VA Aid and Attendance for Assisted Living in Hawaii

In Hawaii, the country's most expensive state for assisted living, the VA Aid and Attendance pension can pay a veteran with one dependent up to $34,488 a year, or $2,874 a month. For a surviving spouse with no dependents the annual ceiling is $18,697. The way the VA counts your care costs can also make a veteran qualify who first assumed their income was too high.

This guide walks through what assisted living costs in Hawaii, how much Aid and Attendance pays, how those care costs lower your countable income, who qualifies, how the benefit works with Hawaii Medicaid, and how to get help applying.

In This Guide

• Key Takeaways
• How Much Assisted Living Costs in Hawaii
• How Aid and Attendance Helps Pay for Assisted Living in Hawaii
• How Hawaii Assisted Living Costs Lower Your Countable Income
• Who Qualifies
• How Aid and Attendance Works with Hawaii Medicaid (Med-QUEST)
• How to Apply and Get Help
• Frequently Asked Questions
• Learn More

How Much Assisted Living Costs in Hawaii

Hawaii has among the highest long-term care costs in the country. Per the CareScout 2025 Cost of Care Survey, the median cost of assisted living in Hawaii is about $145,065 to $145,155 a year, because CareScout publishes two figures for the same private one-bedroom unit: $145,155 in its data tables, which also report a monthly median of $12,096, and $145,065 in its Hawaii state release. Either way it is the highest of any state, and well above the national median of about $74,400 per year, or $6,200 per month.1 Costs are climbing fast, too: in a separate CareScout analysis comparing its 2022 and 2025 surveys, Hawaii ranked No. 1 in the country for the fastest-rising senior care costs, with assisted living up 36.9% and all four settings measured landing in the top 10.1

These are industry-survey medians, not government figures, and CareScout cautions that actual costs can vary with individual care needs, provider availability, and local market conditions.1

How Aid and Attendance Helps Pay for Assisted Living in Hawaii

Aid and Attendance is an increase to a monthly VA pension for people who meet at least one aid-and-attendance need: VA describes it as monthly payments added to the amount of a monthly VA pension.3 On the pension route, the increase takes the form of a higher maximum annual pension rate that replaces the basic rate, rather than a second payment on top of it.6

VA publishes these rates as annual maximums. A maximum is what it sounds like: the VA pays the difference between your income for VA purposes and the limit Congress sets, so a household with countable income is awarded less than the figures below. Pension is paid monthly, and under 38 CFR 3.273 VA works out the monthly rate by subtracting your countable income from the annual maximum and dividing what is left by 12, and 38 CFR 3.29(b) rounds a result that is not a whole dollar down to the nearest dollar. For the December 1, 2025 through November 30, 2026 rate year, the annual ceilings are:2

Set against a Hawaii assisted living bill of about $12,096 a month at the median in CareScout's data tables, the Aid and Attendance ceilings above do not cover the full bill on their own.1,2 The rest has to come from other income, savings, or, for some families, Medicaid.

How Hawaii Assisted Living Costs Lower Your Countable Income for Aid and Attendance

Aid and Attendance is needs-based: to be eligible, your yearly family income and net worth have to be within limits Congress sets, so the lower the income the VA counts, the better your position.2 Because the benefit is keyed to income, you can subtract unreimbursed medical expenses, and assisted living fees can count when the conditions below are met.

The rule has a floor. You can deduct only the portion of those care costs that exceeds 5% of your applicable pension rate.2 The VA puts it this way: you may deduct only the amount above 5% of your MAPR, $872 for a veteran with no spouse or child in 2026.2 The floor is higher if you have a spouse or child, because the 5% is taken on the larger rate that includes family members, but it never counts the aid-and-attendance or housebound increase.2 For assisted living, VA's rule for a care facility other than a nursing home (38 CFR 3.278(d)(3)) sets the conditions, and it treats the bill in two parts.2 Payments for help with daily activities count if the resident is receiving health care or custodial care in the facility and either needs Aid and Attendance or is housebound, or has a written statement from a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist that a physical, mental, developmental, or cognitive disorder means they need to be in a protected environment.2 Meals, lodging, and other facility charges count if the facility provides or contracts for the resident's health or custodial care, or if one of those clinicians states in writing that the resident must live in the facility (or a similar one) to separately contract with a third-party provider for health or custodial care, or to receive that care, paid or unpaid, from family or friends.2 The facility itself must be licensed if Hawaii requires that type of facility to be licensed, and a residential facility must have care providers on staff 24 hours a day.2

