VA Aid and Attendance for In-Home Care in California

VA Aid and Attendance can help pay for in-home care in California, and it's one of the most flexible benefits a veteran can use. It's a monthly cash payment that goes straight to the veteran, who decides how to spend it: a home health aide, a homemaker, or even a family member providing the care. For a wartime veteran or surviving spouse who needs help with daily activities, it can make staying at home affordable.

This guide explains what in-home care costs in California, how much Aid and Attendance pays, who qualifies, and how the benefit works alongside Medi-Cal.

In This Guide

• Key Takeaways
• How Much In-Home Care Costs in California
• How Aid and Attendance Helps Pay for In-Home Care in California
• How In-Home Care Costs Lower Your Countable Income
• Who Qualifies
• Using Aid and Attendance to Pay a Family Caregiver
• Using IHSS and Aid and Attendance for In-Home Care in California
• How Aid and Attendance Works with Medi-Cal
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much In-Home Care Costs in California

In-home care in California is expensive, in line with the state's high overall cost of care. Per the CareScout 2025 Cost of Care Survey (released March 2026), a non-medical caregiver in California runs a median of $91,520 per year, well above the national median of $80,080.2 Beginning with its 2025 survey, CareScout reports an hourly non-medical caregiver rate, $40 an hour in California against $35 nationally, and builds its annual figures on 44 hours a week for 52 weeks.2

CareScout's published cost tables report by state, not by metro area, so that median won't tell you what agencies in your county charge.2 Get quotes from local providers before you budget. This is exactly the kind of expense Aid and Attendance is designed to offset.

How Aid and Attendance Helps Pay for In-Home Care in California

Aid and Attendance is an increased monthly VA pension for wartime veterans and surviving spouses who need help with daily activities.5 It is paid as cash directly to the veteran, who decides how to use it. Because it is paid to the beneficiary as part of the monthly pension, families commonly put it toward a home health aide, a homemaker, or a family caregiver.

VA publishes these rates as annual maximums, but it pays pension monthly: under 38 CFR 3.273 it subtracts your countable income from the annual rate and divides what's left by 12, and 38 CFR 3.29(b) rounds the result down to the whole dollar.1 And a maximum is not a payment: VA bases the amount on the difference between your income for VA purposes and the limit Congress sets, so a household with countable income gets less than the figures below.1

At up to $29,093 a year for a veteran, or up to $34,488 a year for a veteran with a spouse, the benefit can cover a meaningful share of California's high in-home care costs.1 Keep in mind the VA pays the veteran; the veteran arranges and pays for the care.

How In-Home Care Costs Lower Your Countable Income

VA pension, including the 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.1 Out-of-pocket care costs, such as paying a home health aide, count as unreimbursed medical expenses (UMEs) that reduce the income the VA counts, which is why many veterans who look "too rich" on paper still qualify once their care bills are subtracted.

Only the portion of those expenses above 5% of the applicable Maximum Annual Pension Rate is deductible, counting that rate with any increase for family members but without the increase for aid and attendance or being housebound.1 For 2026 that floor is $872 per year for a veteran with no spouse or child, and it rises with dependents.1 Payments to an in-home attendant count as medical expenses as long as the attendant provides health care or custodial care, and the payments must line up with the hours the attendant actually works.1 For in-home attendant care, the attendant must be a health care provider unless the veteran needs aid and attendance or is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that a physical, mental, developmental, or cognitive disorder makes that care necessary.1

