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Odisha is in advanced talks with the National Health Authority (NHA) to join the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY), sources in the Union Health Ministry have said.
PMJAY provides annual health cover of Rs 5 lakh per family for secondary and tertiary care hospitalisation.
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“Odisha is already implementing its own health scheme, which will now run alongside this central scheme, and some technical issues are being worked out,” said sources.
Technicalities, including integrating the state scheme’s information technology platform with PMJAY and regularising beneficiary lists, are being discussed.
“While PMJAY is an Aadhaar-based scheme, Odisha’s state scheme covers over 90 per cent of its population and is not based on Aadhaar. They will have to link it to the Aadhaar card so that beneficiaries eligible under PMJAY can get benefits,” said a senior government official.
The Odisha Health Department and NHA did not immediately respond to emailed questions. The story will be updated if they do.
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Odisha’s Gopabandhu Jan Arogya Yojana (GJAY), earlier known as Biju Swasthya Kalyan Yojana (BSKY), provides Rs 5 lakh health coverage in private hospitals to the state's rural families, except government employees and income taxpayers.
GJAY is estimated to have 10.3 million families as eligible beneficiaries to nearly and reaches 47.9 million individuals through 979 private empanelled hospitals in and outside the state, according to data available on the BSKY dashboard.
Since PMJAY covers beneficiaries based on deprivation and occupational criteria of the Socio-Economic Caste Census (SECC) 2011, an estimated 7 million families in Odisha are eligible. This is far fewer than the number of beneficiaries covered under the state scheme.
PMJAY also provides an additional Rs 5 lakh coverage for women of families after exhaustion of the initial limit.
After the scheme is integrated in Odisha, the central government will share the financial burden for families eligible for PMJAY under a 60:40 framework.
“For those not eligible under the central scheme, the state will fund from its budget. Since women members are covered for an additional Rs 5 lakh in Odisha, the extra coverage for them will be borne by the state,” said a source.
When Odisha joins PMJAY, 34 states and union territories would have implemented the scheme. West Bengal and Delhi have not adopted PMJAY.
As many as 18 states have converged their schemes with PMJAY, of which four—namely Uttar Pradesh, Haryana, Uttarakhand, and Nagaland—run their state employee schemes in convergence with PMJAY hospitals and IT platform.
The NHA is also in the process of integrating Karnataka’s Karnataka Arogya Sanjeevani Scheme into its IT platform.
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