"Universal Health Coverage in India hinges as much on State buy-in as on Central funding." Discuss with reference to AB PM-JAY.

Health is a State subject (List II, Entry 6), so AB PM-JAY — a ₹5 lakh per family per year assurance cover for secondary and tertiary hospitalisation [2] — reaches citizens only through an opt-in MoU between the National Health Authority (NHA) and a State [1]. Central money is thus necessary but not sufficient; delivery rests on State consent and capacity.

Central funding is the enabling base

• 60:40 Centre–State cost sharing (90:10 for NE and Himalayan States; fully central for UTs without legislature) makes the scheme fiscally viable for poorer States [2].
• Central design supplies scale: SECC 2011 deprivation-based targeting of the bottom 40% and nationwide portability of entitlements across empanelled hospitals [2].
• The 2024 Cabinet decision extending free ₹5 lakh cover to all citizens aged 70+ irrespective of income was a purely Central expansion of entitlement [4].

But State buy-in determines actual coverage

• Empanelment of hospitals, State Health Agency capacity and grievance redress are State functions; without them the Central card is an unusable entitlement.
• States choose the implementation mode — trust, insurance or hybrid — which shapes claim settlement speed and fraud control [2].
• Political contestation over branding and credit kept holdouts out: West Bengal ran its own Swasthya Sathi and stayed outside until it signed an MoU to become the 36th State/UT [1]; Delhi joined only in 2025 as the 35th [3]. For years, crores of citizens were excluded despite Central funds being available.
• Where States co-brand and top up — Odisha's Gopabandhu Jan Arogya Yojana model — coverage widens rather than duplicates.

Universal Health Coverage is therefore a co-produced outcome: the Centre supplies risk pooling and portability, States supply the hospitals, staff and last-mile trust. The way forward lies in incentivising accession through outcome-linked grants, permitting co-branding to accommodate State political ownership, and pairing insurance with supply-side investment under PM-ABHIM and Ayushman Arogya Mandirs. Such cooperative federalism best advances the Article 47 mandate to raise public health and SDG-3's promise of health for all.