The Government Scheme Patients Can’t Find: Marketing Ayushman Bharat & State Health Scheme Empanelment

A woman sits outside a 60-bed hospital in a Tier 3 town in Tamil Nadu, holding a family ration card and an income certificate. She has heard that “government scheme” patients can get treated for free somewhere nearby. She doesn’t know if this hospital is one of them.

There is no board at the entrance that says so. The receptionist, when asked, says “check with the insurance desk,” and the insurance desk is a man who handles TPA pre-authorizations for private insurance and isn’t sure himself whether the hospital’s PM-JAY empanelment is still active this year. She leaves, unsure, and either pays out of pocket somewhere else or avoids treatment altogether.

This scene repeats daily across mid-market and smaller hospitals in India. The hospital may genuinely be empanelled under Ayushman Bharat (PM-JAY) or a state scheme like Tamil Nadu’s Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS). The patient may genuinely be eligible. Both facts exist. Neither reaches the other, because nobody built the communication bridge between them.

This is not a TPA or private insurance empanelment problem — that is a separate operational and commercial relationship with a different set of frictions, which we’ve covered elsewhere. This is specifically about government scheme empanelment: a different patient segment, a different trust problem, and a different reason hospitals go quiet about something they should be stating clearly.

How Government Scheme Empanelment Actually Works

PM-JAY empanelment is not automatic and not informal. A hospital applies through the National Health Authority’s Hospital Empanelment Module (HEM) portal and is verified — either by a District Empanelment Committee within 15 working days, or on a faster track if it already holds NABH or comparable quality certification. Minimum criteria include at least 10 inpatient beds (5 in aspirational districts), round-the-clock emergency and surgical cover, a functioning operation theatre and post-operative ICU where surgery is offered, fire-safety compliance, and a NEFT-enabled bank account for direct claim settlement, among other requirements in the NHA’s own guidelines (NHA Hospital Empanelment Guidelines, Dec 2022).

Once empanelled, a hospital can treat eligible beneficiaries for a defined list of procedures at no direct cost to the patient, up to the package rates the scheme sets for each procedure — not the hospital’s own private tariff. State schemes layer on top of or alongside this. Tamil Nadu’s CMCHIS, for instance, currently covers a defined set of procedures, diagnostics, and listed high-end treatments, with pre- and post-hospitalization expenses included for covered conditions and clear exclusions for OPD consultations, cosmetic procedures, fertility treatment, and care outside Tamil Nadu (Joinditto, CMCHIS breakdown). In August 2026, Tamil Nadu’s government announced it was raising CMCHIS’s annual family cover fivefold, from ₹5 lakh to ₹25 lakh — a reminder that scheme terms are not static, and that “what’s covered” needs to be re-verified periodically, not assumed (Outlook Money).

The Scale Nobody Tells Patients About

As of the National Health Authority’s own 2025 annual report, more than 31,000 hospitals were empanelled under PM-JAY nationally — and separately, Rajya Sabha data cited a figure of 31,805 empanelled hospitals, of which 14,394 (roughly 45%) were private facilities (laex.in summary of NHA 2025 report; Digital Health News, citing Rajya Sabha data). The scheme has recorded roughly 9.19 crore hospitalizations since its 2018 launch. In Tamil Nadu specifically, more than 2,157 government and private hospitals are empanelled under CMCHIS across urban and rural areas (Joinditto).

That is not a niche program. In a Tier 2 or Tier 3 catchment, a meaningful share of the patients walking past a hospital’s gate are plausibly eligible for one of these schemes. And yet most of those patients have no reliable, low-friction way to know whether the specific hospital in front of them is on the list, for which procedures, and under what current terms.

Why Patients Still Can’t Find the Hospitals That Already Treat Them

The published empanelment lists are not dependable by themselves. In one investigation, a reporter called eight hospitals from an official empanelled list — several said they were no longer empanelled, and a couple didn’t answer at all. Empanelment can also be partial: a hospital might be listed under PM-JAY only for angioplasty and bypass surgery, or only for radiation oncology, not for whatever condition the patient actually has (The News Minute). Being “on the list” and being able to treat a given patient’s condition under the scheme are two different facts, and most patients have no way to tell them apart before they arrive.

Awareness is the deeper problem. A 2021 sample in Gautam Buddha Nagar found only 9% of eligible urban residents and 19% of eligible rural residents knew what the scheme actually covered (cited in The News Minute). Separately, a study of more than 110,000 scheme-related grievances found that three in four arose from hospitals demanding payment from patients who should have been treated free under the scheme — a pattern researchers tied directly to poor governance and to beneficiaries not understanding their own entitlements. When a patient doesn’t know what they’re entitled to, they can’t push back when a front desk quietly asks for cash anyway.

This is the exact failure STYL’s clients should not want to be implicated in, even by omission. A hospital that is genuinely, currently empanelled, but says nothing clear about it, is indistinguishable — from the patient’s side of the counter — from a hospital gaming the system.

