State Government Health Scheme Empanelment India 2026: All Major State Schemes Compared

Beyond PMJAY, every major state in India runs its own government health insurance scheme — and in many states, these schemes cover more beneficiaries than PMJAY itself. Tamil Nadu's Chief Minister's Comprehensive Health Insurance Scheme covers 1.96 crore families; Andhra Pradesh's YSR Aarogyasri covers 2.24 crore families; Maharashtra's Mahatma Phule Jan Arogya Yojana covers 1.5 crore families. For hospitals in these states, state scheme empanelment is often more valuable than PMJAY alone. This guide compares all major state health schemes and explains how to get empanelled.

Major State Health Schemes in India 2026

State Scheme vs PMJAY: Key Differences

Understanding how state schemes differ from PMJAY is essential for hospitals that want to maximise government scheme revenue:

• Beneficiary eligibility: PMJAY targets the bottom 40% by income (SECC database). State schemes often extend broader — Rajasthan's Chiranjeevi covers ALL families (universal), West Bengal's Swasthya Sathi covers all state residents. This means state schemes can bring in patients who don't qualify for PMJAY.
• Package rates: State schemes often supplement PMJAY base rates with state-specific top-ups. Tamil Nadu's CMCHIS pays higher rates than PMJAY for several specialties (cardiology, oncology). Maharashtra's MPJAY is fully integrated with PMJAY — hospitals claim from a single portal.
• Claim process: Each state scheme has its own claim submission portal and timeline. Hospitals empanelled in multiple schemes must manage multiple portals — unless their HMS integrates all scheme billings into one dashboard.
• Empanelment authority: State schemes are managed by the State Health Agency (SHA) or State Nodal Agency — different from the NHA managing PMJAY at national level. You may need to apply separately for PMJAY and each state scheme.

Rajasthan Chiranjeevi: India's Most Expansive State Scheme

Rajasthan's Mukhyamantri Chiranjeevi Swasthya Bima Yojana (launched 2021) is India's most expansive state health scheme — it covers every family in Rajasthan, with ₹10 lakh cover per year (₹5 lakh for general conditions, additional ₹5 lakh for serious illnesses). For hospitals in Rajasthan, this means virtually every patient who walks in can access cashless treatment:

• BPL families: Free registration, full ₹10 lakh cover.
• Small and marginal farmers: Free registration.
• Other families: ₹850/year premium for ₹10 lakh cover.
• Empanelment is through the Rajasthan State Health Assurance Agency (RSHA). The empanelment process is similar to PMJAY — minimum beds, infrastructure inspection, ABDM registration.

How to Get Empanelled in Multiple State Schemes Simultaneously

For hospitals in border districts or hospital chains operating in multiple states:

• Each state scheme requires a separate empanelment application — there is no national single-window for state schemes (unlike PMJAY, which has one national portal).
• Most state schemes require the same core documents: clinical establishment registration, NABH certificate (preferred), bed strength certificate, specialist list with registration numbers, and infrastructure inspection.
• Hospital chains with branches in multiple states can file simultaneous applications in each state — the common document set (company registration, NABH, GST) applies; only the state-specific clinical establishment and local inspection varies.
• Maintain scheme-wise claims in your HMS — separate AR (Accounts Receivable) ledgers for PMJAY, CMCHIS, MPJAY, etc. — so you can track claim status and payment timelines for each scheme separately.

Frequently Asked Questions About State Health Scheme Empanelment

Can a hospital be empanelled in both PMJAY and a state scheme simultaneously?

Yes — and in most states, this is encouraged. In Maharashtra, the MPJAY portal is integrated with the PMJAY TMS, so hospitals submit one claim that is automatically adjudicated against whichever scheme applies to the patient. In Tamil Nadu, CMCHIS operates separately from PMJAY — hospitals need separate empanelment and submit separate claims. In Karnataka and Kerala, the state tops up PMJAY for eligible beneficiaries — one claim covers both.

Which state has the best government health scheme rates for hospitals?

Based on package rate analysis, Tamil Nadu's CMCHIS offers the most competitive rates for tertiary care procedures — particularly cardiac surgery, oncology, and joint replacements, where CMCHIS rates are 10-20% higher than PMJAY base rates. Rajasthan's Chiranjeevi offers the highest coverage sum (₹10 lakh), driving high claim volumes. Gujarat's MA Yojana has the most streamlined claim process (fastest payment timelines among state schemes).

Is NABH accreditation required for state scheme empanelment?

Not mandatory for most state schemes — but NABH-accredited hospitals typically receive a 10-15% quality incentive on package rates (similar to PMJAY). In Maharashtra, NABH accreditation is a prerequisite for certain high-value package categories under MPJAY. In Gujarat, NABH hospitals have priority in the empanelment waitlist. Given the dual benefit (quality incentive + faster empanelment), NABH accreditation is strongly recommended for hospitals targeting multiple government scheme empanelments.