The Department of Food and Public Distribution has flagged the use of ration cards for identifying families under the Ayushman Bharat health insurance scheme, saying the practice can create operational difficulties and effectively make the document compulsory for beneficiaries.
In a letter to the Cabinet Secretary in September, the department highlighted the issue of ration cards being used to establish family identity under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), even though they are not a formal eligibility criterion for the scheme, a government official said.
“We have only informed the Cabinet Secretariat that the ration card is not an eligibility criterion,” the official said, adding that the problem arises during implementation at the ground level.
The move raises questions about how beneficiaries are identified under a scheme intended to cover the bottom 40% of India’s population. While requiring ration cards can exclude eligible people who do not possess them, removing the linkage could also make it harder to identify poor households covered through ration-card databases, experts argue.
The scheme provides health cover of up to ₹5 lakh per family a year for hospitalisation. Its original beneficiary base was 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 make it easier to identify eligible families using ration-card numbers. The food department asked states and Union territories in January that year to share ration-card data, along with corresponding Aadhaar details, with the NHA.
Ration cards can help establish family composition and verify beneficiary details. However, the food department’s concern is that this operational practice can make the document appear compulsory even for someone who qualifies for Ayushman Bharat but is not eligible for a ration card or has not obtained one.
“If somebody in a family is seriously ill and does not have a ration card, they may be asked to get one immediately,” the official said, describing the administrative difficulties this creates for beneficiaries and government technical teams.
The problem is not limited to people without ration cards. A significant number of households that possess ration cards remain outside the health insurance scheme, highlighting the gap between food security coverage and health insurance coverage.
A chapter titled Government-funded Health Insurance: Does Coverage Mean Care? published in Realising Rights: A Handbook of Welfare in India, highlights this gap in section 10.3, which examines the exclusion of needy households from government-funded health insurance schemes.
Based on the National Sample Survey’s Consumer Expenditure Survey for 2022-23, the chapter estimates that 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 exclusion rates are 72% in rural areas and 80% in urban areas.
These figures suggest that possession of a ration card does not automatically translate into health insurance coverage. They also show why ration-card data cannot, by itself, establish eligibility for Ayushman Bharat.
Rajendran Narayanan, economics professor at Azim Premji University, said around 67% of Indian households have ration cards, while Ayushman Bharat is intended to cover the bottom 40% of the population.
“There are several people who are entitled to ration cards but still don’t have them. ...several others who have ration cards but are still out of PMJAY coverage,” he said.
Mandating ration cards for access to PMJAY could exclude poor people who qualify for subsidised foodgrain but have not obtained the document, Narayanan said. However, he cautioned that delinking the two databases could also reduce the scheme’s reach if alternative systems to identify eligible households are not put in place.
“While mandating ration cards for PMJAY may not be a good idea because many poor who are eligible for rations don’t have ration cards, delinking ration cards from PMJAY is likely to further decrease the coverage of PMJAY,” he said.
The food department’s concern is that the existing arrangement has turned a document used only for administrative convenience into a requirement for accessing healthcare.
The official said states were developing their own social registries to establish family-level records, which could offer an alternative means of identifying beneficiaries. Updated census data could also help address gaps in existing databases, the official said.