September 23, 2018:

The PMJAY is expected to cover 28.5 million individuals in 7.7 million poor families

As the Centre’s ambitious project, the Pradhan Mantri Jan Aarogya Yojana (PMJ.Y), widely refered to as Ayushman Bharat or Modicare, is all set for a nation wide launch on Sunday, states are gearing up to implement the scheme, integrating it with their own public health insurance plans & tying up Field the loose ends.

Experts feel that the initial days of the scheme are likely to see teething troubles, like lack of manpower.

Sample this: Tamil Nadu, the only southern state to be on board for now for Ayushman Bharat, has a tough task at hand.

It has said that the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), in operation since 2008, would be suitably linked with the PMJAY.

It plans to extend the Rs 500,000 cover per family per year not only to those eligible under the PMJAY, but also to those already covered under the CMCHIS.

The PMJAY is expected to cover 28.5 million individuals in 7.7 million poor families under the socio-economic caste census (SECC) list. In contrast, the existing CMCHIS covers 15.7 million families with Rs 100,000 per year for 1,027 procedures.

Around 154 procedures are entitled for grant of Rs 200,000 per year. Tamil Nadu chief minister Edappadi K Palanisamy ordered that the CMCHIS coverage would be raised up to Rs 500,000 to ensure uniform benefit for all. Experts feel that this may increase the financial burden for the state government significantly.

Tamil Nadu has opted for a model wherein the Centre would provide 60 per cent of the net expenditure for 7.7 million families which is estimated to be around Rs 3.5-4 billion. At present, the state government is spending around Rs 13.50 billion. The premium per family works out to around Rs 699. Tamil Nadu would implement the scheme through a mix of both assurance & insurance models.

In Gujarat, the existing beneficiaries of its Mukhyamantri Amrutam (MA) Yojana (who now get around Rs 300,000 cover) would stand to gain from the enhanced cover.

While the Gujarat government claims to have covered around 90 per cent of beneficiary families as on date under its existing Mukhyamantri Amrutam (MA) &Mukhyamantri Amrutam Vatsalya (MAV) health insurance schemes, a recent Comptroller & Auditor General (CAG) probe has found serious lapses in implementation of the plans.

According to the audit report for the year 2016-17, Gujarat was able to manage only 54.54 per cent of enrolment of total below poverty line (BPL) beneficiary families under the existing health schemes as on March 2017.

The total number of BPL families as on March 2017 as per the CAG audit report were 4.15 million.

Source HT

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