Community Services Cards

Introduction

The Community Services Card is an entitlement card available to people on low to middle incomes or receiving income support. The card may be used to obtain higher subsidies for after hours and out-of-town doctors' fees as well as access to other health services from public hospitals.

People receiving income support, Veteran's Pensions and the Residential Care Subsidy automatically receive a Community Services Card (and subsequent replacement cards), so they don't have to complete application forms. Many students in receipt of a Student Allowance are also issued cards automatically.

People who are working need to complete an application form in order to have their eligibility for a Community Services Card assessed. An information sharing agreement with Inland Revenue is used to identify and contact working people with children who receive Family Tax Credits. Eligible families have their cards automatically renewed.

People receiving New Zealand Superannuation must apply for their first Community Services Card. This is because the Community Services Card is income tested for all recipients including those receiving New Zealand Superannuation. Once the first application has been made, card renewal is automatic for more than 80% of people receiving New Zealand Superannuation.

Following the launch of the Primary Health Strategy in 2001, the Ministry of Health introduced Primary Health Organisations (PHOs) from 1 July 2002. Patients enrolled with PHOs don't require a Community Services Card in order to access low fees for doctors’ visits and prescriptions. Between 2002 and 2007 low-cost access was rolled out incrementally across New Zealand by age cohorts, starting with children, then seniors, and then working age people.

From 1 July 2007 all PHO enrolees have received low or reduced cost services when they access care from their "home" practice. The Community Services Card continues to be used for eligible PHO enrolees when they access care away from their home practice and are treated on a casual basis. This occurs in the following situations:

• when patients travel away from home, for example on holiday, or work, including seasonal work or students returning to their home
• when patients need to access urgent medical care from an Accident and Medical centre or other after-hours service provider
• when new patients enrol with a primary health care provider, including those who are changing from one PHO practice to another, many PHO practices treat them as casuals until the next payment quarter when they receive their capitation payment for that patient.

The Community Services Card enables health providers to identify low socio-economic family groups and individuals without further means testing. It is therefore used to target a number of health services and disability support services to high need people when resources are insufficient to enable universal coverage.

The health and disability support services where cards are commonly used to target low income people are:

• Family Planning Association contract - The Ministry of Health contract with the Family Planning Association is funded on the basis of cardholders aged 22 years and over being charged a reduced co-payment of $5 for a general consultation rather than the $22.50 co-payment charged to those without a card
• National Travel Assistance - cardholder status is considered in conjunction with travel distance and age to qualify for National Travel Assistance
• Oral health - District Health Boards use the card as a means of targeting emergency dental services (relief of pain and infection) to low-income people. Demand for this service is very high and for many low-income people is their only access to dental care
• Home Help - DHBs and MSD use the card to target access to Home Help for people following a needs assessment by a Needs Assessment and Service Co-ordination agency
• Spectacle Subsidy for children - the Ministry of Health pays up to a maximum of $250 (GST excl.) per child per year towards the price of spectacles and examinations for children 15 years and under who have a card, or whose families hold a card
• Other health services where some DHBs use cards for targeting purposes. Some DHBs target services to cardholders. Services targeted in this way are post hospital discharge home support, medical alarms, free access to sterilisations, and removal of skin lesions in community settings
• Use of cards by other sectors - the card is used by other government agencies and local government for targeting a number of services including:
  • Healthy Housing intersectoral initiative - this initiative involving a number of Government agencies target households which include one or more cardholders for the provision of retrofitting to provide insulation for warmth
  • Travel assistance for pregnancy termination - Work and Income provides travel assistance to cardholders referred by their primary health care provider for a termination of pregnancy
  • Access to swimming pools - a number of territorial local authorities give cardholders access to swimming pools at reduced rates.

Some private organisations also offer discounts to Community Services Card holders. The number of private organisations which offer discounts is not monitored by either the Ministry of Health or MSD

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Trends in the number of Community Services Cards on issue

The number of Community Services Cards on issue has decreased since 2004 (see table 7.1), reflecting several factors, including:

• the downward trend in the number of people receiving main benefits
• increases in the adult minimum and average ordinary wage rates
• the completed roll-out of PHO funding for Primary Health Services for all age cohorts, which has meant that people only need a card to access subsidies for after hours' and out-of-town doctor's visits
• changes between 2005 and 2008 to the Working for Families Tax Credit (formerly Family Assistance) eligibility criteria have led to an increase in the numbers of Family Tax Credit recipients holding a card.

Thirty-six percent of people holding Community Services Cards in 2008 were receiving main benefits, compared with 41% in 2004 (see table 7.1). Over this period, around 30% of cardholders have been receiving New Zealand Superannuation or Veteran's Pension. Between 2005 and 2008, the proportion of cardholders who were receiving a Family Tax Credit increased from 13% to 21%.

Table 7.1 Trends in the categories of clients holding Community Services Cards

Category of clients card are issued to	Community Services Cards on issue1
	2004 Number	2005 Number	2006 Number	2007 Number	2008 Number
Low-income earners and students not receiving Student Allowance2	83,791	75,640	68,055	54,598	43,185
Family Support/Family Tax Credit recipients3	132,951	130,874	152,782	175,826	189,114
Veteran's Pension recipients	5,389	5,169	6,773	6,822	7,843
Students2	41,390	43,660	41,817	47,930	36,542
Main benefit recipients4,5	435,009	409,608	397,666	330,456	330,697
New Zealand Superannuation recipients6	310,133	305,810	301,883	272,171	275,006
Residential Care Subsidy recipients	19,640	19,419	21,022	17,509	16,255
Families not receiving Family Support/Family Tax Credits	24,958	24,260	23,526	18,780	12,425
Total	1,053,261	1,014,440	1,013,524	924,092	911,067