Who Qualifies

To qualify for Aid and Attendance, a veteran generally must:5

• Meet VA's service test, with at least one day during a wartime period: at least 90 days of active duty for someone who started before September 8, 1980, or generally 24 months or the full period called to active duty for an enlisted person who started after September 7, 19805
• Have not received a dishonorable discharge, and meet at least one of four tests: be 65 or older, have a permanent and total disability, be a patient in a nursing home for long-term care because of a disability, or be getting Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)5
• Need aid and attendance: another person's help with daily activities such as bathing, feeding, and dressing; having to stay in bed, or spend a large part of the day in bed, because of illness; being a nursing home patient due to lost mental or physical abilities related to a disability; or severely limited eyesight (Housebound is a separate benefit, and you can't get both at once)5,6
• Have a net worth below $163,699 (this limit counts your assets and income, including your dependents', but excludes the primary home, the car, and basic home items)1

The VA enforces a 3-year look-back on assets transferred for less than fair market value before filing.5 A surviving spouse can qualify under the Survivors Pension using the same net worth limit.1

Using Aid and Attendance to Pay a Family Caregiver

Many families want to keep care in the family, and there are two ways VA benefits make that possible. First, Aid and Attendance comes as monthly payments added to the veteran's pension, and under 38 CFR 3.352(c), care given by a relative or another member of the household does not prevent VA from granting the allowance, so a California veteran cared for at home by family can still qualify.5

Second, the Veteran-Directed Care (VDC) program gives an enrolled veteran a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers, including family, friends and/or neighbors.3 It's open to enrolled veterans who are eligible for community care and meet the clinical criteria, where the program is available.3 VA medical centers deliver VDC through local aging and disability network agencies, such as Area Agencies on Aging, where an options counselor helps with assessment and care planning and arranges fiscal management services.3 To ask about VDC, start with your local VA medical center.

Using IHSS and Aid and Attendance for In-Home Care in California

California's In-Home Supportive Services (IHSS) program, delivered mainly as a Medi-Cal benefit, pays for in-home care directly, and for many veterans it can work alongside Aid and Attendance. IHSS provides in-home assistance to eligible aged, blind, and disabled Californians as an alternative to out-of-home care, and the provider the recipient hires is often a family member or relative.7

To qualify, the recipient must be aged, blind, or disabled, be a California resident with a Medi-Cal eligibility determination, and live at home or in a place of their own choosing (a hospital, long-term care facility, or licensed community care facility doesn't count as their own home).7 A county social worker assesses the person's needs in the home to decide what type of help, and how many hours, IHSS will provide.7 California lets a spouse be paid as an IHSS provider for some services, mainly personal care and paramedical tasks,8 and parents can be paid to care for a minor child except in the PCSP sub-program.9 Each county sets its own provider pay rates, and California's statewide minimum wage, which the Legislative Analyst's Office links to IHSS wage growth, rose to $16.90 an hour on January 1, 2026.7

Because Aid and Attendance is a federal VA benefit and IHSS runs through Medi-Cal, a veteran may be able to use both. Under the SSI income rules that federal Medicaid rules point to for an aged, blind, or disabled applicant, the basic VA pension counts as income and the Aid and Attendance amount doesn't, though a state may use stricter rules, so confirm with your county Medi-Cal office; the timing and order of applications matters.6 A benefits counselor who understands both programs should review your case first.

How Aid and Attendance Works with Medi-Cal

VA Aid and Attendance is a federal benefit administered separately from Medi-Cal, California's Medicaid program; the two have different agencies, applications, and rules, and a veteran can receive both at the same time.6 For VA pension purposes, unreimbursed medical expenses such as in-home care can be deducted from countable income, which can raise the Aid and Attendance amount.6

