The Maharashtra government has cleared dues worth ₹ 1,299 crore to hospitals empanelled under the Mahatma Jyotirao Phule Jan Aarogya Yojana (MJPJAY) and the Pradhan Mantri Jan Aarogya Yojana (PMJAY) between March 1 and April 17, 2025, said the officials on Thursday.
As per officials, the schemes earlier worked on an insurance model, and the government paid the insurance premium, and the insurance company later paid the health claim to hospitals. However, in July 2024, the scheme changed from insurance mode to assurance mode, and the state government took responsibility for paying the treatment charges. This transition in the mode of the scheme caused a delay in releasing the payment from the government for the past several months, said the officials.
Annasaheb Chavan, chief executive officer (CEO), State Health Assurance Society, said, “We have cleared dues of ₹ 1,299 crore of both the MJPJAY and PMJAY scheme. All dues are cleared, and the process is ongoing,” he said.
The state government, in 2023 revamped the MJPJAY scheme, making it universal and increasing the medical treatment cover from the earlier ₹1.5 lakh to ₹5 lakh. Under the PMJAY scheme, beneficiaries are provided coverage of up to ₹5 lakh per year per family. Currently, there are 1359 private and 672 government facilities empanelled under both schemes in the state. Besides, 1,352 health procedures are covered under the scheme.
Dayanand Jagtap, deputy CEO of State Health Assurance Society, said, that in Maharashtra, there are 13.5 crore and 3.73 lakh families that are beneficiaries of the schemes. “The delay was there as the payment was not released by the state government due to the transition. The state government pays the entire amount for MJPJAY and PM-JAY, 40% of expenses are borne by the state government and 60% by the central government. The state government gave ₹ 1162 crores to the society to clear the dues, and the society is likely to receive over ₹ 200 crores from the central government. However, the scrutiny of bills and treatment documents takes time for releasing the payment,” he said.
{{/usCountry}}Dayanand Jagtap, deputy CEO of State Health Assurance Society, said, that in Maharashtra, there are 13.5 crore and 3.73 lakh families that are beneficiaries of the schemes. “The delay was there as the payment was not released by the state government due to the transition. The state government pays the entire amount for MJPJAY and PM-JAY, 40% of expenses are borne by the state government and 60% by the central government. The state government gave ₹ 1162 crores to the society to clear the dues, and the society is likely to receive over ₹ 200 crores from the central government. However, the scrutiny of bills and treatment documents takes time for releasing the payment,” he said.
{{/usCountry}}Dr Omprakash Shete, head of the Ayushman Bharat Mission Maharashtra committee, said, all dues have been cleared by the government, and the schemes have been running smoothly since March.
“The system is now streamlined, and there will be no issues in future. We have asked all empanelled hospitals to admit and treat patients without delay and without demanding upfront payments,” he said.