Maharashtra Clears Rs 1,299 Crore Dues to Hospitals under MJPJAY, PMJAY
Pune: In a move aimed at
improving healthcare delivery in Maharashtra, the state government has cleared dues amounting to Rs. 1,299 crore to
hospitals empanelled under the Mahatma Jyotirao Phule Jan Aarogya Yojana (MJPJAY) and the Pradhan Mantri Jan Aarogya Yojana (PMJAY) schemes. These payments were
made between March 1 and April 17, 2025, to ensure the smooth continuation of medical services.
Currently, 1,359 private and 672 government hospitals are empanelled under these two schemes in Maharashtra. Additionally, 1,352 health procedures are covered, providing access to a wide range of medical treatments for beneficiaries across the state.
Previously, both MJPJAY
and PMJAY operated under an insurance model, where the state government paid
premiums, and the insurance company handled health claims for the empanelled
hospitals. However, in July 2024, the state switched from the insurance model
to the assurance model, where the Maharashtra government directly took
responsibility for settling treatment charges. This change in the scheme’s
structure led to delays in releasing payments to hospitals over the past
several months, reports the Daily.
Speaking to Hindustan Times, 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 MJPJAY, revamped in
2023, provides universal coverage to beneficiaries, increasing the medical
treatment coverage from ₹1.5 lakh to Rs. 5 lakh per family. Similarly, under
PMJAY, families are entitled to coverage of up to Rs. 5 lakh per year for medical
treatment.
As per the recent media
reports, 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.
According to Dr.
Omprakash Shete, Head of the Ayushman Bharat Mission Maharashtra Committee, the
government has now successfully cleared all outstanding dues, and the schemes
have been running smoothly since March 2025. He also mentioned that the system had
now been streamlined and that there would be no issues in the future. All
empanelled hospitals had been asked to admit and treat patients without delay
and without demanding upfront payments.
Medical Dialogues had
previously reported that the state
government de-empanelled 9 hospitals from the state’s health insurance scheme,
Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), which was launched in 2012 for
the poor patients after the raids carried out by a state-level monitoring team
in the private hospitals at Kolhapur and Sangli.
However, there have been successful
models like the orthopaedics department IGGMCH, also known as Mayo Hospital in
Nagpur, that set a remarkable example among government hospitals by delivering
high-quality treatment while maintaining financial sustainability. Over the
past year, the Hospital generated approximately Rs. 3.64 crore in revenue
through surgeries performed under the Mahatma Jyotiba Phule Jan Arogya Yojana.