Health for all without borders: enhancing access and affordability in Rajasthan, India

Premila, 80, from Madhya Pradesh lived for nearly two years with unbearable pain in her hip and could barely move without support. She needed hip replacement surgery but unfortunately, under her health card, no nearby hospital could offer that service.

“I felt helpless and thought I would have to live with this pain. One morning, my son read in the newspaper that the Government of Rajasthan had started portability services under the MAA Yojana, allowing patients like me to get treatment in hospitals in Rajasthan.

“That news gave me hope after months of despair. My son and I immediately contacted the Geentanjali hospital in Udaipur, Rajasthan, and soon after, I came here for treatment. I underwent a left hip replacement surgery, and the entire process was completely cashless. The doctors and nurses treated me with such kindness and respect, I never felt like I was away from home. Today, I can walk again without pain,” said Premila.

Removing barriers to care 

Many people across India struggle to afford and access health care, leading to financial hardship and vulnerability. Households often forego necessary care, with a detrimental effect on their health and wellbeing.

In 2018, India launched the pan-India Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) nationwide, with a vision to provide financial coverage for hospital-based services to vulnerable households across the country. These services are offered across a network of public and private hospitals.

The State of Rajasthan adapted this scheme under the Mukhya Mantri Ayushman Arogya (MMA) Yojana and took a major leap in advancing universal health coverage (UHC) by offering one of India’s highest financial protection thresholds under the broader umbrella of AB PM-JAY.

A woman with her card to identify she is eligible for health care in Rajasthan © WHO India

However, there were limitations. Though wide-reaching and successful within the State, MAA Yojana’s benefits were confined to Rajasthan’s residents, as the State chose not to adopt the portability function which facilitates the use of hospitals anywhere in India for AB PM-JAY beneficiaries.

People living in neighbouring states, often just a few kilometers from the border, could not access Rajasthan’s network of hospitals, even when they were the nearest or best-equipped facilities. This created an unintended equity divide, leaving many patients without timely or affordable care arising from access issues.

Recognizing this gap, the Rajasthan State Health Assurance Agency (RSHAA), with support from WHO through the UHC Partnership, decided to introduce the portability provision under the MAA Yojana, and enhance benefits. This reform removed a long-standing barrier to care and reflects the broader principle that the right to quality healthcare must be nationwide and transcend state boundaries.

Early Results and Impact

Between April and November 2025, 7,898 patients from outside Rajasthan have accessed treatment under the portability provision amounting to USD 5.63 million worth of healthcare services.

“Thanks to the new portability provision introduced by the Government of Rajasthan, I was able to travel and avail treatment under the same scheme, without paying anything from my pocket […] I am relieved and hopeful again. For me, this is not just medical support, it’s the gift of a second life,” Santosh, 43, who is receiving treatment for oral cancer. 

Patients have started coming to Rajasthan from Assam, Bihar, Chhattisgarh, Delhi, Gujarat, Haryana, Jammu and Kashmir, Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Punjab, Uttar Pradesh, and Uttarakhand. This remarkable shift reflects Rajasthan’s growing reputation as a trusted healthcare destination.

“Portability services were the missing link in ensuring equitable access. Earlier, we would often see patients coming from neighbouring states who were unable to use their scheme benefits. Today, with portability live, people can receive quality treatment without worrying about boundaries or paperwork,” said Nimisha Devda Barmer, District Programme Coordinator.

Health for all, without borders

The implementation of portability in Rajasthan has bridged a critical access and equity gap, enabling eligible patients from neighbouring states to receive health services treatment seamlessly. This reform not only strengthens the financial protection architecture of MAA Yojana but also upholds the spirit of UHC ensuring no patient is left behind.

“Rajasthan's efforts to enhance portability for out-of-state beneficiaries is a boon to India's UHC goals. WHO remains committed to contributing to these goals through its sustained support on key policy reforms” said Ms Payden, WHO Representative to India a.i.

The UHC Partnership operates in over 125 countries, representing over 3 billion people. It is supported and funded by Belgium, Canada, the European Union, France, Germany, Ireland, Luxembourg, Japan, the United Kingdom of Great Britain and Northern Ireland, and WHO.