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.

This guide explains how Aid and Attendance pays for nursing home care in 2026, how nursing home costs lower the income the VA counts, the $90 Medicaid cap and exactly when it applies, who qualifies, and how to apply.

In This Guide

Does the VA Pay for Nursing Home Care?

Usually not directly. The VA operates its own Community Living Centers and contracts with some community nursing homes for veterans who qualify on a service-connected basis, but for most families using the pension, the VA is not paying the nursing facility on the resident's behalf.

What the VA can do is pay a qualifying veteran or surviving spouse a monthly pension benefit. 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: for most families, the VA does not pay your nursing home, but Aid and Attendance can put real money in your hands to help cover the cost while the resident is paying privately.

How Aid and Attendance Pays for a Nursing Home

VA Pension, including its Aid and Attendance increase, is a needs-based benefit. The VA pays the difference between your countable income and the applicable Maximum Annual Pension Rate, or MAPR, set by Congress. If your countable income is low, the VA pays you more; if it's high, the VA pays you less or nothing. 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 continuing, 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 dependents (5% of the $17,441 MAPR) and $1,141 for a veteran with one dependent (5% of the $22,839 MAPR). The floor scales with the veteran's own MAPR category. 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

For a resident receiving skilled nursing or custodial care, the full cost of the facility, including room and board, is generally a deductible medical expense, because the facility provides health care. Other recurring medical costs are deductible as well, including care by health care providers, prescription and non-prescription medications, medically necessary supplies, and health insurance premiums such as Medicare Parts A, B, and D and long-term care insurance.

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 single veteran with no spouse or dependent children is covered by Medicaid for nursing facility care, federal law limits the VA pension (including the Aid and Attendance amount) to no more than $90 per month for any period after the month of admission. That reduced amount is treated as a personal allowance the resident keeps for personal needs, not as a contribution toward the cost of care. The authority is 38 U.S.C. 5503(d)(2), implemented at 38 CFR 3.551.

Two points matter for families. First, the cap applies specifically to Medicaid-covered nursing facility care for a single beneficiary. 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, VA pension income, including Aid and Attendance, generally counts as income for Medicaid and can affect Medicaid eligibility or a resident's share-of-cost (patient-pay) amount, and how that income is treated varies by state. 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

These are the maximum monthly Aid and Attendance pension amounts for the rate period running December 1, 2025 through November 30, 2026. The actual amount paid is the maximum minus your countable income, which is why the medical-expense deduction above matters so much.

Category Maximum Monthly Amount
Veteran alone Up to $2,424
Veteran with spouse Up to $2,874
Surviving spouse Up to $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. At least 90 days of active duty with at least one day during a recognized wartime period (WWII, Korea, Vietnam, or the Gulf War / post-9/11 era). Gulf War service requires 24 months of continuous active duty or the full period called to active duty.
  • Be 65 or older, or permanently and totally disabled.
  • 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 mental or physical incapacity; or having severely limited eyesight.
  • Have net worth under $163,699 (2026). Net worth combines assets and annual income, but excludes the primary home, vehicles, and basic household 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

You apply for Aid and Attendance with two forms:

  1. VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance). A doctor completes this to document the need for assistance.
  2. VA Form 21P-527EZ (Application for Veterans Pension), if you're not already receiving VA pension.

You can submit the forms online at va.gov, by mail, or through an accredited representative. To find an accredited claims agent or attorney, use the VA's search tools or contact a Veterans Service Organization. Processing times vary, and in practice claims often take three to six months or longer. You can apply while your loved one is already living in a nursing home and receiving care.

Ready to start an Aid and Attendance application? Chat with Brevy's care navigator for a quick eligibility check.

Frequently Asked Questions

For most families using the pension, no. 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. The VA does run its own Community Living Centers and contracts with some community nursing homes for veterans who qualify on a service-connected basis, but that is a separate pathway from the pension.

Because of a federal rule. When a single veteran with no spouse or dependents is covered by Medicaid for nursing facility care, the VA pension, including Aid and Attendance, is limited to no more than $90 per month for any period after the month of admission, kept as a personal allowance. 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.

Often, yes. They are separate programs run by different agencies. But VA pension income, including Aid and Attendance, generally counts as income for Medicaid and can affect Medicaid eligibility or a resident's share-of-cost, and the $90 cap applies once Medicaid covers nursing facility care for a single beneficiary. How VA income is treated varies by state, so confirm timing with your state Medicaid agency.

For a veteran paying privately, the maximum monthly Aid and Attendance amount is up to $2,424 for a veteran alone, up to $2,874 for a veteran with a spouse, and up to $1,558 for a surviving spouse. The amount you actually receive is the maximum minus your countable income.

Learn More

Related Brevy guides:

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.