The Tension Hospitals Don’t Say Out Loud

Here is the part most marketing content about government schemes skips, and STYL’s brief is not to skip it: scheme empanelment creates real commercial friction, and hospitals feel it even when they don’t say so publicly. Package rates under PM-JAY are fixed by the scheme and are frequently lower than a hospital’s private tariff for the same procedure. Hospital administrators have described claim deductions eroding 15–16% of margins on scheme cases, and reimbursement delays compounding the squeeze — in Haryana, unpaid dues reportedly reached roughly ₹400 crore before the state IMA chapter suspended scheme services in protest. Nationally, 609 private hospitals have exited PM-JAY since 2018, including 174 in 2023–24 alone, led by Gujarat, Kerala, and Maharashtra (Digital Health News). Some large private hospitals treat scheme caseload as closer to a CSR commitment than a commercial line — a framing one hospital CEO used explicitly (The News Minute).

This tension is real, and STYL’s position is not to pretend it isn’t. A hospital running on tight margins has a legitimate reason to manage how much scheme-rate capacity it carries relative to private-pay capacity. That is a capacity-planning and financial-sustainability decision, and it is not, by itself, dishonest. What is dishonest — or at least corrosive to trust — is a hospital that stays empanelled, continues drawing scheme patients through word of mouth or compulsion, and never clearly communicates its status, its limits, or its current coverage, because clarity might invite more scheme-rate demand than the hospital wants to absorb. That ambivalence gets resolved silently, at the patient’s expense, through confusion at the front desk rather than through an honest published policy.

Empanelment Is Not Permanent — and Patients Should Know That Too

Empanelment also isn’t a one-time badge. A hospital empanelled on the basis of quality certification must renew that basis roughly every three years, or whenever the certification lapses. Disciplinary findings can lead to suspension of up to six months or outright de-empanelment, with a default de-empanelment period of one year that a State Empanelment Committee can extend further or convert to blacklisting for serious violations. A hospital that voluntarily withdraws must give 30 days’ notice and cannot re-enter for at least six months (NHA Hospital Empanelment Guidelines).

In practice, this means a hospital’s empanelment status is a living fact, not a fixed one — and a patient who relied on a two-year-old pamphlet or a word-of-mouth claim is at real risk of showing up to a hospital that no longer carries that status, for that procedure, this year.

What Honest Communication Looks Like

STYL’s lens on this is simple: clarity before cost, and dignity in how the scheme-eligible patient segment is addressed. Specifically, for a genuinely and currently empanelled hospital, that means:

• State it plainly, where it’s true. If your hospital is currently empanelled under PM-JAY and/or a state scheme, say so on your website, at the entrance, and at the help desk — naming the scheme, the specific procedures or departments covered, and the date the status was last verified. Don’t bury it in a footer because you’re ambivalent about scheme-rate volume.
• Never say “free treatment” without qualification. State what the scheme covers (specific procedures, pre/post-hospitalization windows, annual family limits) and what it doesn’t (OPD visits, excluded procedures, treatment outside the state, anything above the package cap). “Free” without boundaries is an overpromise that turns into a dignity violation at billing time.
• Build a verification path patients can use before they travel. A phone number or help-desk contact specifically for scheme eligibility questions — staffed by someone who actually knows current empanelment status — does more for trust than any amount of signage. Patients from Tier 2/3 catchments often travel to reach a hospital; confirming coverage before that trip, not after, is the respectful default.
• Keep the list current, not aspirational. If a procedure or department has lost empanelment, say so immediately rather than letting a patient discover it at check-in. If your hospital voluntarily withdrew or was suspended, your own public materials should reflect that before a scheme audit or a frustrated patient forces the correction.
• Train the front desk to answer this without hedging. “Check with the insurance desk” is not an answer for a family that has traveled to get here. Whoever greets a scheme-eligible patient first should be able to state, with confidence, current status, covered procedures, and required documents — the same fluency most hospitals already expect at the private-insurance TPA desk.
• Don’t let internal ambivalence become the patient’s problem. If capacity constraints genuinely mean a department is not accepting new scheme admissions this month, say that directly and offer the next honest step — a waitlist, a referral, or a date to check back — rather than letting vague unresponsiveness do the discouraging for you.

The STYL View

A hospital that is honestly empanelled and says nothing, and a hospital that oversells “free government treatment” without boundaries, fail the same patient in two different directions. The fix in both cases is the same: treat empanelment status as a fact worth stating precisely, not a marketing lever to be either hidden out of ambivalence or inflated out of appeal. For hospitals serving mixed-income catchments, especially outside the metros, this single piece of clear, current, dignified communication is often the difference between a patient who gets treated and one who walks away unsure and untreated.

Sources

• NHA Hospital Empanelment Guidelines (Dec 2022)
• Over 600 Private Hospitals Exit AB-PMJAY; Gujarat Leads Opt-Outs — Digital Health News
• How Patients — And Private Hospitals — Are Struggling With Ayushman Bharat — The News Minute
• Ayushman Bharat – PM-JAY: Latest Report Highlights (2025) — laex.in
• Kalaignar Kaappittu Thittam / CMCHIS overview — Joinditto
• How to apply for Tamil Nadu CM’s Comprehensive Health Insurance Scheme — DT Next
• Tamil Nadu health scheme cover raised fivefold to Rs 25 lakh — Outlook Money