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Disregard A&A and housebound allowances when determining the patient liability or cost share amount for Institutional Medicaid and Community Waivers. This rule does not apply to State Veterans Home residents without dependents (see Section 15.3.26.3 Patient Liability Calculation for State Veterans Home Residents Without Dependents). Example 3 Jack is a single veteran living in his home. He receives a $2,051 monthly need-based VA pension. His VA pension includes an A&A allowance of $821 per month. The A&A allowance is disregarded for Medicaid eligibility. $2,051 VA pension - $821 A&A allowance (disregarded) _______________________________ = $1,230 budgetable income

Example 4 Donald is a married veteran living with his spouse and two children. He is disabled (as determined by the VA) and receives VA disability compensation benefits in the amount of $1,963 per month. He does not receive A&A or housebound allowances and the VA did not consider any unreimbursed medical expenses when calculating the VA disability compensation benefit amount. The full $1,963 is budgetable income to the household. When a single veteran or a surviving spouse without dependents is in a nursing home and enrolled in Medicaid, the VA is required to reduce the pension amount to no more than $90, except when the member is in a State Veterans Home. These reduced pensions of $90 or less are always considered A&A, so the full amount of these reduced pensions is disregarded for Medicaid eligibility as well as cost share or patient liability determinations. Example 5 Patrick is a single veteran with no dependents who is in a nursing home and open for Institutional Medicaid. He receives a $90 monthly VA pension. The entire $90 VA pension amount is A&A and is disregarded for both his Medicaid eligibility and patient liability determinations. 15.3.26.2 Unreimbursed Medical Expenses (UME) When the VA determines the amount of a need-based benefit payment, it may consider any unreimbursed medical expenses incurred by the beneficiary or a member of their household that exceed 5% of the VA’s basic Maximum Annual Pension Rate (MAPR). These expenses are sometimes referred to as “unreimbursed” or “unusual” medical expenses (UME). The VA deducts UME from countable income when computing the VA payment, resulting in a higher monthly payment. Disregard any portion of a VA benefit that is for UME when determining eligibility for any category of EBD Medicaid. Disregard any portion of a VA benefit that is for UME when determining the patient liability or cost share amount for Institutional or Community Waivers Medicaid. This rule does not apply to State Veterans Home residents without dependents (SEE SECTION 15.3.26.3 PATIENT LIABILITY CALCULATION FOR STATE VETERANS HOME RESIDENTS WITHOUT DEPENDENTS). Example 6 Allan is a veteran who resides in an assisted living facility. He receives a $1,200 monthly Social Security benefit and a monthly VA pension. His VA pension includes an A&A allowance of $883 per month. When calculating his pension amount, the VA also considered Allan’s $42,000 annual ($3,500 monthly) assisted living fees as UME. The UME reduced his countable income (for VA purposes) to $0, resulting in a VA pension amount of $2,051 per month.