Can you have Medicaid and VA benefits at the same time?
Yes. VA health care can be used alongside other coverage; many veterans also qualify for Medicaid (especially for long-term services and supports). VA doesn’t bill Medicare or Medicaid for care at VA facilities; Medicaid remains payer of last resort for covered services outside VA. Source: VA (“VA health care and other insurance”), Medicaid TPL overview; last checked: Sep 11, 2025. Veterans Affairs+1
Bottom line: You can have both, but coordinate before you receive services to avoid denials and overpayments.
What each program pays (plain English)
VA health care (enrolled veteran)
- Care at VA facilities (and certain authorized community care).
- VA does not bill Medicaid; it may bill private insurance for non-service-connected care. Veterans Affairs
VA pension + Aid & Attendance (A&A) / Housebound
- VA pension is needs-based cash. A&A/Housebound are add-ons for those who need help with daily activities or are housebound. For SSI policy (often mirrored by ABD Medicaid), **A&A/HB are not income. Source: SSA POMS; last checked: Sep 11, 2025. Social Security Administration
CHAMPVA (for eligible spouses/dependents)
- Health coverage for certain spouses/survivors. Generally secondary, but CHAMPVA pays before Medicaid (Medicaid is last). Source: VA CHAMPVA resources; last checked: Sep 11, 2025. Veterans Affairs+1
Medicaid (state-run)
- Health coverage for low-income adults/children (MAGI) and ABD categories.
- Long-term care (LTSS): nursing home and home- and community-based services (HCBS); strict income/resource rules apply. States must pursue third-party liability; Medicaid pays last. Medicaid
Bottom line: Think of VA pension/A&A as cash support, VA health care as a separate delivery system, CHAMPVA as insurance for dependents, and Medicaid as the safety-net and LTSS payer—with coordination rules.
The conflicts to avoid—and the rules behind them
The $90 VA pension rule in Medicaid nursing homes
If a pension beneficiary with no spouse or dependent child enters a Medicaid-covered nursing home, VA pension is limited to $90/month starting after Medicaid payments begin. That $90 is treated as aid and attendance and is not income for SSI purposes; it’s not applied to the Medicaid patient liability. Sources (law & policy): 38 U.S.C. §5503(d); 38 C.F.R. §3.551; VA M21-1 guidance. Last checked: Sep 11, 2025. Legal Information Institute+2Legal Information Institute+2
Exception: State Veterans Homes (SVH). VA’s manual notes SVH residents are exempt from the $90 limit. SVHs are state-run facilities that receive VA per-diem; many also accept Medicaid. Source: VA M21-1; VA SVH fact sheet; last checked: Sep 11, 2025. KnowVA+1
Bottom line: In ordinary nursing homes with Medicaid, expect a $90 VA pension; in SVHs, the $90 cap doesn’t apply.
Aid & Attendance and Medicaid—what counts and when
- SSI policy: A&A/Housebound allowances are not income. Some states adopt this for ABD Medicaid; state manuals often confirm A&A is not income for eligibility (but check your state). Sources: SSA POMS SI 00830.308; example state ABD policy; last checked: Sep 11, 2025. Social Security Administration+1
- Nursing home scenario: When the $90 special pension applies, the $90 is A&A and not part of patient liability. Source: VA manual; last checked: Sep 11, 2025. Benefits
- Home/assisted living/HCBS: State rules differ. Many states exclude A&A when determining eligibility and sometimes patient responsibility, but you must verify. Source: SSA POMS; state policy varies. Social Security Administration
Bottom line: A&A usually helps, not hurts, but confirm your state’s ABD LTC policy before relying on it.
Who gets billed—and why Medicaid is often last
- Medicaid = payer of last resort. States must seek payment from liable third parties first. Source: Medicaid COB/TPL; last checked: Sep 11, 2025. Medicaid
- VA facilities: VA doesn’t bill Medicaid/Medicare; it may bill private insurance for non-service-connected care. Source: VA. Veterans Affairs
- CHAMPVA + Medicaid: CHAMPVA pays before Medicaid. Source: VA CHAMPVA guidance. Veterans Affairs
Bottom line: Tell providers all coverages up front; expect Medicaid to pay last (outside VA facilities).
