Why 650 Haryana hospitals have halted AB-PMJAY services, in move set to hit 1.4 crore beneficiaries

The Print

2 days ago

The Centre's flagship health insurance scheme, AB-PMJAY, provides Rs 5 lakh annual coverage per family for secondary and tertiary hospitalisation, benefitting over 12 crore economically vulnerable families across India. Of them, 1.364 crore beneficiaries are from Haryana.
The Indian Medical Association, Haryana, has declared a complete halt in the implementation of the scheme in private hospitals over pending dues estimated at Rs 500 crore. According to IMA, Haryana, nearly 650 private hospitals have not received reimbursements this quarter, and some dues have been pending for over a year now.
New Delhi: Haryana private hospitals empanelled under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have suspended services under the healthcare scheme, citing non-payment of reimbursements by the state government.
On 6 August, at an emergency meeting with Haryana's chief secretary and senior health officials, the IMA learnt that Haryana had released Rs 145 crore and the Centre Rs 70 crore for the scheme implementation in the current quarter. Even with Rs 245 crore paid by the two governments—an IMA statement said—dues of Rs 490 crore are still pending.
'The root of the problem is the budgetary mismatch,' said Dr Suresh Arora, a senior consultant at Surya Ortho & Trauma Centre in Faridabad, which is among the private hospitals suspending services under AB-PMJAY. 'Haryana's annual budget for the scheme is nearly Rs 700 crore, but actual expenses exceed Rs 1,400–1,500 crore. This shortfall has persisted for the last three years.'
His hospital alone has pending dues of Rs 20 lakh.
ThePrint has learnt that another large, multi- or super-speciality hospital, the 2,600-bed Amrita Hospital, which Prime Minister Narendra Modi inaugurated in Faridabad on 24 August 2022, is yet to be reimbursed Rs 18 crore under the scheme.
A total of 32,736 hospitals are empanelled under AB-PMJAY across India, including 15,024 private and 17,712 government hospitals. Haryana currently has 1,341 empanelled hospitals, according to official data.
'This has become a pattern every three months,' said Dr Dhirendar K. Soni, the secretary of IMA Haryana. 'Payments delayed, hospitals threaten to suspend services, and then a part of the money is released.'
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'Interest clause not honoured'
Hospitals also allege that the Haryana government has failed to honour a key clause in the Memorandum of Understanding (MoU)—paying interest on delayed payments. The original MoU included a clause for interest payment in the case of delayed payments under the PM-JAY scheme, but states like Haryana reportedly have removed it.
'Not only is that not paid, but we are also seeing deductions in reimbursements,' said Dr Arora. 'They are rejecting cases on flimsy grounds, not offering additional payments to NABH-accredited hospitals—those certified for maintaining higher standards of care and patient safety—and in some cases, reimbursing only Rs 4,000–5,000 on bills worth Rs 18,000.'
An IMA delegation, which previously met Chief Minister Nayab Singh Saini in February to raise these concerns, 'was assured of a resolution, but nothing has happened since', Dr Soni said.
Dr Girdhar J. Gyani, Director-General of the Association of Healthcare Providers of India (AHPI), which represents over 15,000 private hospitals, including major chains such as Fortis, Max, Manipal, Medanta, and Apollo, pointed out two structural issues with the scheme.
One issue, Gyani noted, was the lack of a strict clause in the scheme for interest payments to empanelled hospitals in the case of delays to ensure timely reimbursements by governments.
'If the one percent interest clause applied on delays beyond the 15-day agreement period, officials would be more accountable,' he said.
In the current setup, the government often defaults on payments, leaving smaller hospitals grappling with severe cash flow challenges.
Different states, same challenges
The primary issue with the scheme, Dr Gyani said, was inadequate funds allocation.
Haryana is not alone. Newly joining states such as Delhi and others, including Chhattisgarh, are also grappling with reimbursement delays and mounting dissatisfaction among private hospitals under the AB-PMJAY. Delhi has 143 empanelled hospitals, including public and private facilities.
A reply to an RTI filed by activist Dr Ajay Basudev Bose in February this year revealed that dues of Rs 1,21,61,45,63,617 under the scheme are pending across India.
Earlier, ThePrint reported that several large hospital chains were reluctant to join the scheme due to consistent non-payment.
Dr Gyani said that several states, including Tamil Nadu, Andhra Pradesh, Telangana, Maharashtra, and Gujarat, had expanded the coverage under AB-PMJAY, surpassing the number of socio-economically eligible beneficiaries initially identified under the national guidelines. Now, these states are supposed to bear the excess coverage costs from their treasury, but many, however, do not have the funds, he added.
Dr Gyani also raised concerns about the Central Government Health Scheme (CGHS), which offers highly subsidised healthcare, mainly private healthcare, to central government employees and pensioners.
'CGHS [core] rates have not been revised since 2014, despite inflation. The government is now proposing a new agreement, with more stringent conditions, but without updating the rates,' he said. Many hospitals would likely withdraw from CGHS, as well, if the government approved the conditions but did not update the rates, he added.
(Edited by Madhurita Goswami)
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