The practical upshot: a Hawaii veteran whose income looks too high at first glance may still qualify once qualifying assisted living costs are deducted, because only the income left after the deduction counts.2 With Hawaii's costs running so high, that deduction can be large.

Who Qualifies

To qualify for Aid and Attendance, the veteran must meet four basic tests:3

• Wartime service, without a dishonorable discharge: for service that began before September 8, 1980, at least 90 days of active duty with at least one day during a wartime period VA recognizes (such as World War II, the Korean conflict, the Vietnam War era, or the Gulf War, which has no end date yet). Someone who started active duty as an enlisted person after September 7, 1980 generally needs at least 24 months, or the full period they were called or ordered to active duty, with at least one day during wartime. An officer who started active duty after October 16, 1981, and had not previously served on active duty for at least 24 months, meets a third version of the test, also with at least one day during wartime.
• Age, disability, or care status: any one of four alternatives satisfies this test. You need to be at least 65 years old, or have a permanent and total disability, or be a patient in a nursing home for long-term care because of a disability, or be getting Social Security Disability Insurance or Supplemental Security Income. Because any one is enough, a wartime veteran under 65 who gets SSI meets this test without also having a permanent and total disability.
• Yearly family income and net worth within the limits Congress sets, with a net worth limit of $163,699 from December 1, 2025 to November 30, 2026. The VA's net-worth calculation counts the claimant's and their dependents' assets and annual income together, but not the primary residence, the car, or basic household items.3
• Need for aid and attendance: at least one of these must be true: needing another person's help with daily activities such as bathing, dressing, or feeding; having to stay in bed, or spend a large part of the day in bed, because of illness; being a nursing home patient because of lost mental or physical abilities related to a disability; or limited eyesight, meaning that even with glasses or contact lenses you have only 5/200 or less in both eyes, or concentric contraction of the visual field to 5 degrees or less.3

One caution: the VA looks back 36 months from the date it receives the pension claim for assets transferred for less than fair market value that would otherwise have pushed net worth over the limit, and it can assess a penalty period of up to 5 years.3

How Aid and Attendance Works with Hawaii Medicaid (Med-QUEST)

For a Hawaii senior who needs long-term care, Aid and Attendance and Hawaii Medicaid (Med-QUEST) are separate programs that can interact, and Medicaid looks at the VA money in two separate steps.5 The first is financial eligibility. Hawaii is one of the eight Section 209(b) states, which use at least one Medicaid eligibility rule more restrictive than SSI's, so Hawaii is not automatically bound by the SSI rule under which VA aid and attendance and housebound allowances are not income.5 Hawaii's own regulation does address the allowance at this step: HAR §17-1724.1-39 lists the aid and attendance allowance and the housebound allowance as exempt unearned income when Med-QUEST decides the financial eligibility of a MAGI-excepted individual or household. Ask Med-QUEST which eligibility category and chapter apply to you.5