Smart stacking: three real-world patterns
Living at home, needs help with ADLs
- Use: VA pension + A&A for caregiving costs; apply for HCBS Medicaid if income/resources allow.
- Coordination notes: A&A often not counted as income for ABD Medicaid eligibility; confirm state policy. Source: SSA POMS; state manuals vary. Social Security Administration
- Tip: Keep receipts for care; if you later need a nursing home, notify VA and Medicaid immediately to avoid overpayments.
Bottom line: A&A can fund home help while Medicaid HCBS covers services—if your state’s rules align.
Assisted living (or adult family home)
- Use: VA pension + A&A to offset room/board; if your state has Assisted Living/HCBS waivers, Medicaid may cover services (not room/board).
- Coordination notes: Verify whether A&A is excluded from eligibility and whether it affects patient responsibility in your state.
Bottom line: Many veterans combine A&A + Medicaid HCBS to make assisted living viable.
Nursing home, Medicaid paying
- Use: Apply for Medicaid nursing facility coverage; after approval, VA pension usually drops to $90 (no spouse/child). State Veterans Home? The $90 cap doesn’t apply. Legal Information Institute+1
- Coordination notes: The $90 is a personal-needs amount, not part of Medicaid’s payment. Notify VA promptly to adjust the award. Benefits
Bottom line: Expect the $90 rule in regular nursing homes; SVHs are different.
Spousal protections and the 5-year look-back
- Spousal impoverishment: Federal rules protect a community spouse by allowing a resource allowance (CSRA) and a monthly maintenance needs allowance (MMNA) taken from the institutionalized spouse’s income as needed. CMS publishes annual standards. Sources: 42 U.S.C. §1396r-5; CMS bulletins; last checked: Sep 11, 2025. Social Security+2Medicaid+2
- Transfers/look-back: Medicaid applies a 5-year look-back for LTSS; disallowed transfers trigger penalty periods. Source: 42 U.S.C. §1396p(c); last checked: Sep 11, 2025. Legal Information Institute
Bottom line: Protect your spouse using CSRA/MMNA rules, and avoid gifts inside the 5-year window.
Estate recovery vs. VA benefits
- Medicaid estate recovery: States must recover certain LTSS costs from estates of beneficiaries 55+ (and some related services). Policies vary by state; hardship waivers exist. Source: Medicaid.gov; KFF explainer; last checked: Sep 11, 2025. Medicaid+1
- VA estate recovery: VA does not have an estate recovery program for pensions/compensation. Medicaid Planning Assistance
Bottom line: Expect estate recovery for Medicaid LTSS, but not for VA pensions/compensation.
Comparison table: Who pays what (and common conflicts)
| Program | What it can cover | Bills Medicaid? | Conflict watchouts |
|---|---|---|---|
| VA health care | Care at VA facilities (and some community care) | No (VA doesn’t bill Medicare/Medicaid) | Tell providers you have VA; non-service-connected care may be billed to private insurance. Veterans Affairs |
| VA pension + A&A | Cash to help with care needs | N/A | A&A/HB not income (SSI policy); $90 special pension in Medicaid nursing homes; SVH exception. Social Security Administration+2Legal Information Institute+2 |
| CHAMPVA | Insurance for eligible spouses/dependents | Pays before Medicaid | Providers bill other insurance first; CHAMPVA over Medicaid. Veterans Affairs |
| Medicaid (health/LTSS) | Comprehensive coverage; LTSS (nursing home, HCBS) | N/A | Payer of last resort; estate recovery for LTSS; state-specific A&A rules. Medicaid+1 |
| State Veterans Home (SVH) | Nursing home, domiciliary, adult day health (state-run) | Often Medicaid + VA per-diem | $90 cap doesn’t apply in SVHs; confirm payer mix with facility. Veterans Affairs |
Step-by-step: Apply & notify (to avoid conflicts)
Checklist: “No-conflict Medicaid + VA game plan”
- Identify your path: Home care? Assisted living? Nursing home?
