Union Budget 2025-26: PMJAY allocation may not suffice, say experts

Budget estimates (BE) for the financial year (FY) 2025-26 have put the allocation for PMJAY at Rs 9,406 crore, a 28.8 per cent increase from Rs 7,300 crore in FY25's BE

Public health experts have welcomed the increase in allocation for the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) in the Union Budget 2025-26, while raising concerns over whether these funds would be adequate to cover the expanding beneficiary base under the scheme. 

 

Budget estimates (BE) for the financial year 2025-26 (FY26) have put allocation for PMJAY at Rs 9,406 crore, a 28.8 per cent increase from Rs 7,300 crore in FY25 BE. 

 

The increase, however, comes in tandem with the inclusion of more groups and states in the scheme. In her budget speech on Saturday, Finance Minister Nirmala Sitharaman also announced the inclusion of around 10 million gig workers in the PMJAY in the coming years.

 

Commenting on the same, Indu Bhushan, former chief executive officer (CEO) for Ayushman Bharat, added that while the intention is good, there would be implementation challenges in terms of defining gig workers as they do not have a ready database.

 

“One can be a gig worker today and get a regular job tomorrow. Questions remain around how will the system confirm it and what process will be followed. One will have to see how these implementation challenges will be resolved,” Bhushan said.

 

Concerns also remain if the funds are adequate to cover the expanded beneficiary base. In 2024 alone, the scheme was expanded to cover 3.7 million ASHAs and anganwadi workers and their families for free healthcare benefits, with the year ending with the government’s announcement to include around 60 million senior citizens aged 70 years and above. This year, Odisha became the 34th state or union territory (UT) to join PMJAY, adding approximately 6.78 million more families under the scheme’s fold. 

 

Terming the move as a step towards universal health coverage (UHC), health expert K Srinath Reddy said that while the allocation has certainly increased, “we will have to wait and see how they are going to actually increase the pool of PMJAY, with contributions from states, as well as potentially from employers (in case of gig workers), in order to provide funding for all these new categories of people who have joined.”

 

The PMJAY, which provides cashless and paperless benefit cover of Rs 5 lakh per annum per family in empanelled hospitals across India has been seeing an expansion in its beneficiary base since its operationalisation in 2019.

 

It initially covered around 107.4 million poor and vulnerable families, comprising the bottom 40 per cent of India’s population, according to the Socio Economic and Caste Census (SECC) of 2011. The beneficiary base was later revised to 550 million individuals, or 123.4 million families in January 2022.

 

Currently, over 365 million Ayushman Cards have been crested till now, according to data available on the PMJAY dashboard.

 

Hospital claim issue takes forefront

 

While the hospital industry has welcomed the Centre’s move to increase allocation under PMJAY, it has pointed out that sustainability of the scheme hinges on ensuring adequate reimbursement rates and timely payments to hospitals.

 

“We support the poor people that have been able to avail treatment under Ayushman Bharat, but the delay in reimbursement payments have left various empanelled hospitals with operating losses,” said an administrator for a Delhi-based hospital empanelled in PMJAY. 

 

Several private hospital associations have, in the past, complained of lower rates and delays in reimbursement related to procedures performed under the scheme. 

 

Just last month, the Haryana state chapter of Indian Medical Association (IMA) had called for suspension of all treatment under PMJAY in state’s empanelled private hospitals, over the issue of reimbursement payments worth Rs 400 crore pending with the state government.

 

The Private Hospital and Nursing Home Association (PHANA) in Punjab had announced a similar suspension treatment under the scheme last year, over unresolved payments worth Rs 600 crore pending for six months.