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 about $91,520 per year (roughly $7,627 per month, or about $40 an hour on a 44-hour-per-week basis), well above the national non-medical caregiver median of about $80,080 per year.2 Beginning with its 2025 survey, CareScout (formerly Genworth) reports a single non-medical caregiver category rather than separate home health aide and homemaker figures.2 Rates vary across the state, so confirm local pricing with providers.

Costs run far higher in Los Angeles, Orange County, and the Bay Area than in inland and rural areas.2 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.1 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, so a monthly amount is the yearly award divided by 12.1 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, about $2,424 a month, and up to $34,488 a year for a veteran with a spouse, or $2,874 a month, 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 So a veteran paying for in-home care can deduct nearly the entire annual cost once the first $872 is set aside. 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

• Have served at least 90 days of active duty with at least one day during a wartime period
• 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 help with daily activities such as bathing, dressing, or feeding, or be housebound
• 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, because Aid and Attendance is cash paid to the veteran, the veteran can simply use it to pay a relative who provides care.

Second, the Veteran-Directed Care (VDC) program gives the veteran a flexible monthly budget to hire their own caregivers, including family, friends and/or neighbors.3 The veteran (or their representative) decides who provides care and how to spend the budget, and a financial management service handles payroll and taxes.3 Unlike many Medicaid programs, VDC has no blanket ban on hiring a spouse.3 To ask about VDC, contact your local VA medical center's social work or geriatrics department.

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

California's In-Home Supportive Services (IHSS) program is the Medi-Cal-funded route that pays for in-home care directly, and for many veterans it can work alongside Aid and Attendance. IHSS provides in-home personal care to eligible aged, blind, and disabled Californians as an alternative to out-of-home care, and it can pay a family member to provide that care.6

To qualify, the recipient must have full-scope Medi-Cal, be 65 or older (or blind or disabled), live in their own home, and have an assessed need for help with daily activities, documented by a county social worker.6 California is one of a small number of states that lets a spouse be paid as an IHSS provider, through the IHSS-Plus Option, and parents can be paid to care for a minor child with disabilities.6 Provider pay is set county by county and must be at least California's minimum wage, which rose to $16.90 an hour on January 1, 2026.6

Because Aid and Attendance is a federal VA benefit and IHSS runs through Medi-Cal, a veteran may be able to use both, but the basic VA pension counts toward Medi-Cal's income test (the Aid and Attendance amount generally doesn't), so the timing and order of applications matters.7 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.7 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.7

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.7 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.7 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.7 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.7 Medi-Cal looks at VA money in two separate steps. When it decides eligibility, it uses SSI income rules, 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.7 For a resident the section does cover, "Income that was disregarded in determining eligibility must be considered in this process." An Aid and Attendance amount still being paid therefore counts toward what the resident owes the facility.7 Even then, the agency must 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.7 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.7 Either way, the order and timing of applications matters.7 A benefits counselor who understands both programs should review your case before you apply.7

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.8 That form covers Aid and Attendance whether the increase is added to a VA pension or to monthly compensation.8 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.8 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.8 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.8

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.