Under AB-MJPJAY: Maharashtra writes to ECI for Rs 5 Lakh universal coverage nod; further delays likely

“A week ago, we wrote to the Election commission seeking approval to roll out the new policy,” said a senior officer from the state health department. “It is in the pipeline, hoping to get the approval,” he added.

Ever since the scheme was announced, it has encountered numerous hurdles in its implementation on ground. Despite being announced by Union Health Minister Dr Mansukh Mandaviya and Maharashtra’s Deputy Chief Minister Devendra Fadnavis in June 2023 as the first state to merge the AB-MJPJAY with the state’s Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), a scheme aimed at achieving universal healthcare coverage, its government resolution was delayed until July 2023 amid criticism.

However, its implementation has been hindered by seven months due to bureaucratic apathy, and further delays are expected due to the ongoing model code of conduct.

When asked about the reason for the delays spanning over eight months, the officer explained that under the new policy, the MJPJAY — a state-run scheme initiated in 2012 — currently covers 2.25 crore families and offers a medical cover of Rs 1.5 lakh. It was recently expanded so that every family can receive health coverage of Rs 5 lakh per year for secondary and tertiary care hospitalisation in the state under the Centre’s scheme.

“The premium also underwent changes due to this expansion, previously paid to the State Health Insurance Society at the rate of Rs 855 per family. There were several issues back and forth in deciding the new premium under the new policy, which was ultimately finalised a few days ago,” the officer stated.

Under the present MJPJAY scheme, there are close to 2.22 crore beneficiaries in the state. All of them were below the poverty line and were yellow or orange ration card holders. The improvised scheme will cover citizens irrespective of what ration cards they hold. The improvised scheme will cover 1,900 ailments against the existing 996.

However, due to the delayed implementation, patients in need were unable to access the benefits. Vilash Morghe from Shramjeevi Sanghatana told the The Indian Express how his brother-in-law, who needed surgery after an accident, was unable to utilise the Rs5 lakh insurance coverage.

“Firstly, there are very few empanelled hospitals in Palghar. Secondly, despite visiting three private hospitals listed, none could provide the Rs5 lakh coverage as they hadn’t received notification from the state,” said Morghe. “Ultimately, my brother-in-law had to bear the expenses himself,” Morghe said.

Last year, Fadnavis announced that the said co-branded cards (the two merged schemes) will be issued to one crore citizens by August, 2023 and 10 crore citizens in the next six months. The cost of making these 12 crore co-branded cards is estimated to be around Rs 179 crore, which will be funded by the Centre under the NHA. But in actuality, nothing was implemented.

This was a significant achievement for the state health department in this government’s tenure, which could have gained considerable popularity if implemented and potentially influence votes in the upcoming Lok Sabha election. Health activists criticised the state health department for its sluggish approach towards implementing the scheme, which could have provided quality treatment to hundreds of needy patients.

“For a state like Maharashtra, why does it take over eight months to implement such a crucial scheme announced with great fanfare? Health equity is a basic right for people, yet out-of-pocket expenses remain high, making it unaffordable for the most vulnerable populations,” said Dr Abhay Shukla, national co-convenor of Jan Swasthya Abhiyan.