VA Aid and Attendance can help a wartime veteran or surviving spouse pay for nursing home care, but the way it works has one wrinkle that doesn't apply to assisted living or in-home care. The benefit is a monthly pension payment, and for a veteran paying privately for skilled nursing, it can put thousands of dollars toward the bill. Once Medicaid steps in to cover the nursing home, though, a special federal rule caps the pension at $90 a month.

In This Guide

Does the VA Pay for Nursing Home Care?

Sometimes it does, through a different door. The VA offers long-term care to veterans signed up for VA health care in settings that include its own Community Living Centers, community nursing homes it contracts with in many parts of the country, and State Veterans Homes. Access is not automatic on enrollment: the veteran must be signed up for VA health care, the VA must conclude they need the specific service, and a space in that setting must be available near them. The list doesn't close there, though. The VA says it may also consider other factors, like your service-connected disability status or insurance coverage, and for nursing home care specifically it says whether its benefits help pay depends on your income and the level of your service-connected disability. That is the VA health care system paying for care, and it is a separate pathway from the pension this guide covers.

The pension pathway works differently. Here the VA pays a qualifying veteran or surviving spouse a monthly cash benefit rather than paying the facility. The Aid and Attendance increase to that pension is meant for people who need help with daily activities, and a nursing home resident needs that help by definition. The money arrives as cash to the beneficiary, and the family decides how to spend it, which often means it goes toward the cost of skilled nursing care.

So the honest answer is: check both. VA health care may be able to provide or contract for the nursing home care itself, and separately, Aid and Attendance can put real money in your hands to help cover a bill you are paying privately.

How Aid and Attendance Pays for a Nursing Home

VA Pension, including its Aid and Attendance increase, is a needs-based benefit. To be eligible, your yearly family income and net worth have to meet limits set by Congress, expressed as a Maximum Annual Pension Rate, or MAPR. So the key to the whole benefit is your countable income, not your gross income.

Because the benefit is keyed to countable income, you're allowed to lower that income by deducting unreimbursed medical expenses, or UMEs. The cost of nursing home care can count as a UME. That deduction is what makes a veteran whose income looks too high on paper actually qualify, because once a large recurring cost like a nursing home bill is subtracted, countable income can drop sharply or fall to zero.

The 5% rule

There's an important limit. You cannot deduct every dollar of medical expense. Only the portion of your UMEs that exceeds 5% of the applicable MAPR is deductible. For 2026, that 5% threshold is $872 for a veteran with no spouse or child. The floor rises if you have dependents, but it never counts the aid-and-attendance or housebound increase. In plain terms, the first several hundred dollars of medical expense each year don't count toward the deduction; everything above that floor does.

Nursing home care is the most expensive setting in long-term care, so its cost clears that floor easily, leaving nearly all of the bill available as a deduction.

When nursing home costs count

A nursing home is the one setting where the regulation asks nothing further. 38 CFR 3.278(d)(1) states flatly that "Payments to hospitals, nursing homes, medical foster homes, and inpatient treatment centers (including inpatient treatment centers for drug or alcohol addiction), including the cost of meals and lodging charged by such facilities, are medical expenses." So the whole facility bill counts, room and board included, with no clinician certification and no separate test for the lodging portion. Do not import the extra conditions you may have read about elsewhere: the written-certification requirements belong to in-home attendant care at 3.278(d)(2) and to assisted living and other non-nursing-home care facilities at 3.278(d)(3), and applying either one to a nursing home bill would understate what a family can deduct. Insurance premiums are deductible medical expenses as well: payments for health, medical, hospitalization, and long-term care insurance premiums count, and premiums for Medicare Parts A, B, and D and for long-term care insurance are named specifically.

The practical upshot is the one that matters most to families: a veteran whose income appears too high to qualify can still qualify once those large recurring care costs are deducted from countable income.