- Enroll/verify VA status: Apply for VA health care or VA pension/A&A if eligible. Veterans Affairs+1
- Decide on Medicaid track: MAGI (under 65, expansion adults/children) vs ABD/LTSS (65+, disabled, nursing home/HCBS).
- Gather proof: VA award letters, CHAMPVA ID (if applicable), income, resources, medical need for LTSS.
- Apply for Medicaid (state portal/office). Ask how your state treats A&A for ABD/LTSS.
- Tell every provider all coverages (VA, CHAMPVA, Medicare/Medicaid, private). Expect Medicaid last. Medicaid
- If entering a nursing home and Medicaid will pay: Notify VA immediately so pension adjusts to $90 (unless SVH). Legal Information Institute
- If in a State Veterans Home: Ask the business office about VA per-diem + Medicaid and confirm the $90 exception. Veterans Affairs
- Protect the spouse: Use CSRA/MMNA rules; check CMS’s annual standards. Medicaid
- Plan for estate recovery: Ask your state Medicaid agency how LTSS recovery works and hardship waivers. Medicaid
Bottom line: Apply, then notify—especially before nursing home Medicaid starts—to prevent overpayments and lock in the right payer order.
Sensitive facts & sources (placed near key claims)
- VA doesn’t bill Medicare/Medicaid; Medicaid is payer of last resort: Source: VA; Medicaid TPL, last checked Sep 11, 2025. Veterans Affairs+1
- $90 VA pension in Medicaid nursing homes; not applied to patient liability; SVH exception: Source: 38 U.S.C. §5503(d); 38 C.F.R. §3.551; VA M21-1, last checked Sep 11, 2025. Legal Information Institute+2Legal Information Institute+2
- A&A/Housebound not income (SSI policy) and $90 treated as A&A: Source: SSA POMS, last checked Sep 11, 2025. Social Security Administration
- SVH per-diem and oversight: Source: VA SVH fact sheet/VHA notice, last checked Sep 11, 2025. Veterans Affairs+1
- Estate recovery for LTSS: Source: Medicaid.gov; KFF, last checked Sep 11, 2025. Medicaid+1
- Spousal impoverishment rules/2025 standards: Source: SSA/CMS, last checked Sep 11, 2025. Social Security+2Medicaid+2
Disclaimer: This guide is educational, not legal/financial advice. Eligibility and counting rules vary by state and program. Confirm decisions with your state Medicaid office, VA, or a qualified elder-law attorney.
FAQ Section
1) Can I have VA health care and Medicaid at the same time?
Yes. VA care is separate; VA doesn’t bill Medicaid, and Medicaid is payer of last resort for non-VA services. Veterans Affairs+1
2) Does VA Aid & Attendance count as income for Medicaid?
Under SSI policy (often adopted by ABD Medicaid), A&A/Housebound aren’t income. Check your state for ABD/LTSS specifics. Social Security Administration
3) I’m on Medicaid in a nursing home. What happens to my VA pension?
If you don’t have a spouse/child, VA pension typically drops to $90/mo while Medicaid pays; the $90 isn’t applied to your patient liability. SVHs are exempt. Legal Information Institute+1
4) Do State Veterans Homes take Medicaid?
Many do. They also receive a VA per-diem; and the $90 cap doesn’t apply there. Ask the SVH business office about payer mix. Veterans Affairs
5) Is CHAMPVA primary or secondary with Medicaid?
CHAMPVA pays before Medicaid (which is last). Veterans Affairs
6) Will Medicaid take my house after I die if I used A&A?
Medicaid may seek estate recovery for LTSS it paid; VA benefits aren’t recovered by VA. Rules vary by state. Medicaid+1
7) How do spousal protections work?
Medicaid’s CSRA/MMNA rules protect the community spouse’s income/resources; CMS updates standards annually. Medicaid
8) What about the 5-year look-back?
Medicaid LTSS applies a 5-year look-back on transfers for less than fair market value, which can trigger a penalty period. Legal Information I