024. By 17 September 2026, the Department reported that almost 7,600 people had applied and more than 5,500 payments had been made. Applications were running at an average of 14 a week.
Then a national awareness campaign launched on 24 August 2026, across print, radio, digital and social media. In the first three and a half weeks, 202 applications came in. Calls to the confidential freephone line rose from 50 to 60 a week to 523. Requests for paper forms went from about 10 a week to 197. Portal messages and emails went from 70 or 80 a week to 662.
That is not the response of a population who had considered the scheme and declined it. That is the response of a population who did not know. The ceiling on uptake was never willingness. It was that nobody had told them, and a fortnight of radio advertising moved the weekly application rate fourfold.
The Act anticipated this. Section 48 obliges the Minister to commence a review of the scheme’s operation within six months of its second anniversary, and the very first matter that review must consider is “the extent to which persons who are entitled to a payment, or eligible for the provision without charge of health services, under the Scheme have made applications”. Paragraph (f) requires it to consider the extent to which health services have actually been provided to those eligible. In other words, the legislation itself instructed the State to go and measure the gap between the 19,000 and the people who actually hold a card.
How to start, if any of this sounds like you or someone you know
The first call costs nothing and commits you to nothing.
- Confidential Freephone: 1800 843 354
- Online: www.paymentscheme.ie, where you can apply through the portal
- Payment Scheme Office: +353 1 522 9992, Monday to Friday 9am to 6pm, or info@paymentscheme.ie, or by post to Payment Scheme Office, PO Box 13668, Waterford
- Paper forms are available at your local library, your Citizens Information Centre, post offices, primary care centres and nursing homes
- Once a card is issued, the HSE Eligibility Unit on 0818 22 44 78 handles changes of address and queries about what is covered
- If talking about it is hard, the HSE National Counselling Service is free, Monday to Friday 9.30am to 5pm. Outside those hours, Connect Counselling offers trained telephone support on 1800 477 477, generally 6pm to 10pm, seven days
If you cannot face the form, a family member, carer or friend can help you gather the information, and a formally appointed decision-making assistant or co-decision-maker can act with you where such an arrangement is in place.
If you are the family member reading this
You may be the person best placed to do something here, and the doing of it is smaller than it looks. It is not a conversation about the past. It is a conversation about a card.
Try it at the kitchen table rather than in the car on the way to an appointment, and try it as a piece of news rather than a question: there is a medical card for people who spent time in those places, it covers physiotherapy and the dentist, it has nothing to do with income, and I can ring the number if you’d rather I did. If the answer is no, let it be no. Leave the number on the fridge. People come back to things.
And if the answer is yes, remember that the card itself is only the beginning. An entitlement to physiotherapy, chiropody, counselling and home support is worth very little until somebody actually books the first appointment. That part is where families make the difference, and it is the part that tends to get forgotten once the envelope has been opened.
At Críonna Health we write about ageing well in Ireland, which includes the unglamorous business of knowing what you are owed. This is one of the clearest examples we have come across: a lifelong, non-means-tested entitlement, written into primary legislation, with a State estimate of 19,000 eligible people and a closing date in March 2029. If you know someone it might apply to, the kindest thing you can do this week is say so out loud.
This article is general information, not legal or medical advice. Eligibility is decided by the Payment Scheme Office on the facts of each application. If you are weighing a legal waiver, use the scheme’s reimbursement for independent legal advice and talk to a solicitor.
📷 Photo by Kate Macate on Unsplash
