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The current phase of the National Health Mission is scheduled to end by 2021, and the next phase of the scheme is around the corner. This paper undertakes an analysis of the contributions of the scheme in health spending of States, and highlights specific factors affecting them. The analysis suggests that the scheme contributed to reduction of inequality in health spending across states and added funds to the lower tiers of the health pyramid. The contribution of the scheme was however, limited in strengthening health systems in relatively poor performing ‘high-focus’ states. Lack of complementary inputs in states, capacity issues and weak public financial management affected the performance of the scheme. The paper throws light on some of the issues that need attention in the next phase of the scheme.