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VA AID & ATTENDANCE: VA Aid and Attendance (VA A&A) is a monetary compensation paid to a veteran that is expected to cover the veteran’s current month out-of-pocket medical costs. The out-of-pocket medical costs must be current month bills and generally include: • Current month medical bills, • Current month VA A&A approved medical services, and • Current month health insurance premiums NOTE: The VA considers some expenses as medical expenses that Medicaid does not. Expenses the VA considers medical expenses can be used to offset the VA A&A, but not the Medicaid portion of the spend down. VA A&A is not considered income, it is considered a third party liability payment and therefore is not included when determining the spend down amount. The only time a spend down is evaluated for an A&A case, is if the veteran’s out-of-pocket medical needs exceed the A&A payment they receive. Medical expenses used to offset the VA A&A are considered to be paid by a third party and cannot be carried forward to a future benefit month. Cash option cannot be used to meet/reduce the spend down for a veteran who receives A&A. The spend down can only be met when the veteran incurs enough bills to meet both their A&A amount AND their spend down amount. The medical expense option must be used if any filing unit member, whose income is used to determine eligibility and spend down amount, receives VA A&A. For information on calculating the amount of A&A in a VA payment, see CMA 501-1. MEDICAID PAYMENT: Montana Medicaid pays unpaid medical expenses that: 1. An eligible client incurs during a retroactive or prospective eligibility period; 2. Weren’t used to reduce/meet a spend down; 3. Are not the responsibility of a third party; and NOTE: If reasonable measures to determine the third party’s liability have been taken and the third party has not yet paid their portion of the expense, the portion that remains the client’s responsibility can be used to reduce/meet the spend down. 4. Are Medicaid-covered services. Effective Date: January 01, 2020