CHAMPVA and Medicaid: which pays first?

Q: Which pays first, CHAMPVA or Medicaid?

CHAMPVA. VA's CHAMPVA care page says CHAMPVA is always the secondary payer except to Medicaid, State Victims of Crime Compensation Programs, Indian Health Services, and supplemental CHAMPVA policies. The CHAMPVA Guidebook says that if you are eligible under Medicaid, CHAMPVA will pay first, and 38 CFR 17.272 says CHAMPVA assumes primary payer status for Medicaid.

Q: Can you have both CHAMPVA and Medicaid?

VA's rules expect that some CHAMPVA beneficiaries are also eligible for Medicaid: the Guidebook says that if you are eligible under Medicaid, CHAMPVA pays first. Medicaid itself is a joint federal-state program, so whether you qualify for Medicaid is decided by your state, not by VA.

Q: What should I tell my provider if I have CHAMPVA and Medicaid?

Tell the office about every plan you have and show both cards. VA's rules put CHAMPVA ahead of Medicaid. Keep VA updated about your other coverage, for example with VA Form 10-7959c (CHAMPVA Other Health Insurance Certification).

Educational information only, not medical, legal, or insurance advice. Confirm with CHAMPVA and your provider. Last verified against VA.gov: October 16, 2026 (VA CHAMPVA care page updated Aug 12, 2026). Changelog

Short answer: CHAMPVA pays first and Medicaid pays after it. That’s the opposite of how CHAMPVA works with most other coverage, where CHAMPVA pays last.

Which pays first, CHAMPVA or Medicaid?

CHAMPVA. All three official sources say the same thing:

VA’s CHAMPVA care page: “CHAMPVA is always the secondary payer except to these programs: Medicaid, State Victims of Crime Compensation Programs, Indian Health Services, Supplemental CHAMPVA policies.”
CHAMPVA Guidebook: “If you are eligible under Medicaid, CHAMPVA will pay first.” It lists Medicaid as one of only four types of coverage that CHAMPVA pays before.
38 CFR 17.272(a)(3): for services paid by a government agency, “CHAMPVA assumes primary payer status” for Medicaid (and the other three exceptions).

With any other coverage, CHAMPVA is the last payer (38 CFR 17.270; Guidebook). That includes Medicare, employer plans, and Medicare supplements. See CHAMPVA and Medicare: who pays first and other health insurance.

Can you have both CHAMPVA and Medicaid?

VA’s rules expect that some people have both: the Guidebook’s wording (“if you are eligible under Medicaid, CHAMPVA will pay first”) covers exactly that case.

Medicaid is “a joint federal-state program that provides health insurance to eligible low-income adults, children, pregnant women, elderly, and people with disabilities” (Guidebook). Your state decides whether you qualify for Medicaid. VA decides CHAMPVA eligibility separately. See who qualifies for CHAMPVA. CHAMPVA has no open enrollment season, so you can apply when you qualify: Does CHAMPVA have open enrollment?

What should I tell my provider if I have CHAMPVA and Medicaid?

Tell the office about every plan you have and show both cards, so it can bill in the right order.
The billing order under VA’s rules: CHAMPVA first, ahead of Medicaid. This is different from the usual rule (“bill the other insurance first”), which VA applies to other health insurance.
Keep VA updated. The Guidebook says to keep VA informed about any changes in your other health insurance, for example with VA Form 10-7959c (CHAMPVA Other Health Insurance Certification). VA’s care page says you send it with a copy of the front and back of your insurance card. More: other health insurance.
Provider offices can use our billing reference for providers.

What these sources don’t say

VA’s pages, the Guidebook, and 38 CFR don’t explain:

the order when you have Medicare, Medicaid, and CHAMPVA all at once,
how your state Medicaid program handles what’s left after CHAMPVA pays, or
whether you must send VA a copy of your Medicaid card.

For those, call CHAMPVA at 800-733-8387 (TTY 711), Monday–Friday, 8:00 a.m.–7:30 p.m. ET, and ask your state Medicaid office.