Notes

1. Number of Community Services Cards on issue at the end of June. Cards are issued to adults in family units. A family unit can be a single person, or a couple and their dependent children.
2. Since June 2003, most students who receive a Student Allowance have had cards automatically issued. Students who are not entitled to Student Allowance must apply as low-income earners.
3. Family Tax Credit includes both Group 1 (unabated) and Group 2 (abated) recipients, who have both been subsidised at Group 1 levels since July 1993. This assistance was known as Family Support until 2005.
4. "Main benefit recipients" includes students receiving an Unemployment Benefit - Student Hardship or an Emergency Benefit.
5. The number of people in receipt of a main benefit as at the end of June doesn't correspond with the number of such people issued with a Community Services Card shown above. This is because the above numbers include:
   • spouses of people receiving main benefits
   • people who ceased receiving main benefits in the last 12 months whose card has an expiry date after the cessation of their benefit.
6. The number of people receiving New Zealand Superannuation doesn't correspond with the number of New Zealand Superannuation recipients issued with a Community Services Card shown above. This is because income tests for a Community Services Card exclude some people who receive New Zealand Superannuation from receiving a card.

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Trends in the number of Community Services Cards manually issued and renewed

The number of new Community Services Cards manually issued each year has decreased over the last two years (see table 7.2), reflecting the impact of:

• the completion of funding to PHOs by age cohort, which has reduced the need for patients to hold Community Services Cards
• increases to the adult minimum wage rate with the result that single people who work between 35-40 hours per week for minimum wage are not eligible for Community Services Cards
• increases in the number of automatically renewed cards issued to recipients of Working for Families Tax Credits

Fifty-four percent of the new cards issued in 2007/2008 were provided to recipients of Working for Families Tax Credits, compared with 35% in 2004/2005 (see table 7.2). There was a decrease in the proportion provided to low-income clients and students (from 43% to 27%). This reflects:

• decreases in numbers of people receiving main benefits
• the ongoing impact of the Working for Families package through:
  • families being made aware of their entitlement to Family Tax Credits and to a Community Services Card
  • increased numbers of families being entitled to Family Tax Credits.

Between 2003/2004 and 2007/2008, the proportion of renewed cards which were provided to recipients of New Zealand Superannuation has increased from 12% to 25%, with a corresponding decrease in the proportion provided to low-income earners and students (from 77% to 63%) (see table 7.2). This reduction is expected to continue, and reflects several factors including:

• increases to the adult minimum wage rate and ordinary average wage levels which have placed people working 40 hours a week above the threshold for a single person living in shared accommodation
• people in the 26-44 year age group becoming eligible for fully funded services from PHOs from 1 July 2007. From 1 July 2007 all age groups enrolled with PHOs receive full subsidies on primary health services.

Table 7.2 Trends in the number of manual issues and renewals of Community Services Cards

Type of new and renewed Community Services Cards	Community Services Cards manually issued and renewed1
	2003/2004 Number	2004/2005 Number	2005/2006 Number	2006/2007 Number	2007/2008 Number
	New cards
Low-income earners and students	50,955	48,672	41,951	34,508	26,378
Family Support/Family Tax Credit recipients2	39,682	41,331	53,590	60,511	52,926
New Zealand Superannuation recipients	12,755	10,645	13,018	11,226	8,815
Families not receiving Family Support/Family Tax Credit	16,430	16,481	15,698	14,064	9,627
Total	119,822	117,129	124,257	120,309	97,746
	Renewed cards
Low-income earners and students	48,598	41,097	35,177	30,455	23,384
Family Support/Family Tax Credit recipients2	-	-	-	-	0
New Zealand Superannuation recipients	7,316	6,970	5,527	3,078	9,380
Families not receiving Family Support/Family Tax Credit	7,404	6,548	5,979	5,372	4,426
Total	63,318	54,615	46,683	38,905	37,190
	All cards manually issued and renewed
Total (includes issue of renewed cards)	183,140	171,744	170,940	159,214	134,936

Notes

1. Numbers of new Community Services Cards manually issued and Community Services Cards renewed in years ended June.
2. All cards manually issued to recipients of Family Tax Credits (both new cards and renewals) are coded as new cards each year. There are no manual renewal counts of cards issued to Family Tax Credit recipients because these cards are reissued automatically. Family Tax Credit replaced Family Support in 2005.

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Trends in expenditure on Community Services Cards

Expenditure on claims for partial reimbursement of health charges under the Community Services Card Scheme is affected by a number of factors, including:

• seasonal variations (e.g. a mild winter tends to mean fewer claims than otherwise)
• the presence or absence of clusters of claims from or on behalf of high users, which can also affect trends across years
• the completion of funding to PHOs by age cohort, which has reduced the need for patients to hold Community Services Cards.

Expenditure on Community Services Card reimbursements has decreased since 2004 (see table 7.3). This reflects the progressive introduction over this period of subsidies for people enrolled in PHOs as well as the other factors outlined above.

Table 7.3 Trends in annual expenditure on Community Services Cards

	Expenditure on Community Services Cards1,2,3
	2004 Amount ($000)	2005 Amount ($000)	2006 Amount ($000)	2007 Amount ($000)	2008 Amount ($000)
Total	318	227	217	164	93

Notes

1. Ministry of Social Development (MSD) expenditure on partial claims against Community Services Cards in years ended 30 June.
2. MSD expenditure on Community Services Card subsidies is reimbursed by the Ministry of Health.
3. MSD expenditure on SuperGold Card as well as Community Services Card became effective from August 2007.

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