The $90 Medicaid Nursing Home Cap

Here is the rule that sets nursing home care apart from every other setting. VA pension and Medicaid are separate programs, and an older veteran or surviving spouse can often qualify for both at once. But when a veteran without a spouse or child, or a surviving spouse without a child, is receiving Medicaid-covered nursing home care, federal law limits the VA pension or survivors pension (including the Aid and Attendance amount) to no more than $90 per month for any period after the month in which the Medicaid payments begin. The authority is 38 U.S.C. 5503(d)(2), with the surviving-spouse extension at 5503(d)(5), implemented at 38 CFR 3.551(i). The cap turns on a defined term too: 38 U.S.C. 5503(d)(1)(B) limits the nursing facilities it reaches to those "other than a facility that is a State home with respect to which the Secretary makes per diem payments for nursing home care pursuant to section 1741(a) of this title". So check a State veterans home against that definition before assuming the $90 applies. Of that reduced rate, VA says "your facility can't count this monthly payment as income toward your cost of care" and "You would keep the full $90 for personal expenses."

How the $90 lines up with your state's personal needs allowance depends on your state, and you have to check. The federal cap sets the pension amount and keeps it out of the facility's cost-of-care calculation. It does not decide how the retained $90 relates to the Medicaid personal needs allowance, which is a separate deduction applied under each state's post-eligibility treatment of income; 42 CFR 435.725(c)(1) sets only a federal floor of at least $30 a month for an aged, blind, or disabled individual, not the amount any particular state uses. Whether a state provides the $90 in addition to its own personal needs allowance or instead of it is governed by that state's rule and varies from state to state. So never assume the two stack, and never add them together into a combined total without that state's rule in hand. Your state Medicaid agency, or the state guide linked below, is the place to settle it.

Two more points matter for families. First, the cap applies specifically to Medicaid-covered nursing facility care for a beneficiary in one of those categories. It does not apply to a veteran who is paying privately, who has a spouse or dependents, or who is in assisted living, memory care, or receiving care at home. Second, Medicaid counts VA pension in two separate steps, and the Aid and Attendance amount is treated differently at each. When the state decides whether an applicant is financially eligible, it applies SSI income methodologies, and under those the aid and attendance and housebound allowances are not income, so only the basic pension counts toward the income limit. Once the person is eligible, the share-of-cost (patient-pay) calculation must consider income that was disregarded at eligibility, and read that rule narrowly: 42 CFR 435.725 is on its face the post-eligibility treatment of income of institutionalized individuals in SSI states, reaching only individuals in medical institutions and intermediate care facilities. Where 435.725 governs, the Aid and Attendance amount becomes part of the income from which the required deductions are made, and it can raise what the resident owes the facility. Those deductions are not open-ended either: the agency deducts "Amounts for incurred expenses for medical or remedial care that are not subject to payment by a third party," and the category covering care recognized under state law but not covered by the state plan is "subject to reasonable limits the agency may establish." In one of the eight 209(b) states, or for home and community-based waiver services, 435.725 does not settle the answer, so check your own state's post-eligibility rule rather than assuming the federal result. Where the $90 cap applies, the pension cannot be pushed onto the bill at all: 38 U.S.C. 5503(d)(3) provides that "the amount of the payment paid a nursing facility pursuant to a Medicaid plan for services furnished a veteran may not be reduced by any amount of pension permitted to be paid such veteran." States that use eligibility rules more restrictive than SSI may count the allowance at the eligibility step too, so the state's own rule governs there. Because the order and timing of applying for each program depend on your state's Medicaid rules, it's worth confirming your situation with the state Medicaid agency and an accredited representative before relying on both benefits.

Trying to coordinate VA pension and Medicaid for nursing home care? Chat with Brevy to talk through the timing.

2026 Aid and Attendance Amounts

The VA sets these as Maximum Annual Pension Rates (MAPR) for the rate period running December 1, 2025 through November 30, 2026, and pays the award monthly, so the monthly payment is the yearly amount divided by 12. The actual amount paid is the maximum minus your countable income, which is why the medical-expense deduction above matters so much.

Read these as complete ceilings, not as an allowance stacked on a pension. The Aid and Attendance figure already contains the basic pension amount for that household ($17,441 a year for a veteran with no dependents, $22,839 with a spouse, $11,699 for a surviving spouse), so a qualifying veteran moves up to the higher ceiling rather than collecting both numbers.

