The HSE's budget deficit for the year to date has grown to nearly €50 million, according to its latest financial report, which indicates that cutbacks are being planned for the medical card scheme.

The report also indicates that expected savings and income targets in a number of areas are not being achieved.

Latest performance figures show that at the end of May, the HSE's overall deficit was €49.3 million. However, this compares to a deficit of €281 million at the same time last year.

Within the current deficit of €49.3 million there is a core deficit of €29.3m when account is taken of timing issues around the phasing of budgets and the shortfall in retirees to the end of May resulting in lower than target pay savings, according to the HSE's latest performance report.

The Primary Care Reimbursement Service (PCRS), which includes the medical card scheme, has run up a deficit of €15 million, with €10 million of this accounted for by Health Minister James Reilly's delay in implementing promised fee cuts for GPs, pharmacists and other professional contractors providing services to State schemes.

The HSE says an end-of-year deficit of between €65 million and €100 million is now projected for the PCRS unless remedial measures are taken.

It says a draft short list of cutback measures for the medical card and other community schemes aimed at reducing the deficit was now being considered.

The HSE and Department of Health has recently come under fire for restricting the issuing of 'discretionary' medical cards to seriously ill patients, including cancer patients, those with motor neurone disease, and women who develop diabetes in pregnancy.

Hospitals are currently €53 million over budget, according to the HSE financial report.

Deficits in certain areas of HSE expenditure have been offset to date by surpluses in other areas - the Fair Deal scheme is €15 million under budget, according to the report.

The HSE report also says there is some uncertainty over whether the projected €150 million in pay savings for the year will be achieved under the Haddington Road agreement.

In addition, the projected €60 million in expected income this year from Minister Reilly's changes in public hospital private bed charges is not expected to be fully achieved, according to the HSE report.

The HSE says it does not in itself have the capacity to address the shortfalls that may emerge in a number of risk areas including the PCRS, public service pay and hospital private health insurance income.

The report says the HSE is now projecting a deficit of around €104 million at the end of the year. In 2012, the HSE received a €360 million bail-out to meet its end of year deficit.

The HSE says hospital and community services have formally been requested to identify additional cost containment measures to safely bridge the projected direct services deficit.