India spends approximately ₹9,406 crore annually on Ayushman Bharat PM-JAY (20225-26), covering over 500 million citizens for secondary and tertiary hospitalisation. Autism therapy — speech, occupational, and behavioural — is not in the package. Not partially covered. Not pending inclusion. Simply absent. A child from a Below Poverty Line family in Jharkhand or Bihar who needs speech therapy to communicate has exactly the same access under India's flagship health scheme as she did before it was launched: none.
This is not a resource problem. It is a design problem.
The Rights of Persons with Disabilities Act 2016 was India's most comprehensive disability legislation in a generation. It recognised autism spectrum condition as a disability under Indian law for the first time, entitling autistic persons to reservations in higher education, accessible healthcare, and free and appropriate education up to age 18. Section 25 of the Act specifically obligates the government to provide healthcare services, including early intervention and therapeutic services, to persons with disabilities. PM-JAY was launched two years later, in 2018, with the explicit mandate of providing financial protection for health expenditure to India's most vulnerable. The RPWD Act said autistic people have a right to healthcare. PM-JAY was built to deliver it. The two were never connected. India has an estimated 14 to 18 million autistic people — a figure derived by applying the INCLEN Trust's landmark finding of approximately 1 in 100 children with autism spectrum disorder, and accounting for undiagnosed adults across the population.[1]
Sri Lanka, with a per-capita income lower than India's, included early developmental intervention services in its national health programme following its 2018 national autism policy. Thailand, at a comparable development stage, covers autism diagnosis and partial therapy costs under its universal health coverage scheme. These are not wealthy countries making generous choices. They are countries that made a specific administrative decision to classify developmental therapies as health services rather than discretionary welfare — and built that classification into their insurance architecture. India has made the opposite classification, silently and without debate.
The institution responsible is not the Ministry of Health alone. The Standard Treatment Workflows that govern what PM-JAY covers are developed jointly by the National Health Authority and clinical bodies. No autism organisation has a seat at that table. No health economist has modelled the cost-effectiveness of including early intervention in the PM-JAY package versus the downstream hospitalisation and mental health costs of exclusion. The RCI, which should be the professional anchor for this advocacy, is consumed by its registration pipeline rather than by policy influence. The result is a coverage gap that is not the product of malice or resource constraint — it is the product of autism being invisible in the rooms where benefit packages are designed.
The economic cost of that invisibility is substantial, and it falls almost entirely on Families especially mothers. India has an estimated 14 to 18 million autistic people — a figure derived by applying the INCLEN Trust's landmark finding of approximately 1 in 100 children with autism spectrum disorder, and accounting for undiagnosed adults across the population. And each requires a primary caregiver to either reduce work hours or exit the labour force to arrange and supervise therapy, the foregone earnings at India's female urban minimum wage of approximately ₹400 per day amount to roughly ₹43,000 crore per year in unmeasured, uncompensated informal care labour. That figure is larger than India's entire annual National Trust budget by a factor of several hundred. This is not a welfare burden we are absorbing efficiently. This is a cost we are hiding in the unpaid labour of women and calling it family love.
The fix is administrative, not legislative. The National Health Authority has the authority to revise Standard Treatment Workflows and add new service packages without an act of Parliament. A single directive adding autism diagnosis and a defined number of speech and occupational therapy sessions per year to the PM-JAY benefit package — capped and means-tested — would not break the scheme's fiscal architecture. The United Kingdom's NICE guidelines demonstrate that defined therapy entitlements can be costed and delivered at scale. India needs its own version, built for its own infrastructure constraints, but the principle is not exotic. It is a coverage decision. It requires a decision-maker, a timeline, and a number.
India made a legal promise to autistic citizens in 2016. It built the infrastructure to keep that promise in 2018. Then it walked past the door. The 18 million autistic people in this country are not asking for charity. They are asking to be included in a scheme their taxes and their government's credibility already paid for. An autism diagnosis is not a luxury expense that falls outside the scope of public health financing. It is the beginning of every intervention that follows — and right now, in India, that beginning costs more than most families can afford and is covered by a scheme that pretends it does not exist.
Arora NK, Nair MKC, Gulati S, Deshmukh V, Mohapatra A, Mishra D, et al. Neurodevelopmental disorders in children aged 2–9 years: Population-based burden estimates across five regions in India. PLOS Med. 2018;15(7):e1002615. DOI: 10.1371/journal.pmed.1002615
Ministry of Statistics and Programme Implementation, Government of India. Periodic Labour Force Survey (PLFS) Annual Report: July 2023 – June 2024 [Internet]. New Delhi: MOSPI; 2024 [cited 2026 Apr 23]. Available from: https://mospi.gov.in/sites/default/files/press_release/Press_note_AR_PLFS_2023_24_22092024.pdf
World Bank. GDP per capita (current US$) — Bangladesh, India [Internet]. Washington DC: World Bank Group; 2025 [cited 2026 Apr 23]. Available from: https://data.worldbank.org/?locations=IN-BD
Institute of Paediatric Neurodisorder and Autism (IPNA). About IPNA [Internet]. Dhaka: Bangabandhu Sheikh Mujib Medical University; 2014 [cited 2026 Apr 23]. Available from: http://ipnabsmmu.edu.bd/
Koonapapdeelert S, Traivaree C, Kingkaew P, et al. Economic evaluation of the Thai Diagnostic Autism Scale for autism spectrum disorder diagnosis in children aged 1–5 years old. Healthcare (Basel). 2024;12(7):782. DOI: 10.3390/healthcare12070782