J&K private hospitals announce Ayushman Bharat exit from July 1 over ₹275 crore pending claims

Thousands of poor patients suffering from chronic illnesses are likely to face hardship as private hospitals and dialysis centres across the Union Territory of Jammu and Kashmir have announced their decision to stop accepting Ayushman Bharat “Golden Cards” from July 1, citing prolonged delays in the reimbursement of what they describe as genuine claims.

Private hospitals and dialysis centres across Jammu and Kashmir have proposed de-empanelment from the Ayushman Bharat–SEHAT Scheme with effect from July 1, 2026, alleging persistent delays in claim settlements, non-compliance with National Health Authority (NHA) guidelines, and mounting financial pressures that threaten the continuity of patient care.

The Jammu and Kashmir Private Hospitals and Dialysis Centres Association (JKPHDA) said that despite repeated representations to the concerned authorities, payments for approved claims under the scheme have remained pending for extended periods, placing severe operational and financial strain on empanelled healthcare institutions.

The financial crisis confronting private healthcare institutions empanelled under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in Jammu and Kashmir continues unabated, with hospitals reporting that nearly Rs 275 crore in pending dues remain unpaid despite partial clearances made by the authorities in recent days.

The Association, which represents 135 empanelled hospitals and dialysis centres across the Union Territory, had earlier warned of suspending treatment under the scheme from April 15 due to the non-payment of nearly Rs 295 crore. Although the State Health Agency (SHA) has reportedly released a small portion of the outstanding amount in recent days, the bulk of the payments remain pending, leaving hospitals under severe financial stress.

Hospital authorities said they have continued to provide critical healthcare services—including surgeries, cardiac interventions, dialysis, emergency care, and intensive care treatment—for more than a year without receiving timely reimbursements. The prolonged delay, they said, has pushed many institutions to the brink and raised concerns about their operational sustainability.

The association warned that without immediate financial relief, it would become increasingly difficult to sustain services under the flagship health insurance programme, popularly known as the “Golden Card” scheme. Several hospitals have indicated that they may be forced to scale down or suspend services if their supply chains and financial flows are not restored soon.

“Providing essential healthcare services such as dialysis, intensive care, surgeries, emergency treatment, oncology care, cardiac interventions, and trauma care requires an uninterrupted supply of medicines, consumables, skilled healthcare professionals, and properly maintained medical equipment,” an association spokesperson said.

According to the association, delayed reimbursements, coupled with deductions and rejection of claims without an effective review mechanism, have made it increasingly difficult for private healthcare providers to continue offering quality healthcare services under the scheme.

The Association further stated that similar challenges are being faced in specialised fields such as cardiology and orthopaedics, where the procurement of cardiac stents and orthopaedic implants requires substantial working capital. The continued delay in payments, it alleged, has hampered hospitals’ ability to procure life-saving medical products, potentially affecting patient care.

The Association maintained that the prolonged delay in claim settlements is inconsistent with the timelines prescribed under NHA guidelines and the contractual provisions governing the scheme. It further claimed that under Section 6 of the Memorandum of Understanding (MoU), empanelled institutions are entitled to one per cent interest per week on delayed payments, which has not been paid.

In view of the prevailing situation, the association announced that private hospitals and dialysis centres across Jammu and Kashmir have resolved to initiate de-empanelment from the Ayushman Bharat–SEHAT Scheme from July 1, 2026, unless immediate corrective measures are taken by the authorities.

The Association has demanded immediate clearance of all pending claims along with applicable interest, the establishment of a transparent mechanism for reviewing rejected claims, strict adherence to NHA guidelines regarding claim processing and payment timelines, segregation of payment systems for public and private hospitals, restoration of patient choice under the scheme, and urgent engagement with representatives of private healthcare institutions.