The Department of Food and Public Distribution has raised concerns over the use of ration cards to identify beneficiaries under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), stating that the document is not a formal eligibility criterion for the health insurance scheme.
In a letter to the Cabinet Secretary in September, the department highlighted how the practice could create administrative difficulties and effectively make ration cards compulsory for beneficiaries, a government official said.
The scheme provides health insurance coverage of up to ₹5 lakh per family annually for hospitalisation. Its original beneficiaries were identified using the Socio-Economic and Caste Census (SECC) of 2011, alongside other applicable eligibility categories and state-specific arrangements.
The National Health Authority (NHA), which implements the scheme, began integrating the SECC beneficiary database with the National Food Security Act database in 2022 to simplify the identification of eligible families. The Department of Food and Public Distribution subsequently asked states and Union territories to share ration-card data and corresponding Aadhaar details with the NHA.
However, officials have expressed concern that relying on ration cards could create barriers for eligible families who do not possess the document. In some cases, people seeking treatment for serious illnesses may be asked to obtain a ration card before accessing benefits, creating additional administrative burdens.
The issue also highlights gaps between food security and health insurance coverage. According to estimates based on the National Sample Survey’s Consumer Expenditure Survey for 2022-23, more than 60% of priority ration-card holders in rural areas and 70% in urban areas are not covered by government-funded health insurance schemes.
Among Antyodaya ration-card holders, the estimated exclusion rates stand at 72% in rural areas and 80% in urban areas, indicating that possessing a ration card does not automatically ensure health insurance coverage.
Rajendran Narayanan, an economics professor at Azim Premji University, said around 67% of Indian households possess ration cards, while Ayushman Bharat is intended to cover the bottom 40% of the population.
Narayanan cautioned that making ration cards mandatory could exclude eligible poor households that have not obtained the document. However, he also warned that completely separating the databases could reduce the scheme’s reach if alternative beneficiary identification systems are not established.
The department said states were developing social registries to maintain family-level records, which could provide an alternative mechanism for identifying eligible beneficiaries. Updated census data could also help address gaps in existing databases.
The department’s concerns have brought renewed attention to the need for reliable beneficiary identification systems that prevent eligible households from being denied healthcare due to missing documentation.
