NHIF beneficiaries in rural hospitals to start paying cash from next week

The beneficiaries of the National Hospital Insurance Fund (NHIF) in rural areas may be forced to start paying for services in cash effective from Friday next week.

This comes after the Rural Private Hospitals Association of Kenya (RUPHA) threatened to halt the provision of some medical services under the NHIF cover over delays by government disburse funds for the last six months.

RUPHA Chairman Dr. Brian Lishenga, in a letter to NHIF Board Chair Eng. Michael Kamau, urged the government to fulfill its end of the bargain within the next 7 business days.

According to Dr. Lishenga, services whose claims have not been paid and which the beneficiaries may start to pay for include surgical, outpatient capitation scheme, Linda Mama scheme, Edu Afya medical scheme and the suspended e-claims system since 2019 services.

“It has come to our attention that as of 8th December 2023 and for the last 6 months, the Board has failed to make the required payments to health facilities in strict compliance with the provisions of our Agreement,” he stated.

“This non-payment of healthcare providers represents a persistent and clear breach of our agreement with NHIF.”

He added: “As a result of the Board's failure to honour its financial commitments, health facilities are left with no other recourse but to issue immediate notice that beneficiaries of the NHIF Schemes will be required to make top-up cash payments in order to access services, effective from 15th December 2023.”

The RUPHA boss argues that NHIF agreed with healthcare providers to disburse Ksh.1,000 annually per beneficiary, within the first 30 days of the capitated period and to pay for services covered timely with an extended period of up to three months. 

“Clause 1.3.1 clearly states that the Board undertakes to pay to the Health Facility, for a Beneficiary of the National Scheme, a Capitation amount of Kenya Shillings One Thousand (KES 1,000) per Beneficiary per annum within the first thirty (30) days of the capitated period,” Dr. Lishenga noted.

“Clause 12.8 specifies that the Board shall make payments to the Health Care Provider for Services covered under the Fund’s various schemes in accordance with the Schedules of this Agreement on a timely basis but in any event, Clean Claims shall be paid within ninety (90) days of receipt of the claim from the Health Care Provider, in strict compliance with the provisions of this Agreement."