Teachers, police, and prison officers have been dealt a blow over an outstanding medical insurance debt of more than Sh11 billion, forcing them to pay in cash for medical services.
The Medical Administrator Kenya Limited (MAKL), which oversees the medical insurance schemes for teachers and officers from the Kenya Police Serve and Kenya Prison Service, is yet to pay hospitals Sh11.6 billion accrued from April last year.
Sources within MAKL have revealed that the teachers' medical scheme has accumulated Sh7.6 billion while that of the police owes up to Sh4 billion, painting a grim picture of the country's financial crisis.
In an April 9, 2024 letter to hospitals, MAKL acknowledged the backlog and blamed the mess on delayed disbursements from the National Treasury, a development that has disrupted the provision of healthcare services.
“This has been prompted by a delay in remittance of funds by our mutual client. In light of the above, Medical Administrator Kenya Limited (MAKL) wishes to reaffirm our commitment to making payments as of when we receive the anticipated funds from our mutual client,” MAKL said in the letter.
Humble request
“We humbly request your understanding and patience as we work diligently to resolve this administrative challenge. We highly value our partnership with your establishment and assure you that payment regularisation is our utmost priority,” it added.
The last payments were in September 2023, leaving a gap of unpaid seven months.
The National Police Service Commission (NPSC) and the Teachers Service Commission (TSC) are responsible for transferring money to MAKL, which then disburses it to the hospitals. For teachers, however, the money goes from the Treasury to the Ministry of Education, to the TSC, to Minet— the insurance broker— to MAKL, and finally to the health service provider.
For the police, the money goes from the Treasury to the PSC, then to APA/Minet, and then to MAKL, which disburses it to the hospitals.
The TSC awarded Minet the contract in November 2022 for three years, despite demands from teachers to be covered by the National Health Insurance Fund.
This latest development comes just seven days after MAKL announced changes in the administration of the Police Insurance Scheme, with APA Insurance replacing CIC as the lead insurer of the Sh8.67 billion multi-billion scheme for police and prison officers, amid complaints of slow processing of claims.
The administrator has yet to give a reason for the change, but there have been complaints from police and prison officers, with many expressing frustrations at claims being rejected or delayed. Financial challenges for hospitals continue, although the government says it has allocated Sh17.6 billion to the TSC and Sh13.6 billion to the NPSC.
Last year, the Senate launched an investigation into the loss of Sh176.1 billion allocated to medical schemes for teachers, police, and prison officers over the past nine years.
