Nearly a year after the central government expanded the Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana (AB PM-JAY) to include all citizens aged 70 and above, Tamil Nadu is yet to implement the revised scheme.
The delay is due to unresolved disagreements between the Union and State governments over the scheme’s execution. A senior state official confirmed that multiple rounds of discussions have taken place with the Centre, but Tamil Nadu is still waiting for further clarification.
S.K. Mahendran, former MLA and president of the Madras Labour Union, remarked in a statement that inquiries with relevant authorities, including the National Health Authority (NHA), suggest the scheme currently exists only “on paper.”
On 29 October 2024, the Union government announced the expansion of AB PM-JAY to cover all senior citizens aged 70 and above, regardless of their income level. The enhanced plan offers free medical treatment up to ₹5 lakh per year per family. Based on official projections using the 2011 Census and a 3.73% annual growth rate, the scheme is expected to benefit six crore senior citizens from 4.5 crore families across India.
In Tamil Nadu, around 43.19 lakh people from 32.35 lakh families fall into this category. NHA data shows 4.06 lakh individuals from 3.69 lakh families are currently listed in the AB PM-JAY database. The remaining 39.13 lakh people (from 28.66 lakh families) are considered newly eligible under the expanded scheme. The Election Commission estimated that 53.12 lakh voters aged 70+ resided in the state during the 2024 Lok Sabha elections.
Under the current cost-sharing model, the Centre funds 60% of the insurance premium, with the State covering the remaining 40%. However, in northeastern and Himalayan states, the Centre’s contribution rises to 90%. For Tamil Nadu, this currently translates to an annual contribution of ₹1,000 crore by the Centre and ₹200 crore by the State.
Should Tamil Nadu agree to implement the expanded version of the scheme without any income-based eligibility for those aged 70 and above, the State’s financial obligation may rise by another ₹200 crore, bringing the total to ₹400 crore annually. A senior official expressed concern that, considering Tamil Nadu’s high life expectancy and the potential for elevated healthcare costs for the elderly, the financial impact might exceed current estimates.
The AB PM-JAY, launched in September 2018, originally aimed to provide secondary and tertiary hospital care to 12 crore families, identified as the bottom 40% of India’s economically vulnerable population. However, the Centre and Tamil Nadu differ on how this population is defined. The Centre uses data from the 2011 Socio-Economic Caste Census (SECC), while the State determines poverty based on an annual family income limit of ₹1.2 lakh.
Due to this divergence, Tamil Nadu continues to operate its Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS), which covers 1.48 crore families. Of these, 86.5 lakh families are jointly covered under CMCHIS and PM-JAY, with the Centre paying 60% of the ₹849 premium per family. For the remaining 60 lakh families, Tamil Nadu bears the full cost of the premium.
Moreover, the State extends financial coverage of up to ₹22 lakh per beneficiary for advanced medical procedures across the board.
The state government argues that if the Centre is willing to remove the income cap for those aged 70 and above, it should also recognize the State’s broader poverty estimates and share 60% of the premium for the additional 60 lakh families it identifies as economically vulnerable.
(With Inputs From The Hindu)
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