Medi-Cal applies its own income and asset tests. On January 1, 2026, California passed a law that requires Medi-Cal to count assets for some Medi-Cal programs, and DHCS says those limits reach people who are 65 or older, have a disability, live in a nursing home, or are in a family that makes too much money to qualify under federal tax rules. Through June 30, 2027, the most you can own is $130,000 for one person, plus $65,000 for every extra person in your house, up to 10 people.6 That ceiling is on countable assets, and the possessions families worry about most are not counted. DHCS's own table puts the main home you live in, your main vehicle, household items such as furniture and clothes, and retirement funds you are already drawing regular payments from in the column that won't affect eligibility, against second homes, second vehicles, cash, and bank accounts in the counted column.6 A California homeowner is not over the limit because of the home they live in. Starting July 1, 2027, the limit drops to $21,000 for one person and $31,000 for two people, plus $1,550 for every extra person, so anyone planning a 2027 application should plan around that change.6 Don't assume those figures simply add up to a couple's limit. DHCS cautions that not everyone in your home may count toward your family size, and that some married couples and registered domestic partners may qualify for higher limits under the spousal impoverishment rules, so ask your county Medi-Cal office what limit actually applies to your household before you plan around a number.6 Federal Medicaid rules look at VA money in two separate steps. At the eligibility step, they point to SSI income rules for an aged, blind, or disabled applicant, and under those rules the Aid and Attendance amount isn't counted as income, so only the basic VA pension counts toward the income test; a state may use rules stricter than SSI, so confirm your case with your county Medi-Cal office or the California Department of Health Care Services. The second step is narrower than it is usually described. The federal post-eligibility rule at 42 CFR 435.725 states that it applies to individuals in medical institutions and intermediate care facilities, so it sets the share-of-cost arithmetic for someone living in a facility, not for someone receiving home- and community-based waiver services at home.6 For a resident the section does cover, "Income that was disregarded in determining eligibility must be considered in this process." Under that federal rule, an Aid and Attendance amount VA still pays at the full rate is counted toward the resident's share of cost, after the deductions below, but how Medi-Cal applies that to a full-rate amount is something to confirm with your county Medi-Cal office or DHCS.6 The agency must first deduct five amounts, in order, before the rest goes to the facility: a personal needs allowance for the resident, an amount for the maintenance needs of a spouse still at home, an amount for the maintenance needs of a family still at home, incurred expenses for medical or remedial care that no third party pays, and the full amount of SSI and SSP benefits the individual continues to receive.6 If you are getting care at home through a waiver rather than living in a facility, 42 CFR 435.725 is not the rule that sets your share of cost, so ask your county Medi-Cal office or DHCS which post-eligibility rule applies to you.6 Either way, the order and timing of applications matters.6 A benefits counselor who understands both programs should review your case before you apply.6

How to Apply and Get Free Help

To apply for Aid and Attendance, submit VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), and have a medical examiner fill out its examination information section to document the need for help.10 That form covers Aid and Attendance whether the increase is added to a VA pension or to monthly compensation.10 The steps that follow are the pension route, which VA frames this way: you may be eligible for this benefit if you get a VA pension.10 A wartime veteran pursuing that route who is not already receiving a VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application.10 To count what you pay for in-home care, report it on VA Form 21P-8416 (Medical Expense Report), which covers expenses you paid yourself and weren't reimbursed for and don't expect to be.10 You can apply online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office. Asked how long a decision takes, VA's answer is "It depends," and it adds that it processes claims in the order received unless a claim requires priority processing.10

Don't do this alone. California's County Veterans Service Offices (CVSOs), staffed by trained and accredited professionals, handle claims initiation and development, preparing and submitting VA pension and Aid and Attendance claims and gathering the evidence.4 CalVet handles claims development and representation with appeals at its District Offices, and VA says the services an accredited VSO representative provides on your claim are always free, though an accredited attorney or claims agent can charge fees.4

If your claim is denied, you don't have to accept it. CalVet provides claims review and representation for appeals at its District Offices, and a CVSO can help you develop stronger evidence and respond to VA correspondence.4 Find the office nearest you through the CalVet CVSO locator, or call 844-SERV-VET.4

Compare Care Settings in California

Aid and Attendance can help pay for any care setting. See how it works for the others:

• How Aid and Attendance Pays for Assisted Living in California
• How Aid and Attendance Pays for a Nursing Home in California
• How Aid and Attendance Pays for Memory Care in California

Learn More

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.