Maharashtra Makes Health Insurance Empanelment Compulsory for Charitable Hospitals After Patient Death in Pune

Mumbai, 22nd April 2025: The Maharashtra government has made it mandatory for all charitable hospitals in the state to enroll under key public health insurance schemes, including the Mahatma Jyotirao Phule Jan Arogya Yojana (MPJAY), the Pradhan Mantri Jan Arogya Yojana (PMJAY), and the National Child Health Programme. The move aims to prevent denial of treatment to financially vulnerable patients unable to pay in advance.

The decision was formalized through a Government Resolution (GR) issued on Monday by the state’s law and judiciary department. It follows the findings of a state-appointed inquiry committee, which concluded that Pune’s Deenanath Mangeshkar Hospital—despite being a charitable institution—refused timely admission to a woman, resulting in her postnatal death on March 31.

The GR stated, “Based on the committee’s findings, all charitable hospitals must be directed by the charity commissioner to strictly implement the Charity Hospital Scheme to support underprivileged and economically weaker sections of society.”

Until now, hospitals could voluntarily opt into government health schemes. With the new mandate, participation becomes compulsory for charitable healthcare providers. Currently, 2,031 hospitals across Maharashtra are registered under government-run health insurance schemes.

The directive also includes provisions to ensure better transparency and accountability. Hospitals must update details of their Indigent Patient Fund (IPF) accounts on the charity commissioner’s online portal. Emergency medical treatment—especially for women in labor or patients in critical condition—must be provided without delay.

Officials noted that many hospitals route revenue through outsourced services such as pharmacies and diagnostic labs, thereby underreporting their income. “This practice reduces the contribution to the IPF.

Henceforth, hospitals will be required to deposit 2% of the total revenue generated annually from outsourced facilities into the IPF,” the resolution added.

Under the charity scheme, hospitals are already required to set aside 2% of their annual gross billing into this fund, which is used to support patients from economically weaker sections.

Further, the GR mandates prior online approval from the ‘Charity Hospital Emergency Room’ at Mantralaya for planned admissions and surgeries for patients covered under the scheme. “In emergency situations, hospitals must admit and begin treatment immediately and submit the case online for approval within 48 hours,” the order said.

Hospitals have also been barred from demanding unreasonable charges or asking for unnecessary documentation from patients seeking care under the scheme.

The latest step marks a tightening of regulations around charitable medical institutions, aimed at ensuring healthcare access is not compromised by administrative or financial barriers.