Maharashtra Clears Rs 1,299 Crore Dues to Hospitals under MJPJAY, PMJAY

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.