Category Maximum Annual Rate Monthly Equivalent
Veteran alone Up to $29,093 About $2,424
Veteran with spouse Up to $34,488 About $2,874
Surviving spouse Up to $18,697 About $1,558

These figures are set by Congress and adjusted each year with the cost-of-living increase, typically around December 1. If you're reading this later in the benefit year, the numbers above still apply through November 30, 2026.

Who Qualifies

Aid and Attendance does not require a service-connected disability. It is built on the Veterans Pension program, so it carries that program's wartime-service and needs-based requirements. To qualify, the veteran must:

  • Have wartime service. If active duty began before September 8, 1980, at least 90 days of active duty with at least one day during a recognized wartime period (such as World War II, Korea, Vietnam, or the Gulf War). Veterans who entered active duty as an enlisted person after September 7, 1980 generally must serve at least 24 months, or the full period for which they were called or ordered to active duty, with at least one day during wartime. That same 24-month minimum also covers an officer who started on active duty after October 16, 1981 and had not previously served on active duty for at least 24 months.
  • Not have a dishonorable discharge, and meet at least one of four tests. Any single one of these satisfies the requirement: being at least 65 years old; having a permanent and total disability; being a patient in a nursing home for long-term care because of a disability; or getting Social Security Disability Insurance or Supplemental Security Income. The last two stand on their own, so a wartime veteran under 65 who receives SSI qualifies on that basis without any adjudicated permanent-and-total rating.
  • Need help with daily activities. This includes needing help with tasks like bathing, dressing, or feeding oneself; being bedridden; being a patient in a nursing home due to the loss of mental or physical abilities related to a disability; or having severely limited eyesight.
  • Have net worth under $163,699 (2026). Net worth combines the claimant's and dependents' assets and income for VA purposes, and assets exclude the primary residence, the car, and basic home items.

The VA also applies a 3-year look-back period on assets transferred for less than fair market value before filing, with a penalty period that can run up to five years. If you've recently given away assets or set up a trust, talk to an accredited representative before applying.

How to Apply

The steps below are the pension route, the one this guide covers: the VA's condition is that you may be eligible for this benefit if you get a VA pension. Aid and Attendance can also be added to monthly compensation instead, and the examination form in step 2 covers that case too, but the pension application in step 3 is not the form for it.

1
Step 1

File an intent to file, if you're still gathering paperwork

Send VA Form 21-0966 (Intent to File) ahead of the full claim. The VA says "Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive."

2
Step 2

Document the need for care

A medical examiner must fill out the examination information section of VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) to record that you need help with daily activities. This form applies to Aid and Attendance that will be added to monthly compensation as well as to pension.

3
Step 3

File the pension application

A wartime veteran pursuing the pension route who is not already receiving VA pension submits VA Form 21P-527EZ (Application for Veterans Pension). This is the wartime, means-tested pension application, so a veteran who receives VA disability compensation rather than pension does not use it.

4
Step 4

Add the nursing home form

A resident already living in a nursing home will also need to fill out VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance), which the VA requires for a nursing home claim.

5
Step 5

Submit everything and wait

File the forms online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office; an accredited representative can also file the claim for you. On how long a decision takes, the VA's answer is "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.

To find an accredited claims agent or attorney, use the VA's search tools or contact a Veterans Service Organization. You can apply while your loved one is already living in a nursing home and receiving care.

Frequently Asked Questions

Does the VA pay my nursing home directly?

Not through the pension. The VA pays Aid and Attendance as monthly cash to the qualifying veteran or surviving spouse, who can put it toward the nursing home bill. Separately, the VA does provide nursing home care itself through its own Community Living Centers, community nursing homes it contracts with, and State Veterans Homes, for veterans signed up for VA health care whom the VA determines need the service and for whom a space is available nearby. The VA may also consider other factors, like your service-connected disability status or insurance coverage, and for nursing home care it says whether its benefits help pay depends on your income and the level of your service-connected disability. That is a different pathway from the pension, and it is worth asking about on its own.

Why does my parent's VA pension drop to $90 a month in a nursing home?