The second step comes after approval, and here the answer is less settled. For a resident of a medical institution such as a nursing facility, the federal rule that reaches Hawaii (42 CFR 435.733) says income disregarded in determining eligibility must be considered when the state applies the resident's income to the cost of care, and it requires the state to deduct amounts in a set order first: a personal needs allowance, an amount for the maintenance needs of a spouse or family at home, incurred medical or remedial care expenses no third party will pay, and the full amount of any SSI and SSP benefits the person continues to receive.5 Hawaii's own cost-share rule (HAR §17-1724.1-63) applies countable income toward the cost of care for a MAGI-excepted individual who meets institutional level of care, is determined eligible for long-term care services, and is residing in a nursing facility or medical facility, after deducting a personal needs allowance, maintenance amounts for a community spouse and dependent family members, and incurred medical expenses the program does not cover. It does not say in terms whether an Aid and Attendance amount exempt at the eligibility step is part of that countable income, so how Hawaii treats a full-rate Aid and Attendance payment in a resident's cost share is not settled by the rule itself; confirm it with Med-QUEST.5 Both cost-share rules are written for people in institutions (medical institutions and intermediate care facilities under the federal rule, nursing or medical facilities under Hawaii's), so neither speaks to how Med-QUEST treats the VA money for someone living in assisted living; ask about your own setting.5 The incurred-medical-expense deduction mirrors one the VA itself uses: when it assesses income for VA purposes, VA may subtract medical expenses you are not reimbursed for, but only the amount above 5% of your MAPR.5 Hawaii administers Medicaid long-term care through Med-QUEST.5

The exact income and asset treatment depends on the specific Med-QUEST program and the current limits, so confirm the details with Med-QUEST and a Hawaii benefits counselor before relying on any particular outcome.5

How to Apply and Get Help

To document the need for care, submit Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance); a medical examiner must fill out its examination information section. That form covers Aid and Attendance added to a monthly pension and Aid and Attendance added to monthly compensation, so a veteran already drawing VA disability compensation uses it too.6 The rest of this section describes the pension route, where VA says you may be eligible for this benefit if you get a VA pension and meet at least one of its aid-and-attendance requirements, so a wartime veteran who is not already receiving VA pension also files Form 21P-527EZ (Application for Veterans Pension).6 A claimant in an assisted living facility or a nursing home also needs Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance): VA's pension evidence page says to submit it if you're in an assisted living facility or a nursing home.6 Medical expenses you paid for yourself or a family member in your household, were not reimbursed for, and don't expect to be reimbursed for are reported on Form 21P-8416 (Medical Expense Report).6 If you are still gathering information, you can submit Form 21-0966 (Intent to File) first; VA says it can secure the earliest possible effective date for any retroactive payments you may be eligible to receive.6 You can apply online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office, and an accredited attorney, accredited claims agent, or accredited Veterans Service Organization representative can help you file.6 On how long a decision takes, the VA's own answer is "It depends." It works through claims in the order it receives them, unless a claim requires priority processing.6

The State of Hawaii Office of Veterans' Services (OVS) provides VA claims assistance to veterans, dependents, and survivors, and its listed services include helping prepare VA claims, helping file VA appeals, representing veterans at VA hearings, and reviewing medical service records.4 OVS staffs Veterans Services Counselors at offices across the islands, and each office has its own phone number rather than one statewide line: on Oahu, Tripler Army Medical Center at (808) 433-0420 and the Daniel K. Akaka VA Clinic in Kapolei at (808) 458-5072; on Kauai at (808) 369-3535; on Hawaii island, Hilo at (808) 369-3538 and Kailua-Kona at (808) 844-6664; and for Maui, Molokai and Lanai at (808) 369-3541.4 Offices are open Monday through Friday, 7:45am to 4:30pm, closed for lunch from noon to 1:00pm, and every office except Tripler is marked by appointment only, so call ahead.4 OVS calls advocacy the primary service it offers, and says it may take action on behalf of veterans, their families, and survivors to secure appropriate rights, benefits, and services.4

Compare Care Settings in Hawaii

The rules change with the care setting. For example, if a Medicaid plan covers nursing-facility care for a veteran with no spouse or child, the pension VA can pay for any month after the month of admission is capped at $90 (a State home that receives VA's nursing home per diem is excluded from that cap).5 See how it works for the others:

• How Aid and Attendance Pays for a Nursing Home in Hawaii
• How Aid and Attendance Pays for In-Home Care in Hawaii
• How Aid and Attendance Pays for Memory Care in Hawaii

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.