Is the Ayushman Bharat ₹10 lakh cap approved in Madhya Pradesh?

Not yet. AIIMS Bhopal and state officials have urged a move to ₹10 lakh, aligning with steps seen in Rajasthan, Delhi, and Gujarat. At present, the common cap is ₹5 lakh. Local reporting notes support up to ₹10 lakh for serious diseases in government facilities, but a broader state-wide increase needs formal approval and notification. Until that happens, beneficiaries should assume the ₹5 lakh limit and confirm pre-authorization and package coverage at the empaneled hospital before admission.

How could a higher cap change hospital revenues in MP?

A higher limit should raise the share of complex surgeries and ICU care under cashless treatment, improving occupancy and revenue per bed. More consumables, stents, and chemo cycles would move within packages, supporting steadier orders for suppliers. The hospital revenue impact will depend on package rates, clinical throughput, denial rates, and claim timelines. Stronger pre-auth, accurate coding, and timely discharge summaries can reduce rejections and keep cash flows predictable under Ayushman Bharat.

What should patients do to use Ayushman Bharat if the cap rises?

Keep your Ayushman card and ID ready, and verify eligibility at the help desk of an empaneled hospital. Ask for pre-authorization for planned admissions, especially for costly surgeries or ICU care. Confirm the package name, inclusions, and any exclusions in writing. Keep referral slips, test reports, and discharge summaries safe. If the cap increases, the process remains similar, but more high-value procedures may be approved within the limit. Use helplines for grievances or second opinions when needed.

Law and Government

December 22: Ayushman Bharat Cap Hike Push in MP Could Boost Hospital Utilization

ByHuzaifa Zahoor December 23, 2025December 23, 2025

Ayushman Bharat is in focus in Madhya Pradesh as AIIMS Bhopal and state officials press to raise the cover to ₹10 lakh. The move aims to align with Rajasthan, Delhi, and Gujarat and to support costlier procedures that often exceed the ₹5 lakh limit. Early field data from districts like Amethi suggest that higher cover and awareness can lift volumes. For providers and suppliers, MP health policy choices now matter for demand planning, cash flow, and pricing. We outline the likely impact, risks, and next steps to watch.