Because of a federal rule. When a veteran without a spouse or child, or a surviving spouse without a child, is receiving Medicaid-covered nursing home care, the VA pension, including Aid and Attendance, is limited to no more than $90 per month for any period after the month in which the Medicaid payments begin. VA says the facility "can't count this monthly payment as income toward your cost of care" and that you "would keep the full $90 for personal expenses." Whether your state treats that $90 as additional to its own Medicaid personal needs allowance or in place of it is set by state rules and varies, so check your state's rule rather than adding the two together. The cap does not apply to a veteran paying privately, one with a spouse or dependents, or one in assisted living, memory care, or home care.

Can a veteran receive both VA pension and Medicaid?

Often, yes. They are separate programs run by different agencies. Medicaid handles the pension in two steps: when it decides whether you are financially eligible it applies SSI income methodologies, under which the Aid and Attendance amount is not income, so only the basic pension counts toward the income limit; once you are eligible, the post-eligibility rule at 42 CFR 435.725 requires the state to consider income that was disregarded at eligibility, which can raise what you owe the facility. That rule is bounded, though. The agency deducts "Amounts for incurred expenses for medical or remedial care that are not subject to payment by a third party," and care recognized under state law but not covered by the state plan is "subject to reasonable limits the agency may establish." And 435.725 reaches only institutionalized individuals in SSI states, so in one of the eight 209(b) states, or for waiver services, check your own state's post-eligibility rule instead. Separately, the $90 cap applies once Medicaid covers nursing facility care for a single beneficiary, and where it applies the facility's Medicaid payment may not be reduced by any of that pension. States with eligibility rules more restrictive than SSI may count the allowance at the eligibility step too, so confirm timing with your state Medicaid agency.

How much can Aid and Attendance pay toward a nursing home in 2026?

For a veteran paying privately, the Maximum Annual Pension Rate at the Aid and Attendance level is $29,093 for a veteran alone, $34,488 for a veteran with a spouse, and $18,697 for a surviving spouse, or about $2,424, $2,874, and $1,558 a month. Each of those is a total ceiling that already includes the basic pension for that household, not an amount added on top of it, and the amount you actually receive is the ceiling minus your countable income.

Aid and Attendance for Nursing Home Care by State

Aid and Attendance is a federal benefit, so the rules and the maximum amounts above are the same in every state. What changes locally is the nursing home care around it: what nursing homes charge where you live, how Aid and Attendance and your state's Medicaid nursing home coverage fit together, and where to file through a nearby veterans service officer. Your state guide shows how to put the benefit to work for nursing home care where your loved one lives.

Pick your state for a full walkthrough of using Aid and Attendance for nursing home care there, including local costs, how it fits with state Medicaid, and where to file.

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Learn More

VA BenefitsVA Aid and Attendance: Eligibility and How to ApplyVA Aid and Attendance explained: the 2026 monthly amounts, who qualifies, the medical-expense rule that unlocks it, what it pays for, and how to apply. VA BenefitsHow VA Aid and Attendance Pays for Assisted LivingHow VA Aid and Attendance helps pay for assisted living: the 2026 monthly amounts, the medical-expense rule, who qualifies, and how to apply for the benefit. VA BenefitsHow VA Aid and Attendance Pays for Memory CareHow VA Aid and Attendance helps pay for memory care: the 2026 monthly amounts, why dementia often qualifies, the medical-expense rule, and how to apply. VA BenefitsHow VA Aid and Attendance Pays for In-Home CareHow VA Aid and Attendance helps pay for in-home care in 2026: the amounts, paying a family caregiver, Veteran-Directed Care, and how to apply. VA BenefitsVA Pension and Medicaid: How They Work TogetherHow VA benefits and Medicaid work together for long-term care in 2026: the $90 nursing-home pension cap, how each counts income, and why state rules matter. PensionVA.gov: Aid and Attendance and Housebound Allowance

Related Brevy guides:

VA BenefitsUnreimbursed Medical Expenses and VA PensionHow unreimbursed medical expenses lower countable income for VA Pension, the 5%-of-MAPR rule, what care costs count, and how to report them in 2026. VA BenefitsVA Pension Net Worth Limit and the 3-Year Look-BackHow the VA pension net worth limit ($163,699) and the 3-year look-back work in 2026, including penalty period math and how to avoid transfer mistakes.
Your next step Find personalized help paying for nursing home care with VA benefits at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.