VA Aid and Attendance for In-Home Care in Hawaii

VA Aid and Attendance pays up to $29,093 a year, tax-free, to a veteran with no dependents who needs help with daily activities.1,2 VA describes it as monthly payments added to a VA pension.3 In Hawaii, where long-term care costs are among the highest in the nation and CareScout ranked the state No. 1 for the fastest-rising senior care costs between its 2022 and 2025 surveys, that monthly pension is income a family can weigh against what care at home costs.4 Paying an in-home attendant can also count as an unreimbursed medical expense, which can lower the income VA counts against the pension limit.1

This guide explains exactly how Aid and Attendance works for in-home care, how much it pays in 2026, who qualifies, and how to get help filing the claim.

In This Guide

• Key Takeaways
• How Much In-Home Care Costs in Hawaii
• How Aid and Attendance Helps Pay for In-Home Care in Hawaii
• How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in Hawaii
• Who Qualifies
• Family Caregivers and Aid and Attendance
• How Aid and Attendance Works with Hawaii Medicaid
• How to Apply and Get Help
• Frequently Asked Questions
• Learn More

How Much In-Home Care Costs in Hawaii

Hawaii has among the highest long-term care costs in the nation, and in-home care is no exception. In its 2025 Cost of Care Survey (rates collected from providers July through November 2025 and published March 2026), CareScout combined the former homemaker and home health aide categories into a single non-medical caregiver rate. Hawaii's median is $41 an hour, or $93,808 a year at the survey's 44-hours-a-week assumption, the 9th highest in the country and above the national median of $35 an hour ($80,080 a year).4

Skilled nursing at home is the exception: CareScout puts Hawaii's private-duty-nurse median at $65 an hour, below the national $90. And in a separate CareScout comparison of its 2022 and 2025 surveys, Hawaii ranked No. 1 in the country for the fastest-rising senior care costs. These are industry-survey medians, not government figures, and CareScout cautions that actual costs vary with individual care needs, provider availability, and local market conditions, so the real number for any one family depends on how many hours of care are needed each week. Paying out of pocket adds up quickly, which is why an extra monthly benefit matters.4

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

Aid and Attendance is the VA pension paid at a higher maximum rate when a qualifying veteran or surviving spouse needs help with daily activities, so the rates below cap the whole pension rather than paying a second amount alongside the basic pension rate.1,5 VA describes the benefit as monthly payments added to the amount of a monthly VA pension.3 It connects to in-home care in two ways: the monthly pension itself, payable to the veteran or surviving spouse, and a separate rule under which what you pay an in-home attendant can count as an unreimbursed medical expense that lowers the income VA counts (explained in the next section).1

Here are the 2026 maximums (rates effective December 1, 2025 through November 30, 2026). VA publishes these rates as annual maximums, and a maximum is a ceiling, not a payment: VA bases the payment on the difference between your income for VA purposes and the limit, so nobody with countable income receives the full figure. Pension is paid monthly, and under 38 CFR 3.273 and 3.29(b) VA works out the monthly rate by subtracting your countable income from the annual maximum and dividing what remains by 12, rounding down to the whole dollar.1

Against Hawaii's median of $93,808 a year for in-home non-medical care at 44 hours a week, the $29,093 maximum for a veteran with no dependents is a little under a third of that figure, and a veteran with countable income receives less than the maximum.4,1

How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in Hawaii

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 be within limits Congress sets.1 Because the benefit is keyed to income, unreimbursed medical expenses, which can include qualifying in-home attendant care, can be deducted from the income the VA counts, which can make a family that looked "over income" eligible after all.1

The rule has a floor. Only the portion of your unreimbursed medical expenses that exceeds 5% of the applicable Maximum Annual Pension Rate (MAPR) counts. For 2026, the VA states that floor as $872 per year for a veteran with no spouse or child; it is higher if you have a spouse or child, because the 5% is taken on the larger rate that includes family members, and it never counts the aid-and-attendance or housebound increase.1 Paying an in-home attendant for help with daily activities counts as a medical expense as long as the attendant provides health care or custodial care and the pay matches the hours worked, and the attendant has to 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 means the veteran requires the care the attendant provides.1

For example, a veteran with no spouse or child who pays an in-home aide whose care meets those rules might spend $30,000 over a year on that care. The first $872 does not count, but the remaining roughly $29,000 can be subtracted from countable income, which can lower it enough to qualify for the pension or raise the amount paid.1

Who Qualifies

To qualify for Aid and Attendance, a veteran generally must meet all of the following:3

• Wartime service: at least one day during a wartime period (such as World War II, Korea, Vietnam, or the Gulf War), with at least 90 days of active duty if you started before September 8, 1980; an enlisted veteran who started after September 7, 1980 generally needs 24 months or the full period called or ordered to active duty (with some exceptions), with at least one day during wartime; and an officer who started after October 16, 1981 without having previously served at least 24 months on active duty needs at least one day during wartime.3
• No dishonorable discharge, plus one of four status tests: be at least 65 years old; 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 or Supplemental Security Income. Any one of the four is enough, so a wartime veteran under 65 who receives SSI qualifies on this test without an adjudicated permanent-and-total rating.3
• A need for aid and attendance: need help with daily activities such as bathing, dressing, or eating; have to stay in bed, or spend a large part of the day in bed, because of illness; be a nursing home patient because of lost mental or physical abilities related to a disability, or have severely limited eyesight.3
• Yearly family income and net worth within the limits Congress sets. The net worth limit is $163,699 from December 1, 2025 through November 30, 2026. VA's net worth calculation adds your and your dependents' assets to your income for VA purposes, so income counts toward the limit rather than assets alone; your primary home, your car, and basic home items like appliances are excluded.1,3

VA looks back 36 months from the date it receives the pension claim. Transferring an asset for less than fair market value in that window can bring a penalty period of up to 5 years if keeping the asset would have put net worth over the limit, so it is worth planning ahead.3 For a surviving spouse, VA publishes separate Survivors Pension rates, including the Aid and Attendance maximum shown in the table above.1

Family Caregivers and Aid and Attendance

Aid and Attendance is paid to the beneficiary as part of the monthly pension, and a relative doing the caregiving does not stand in the way: under 38 CFR 3.352(c), care provided by a relative or another member of the household will not prevent VA from granting the allowance.3 That rule is about qualifying for the allowance; it does not address paying the relative. On the income side, payments to an in-home attendant count as a medical expense when the attendant provides health care or custodial care and the pay matches the hours worked, and the attendant need not be a health care provider if the veteran needs Aid and Attendance or is housebound.1 That regulation does not say whether the attendant may be a relative, so ask an accredited representative before counting payments to a family member.

If you want a more structured way to pay a family caregiver, ask your VA medical center about Veteran-Directed Care (VDC). VDC is a VA Geriatrics and Extended Care program that gives an enrolled veteran a flexible budget, managed by the veteran or a representative, to hire and supervise their own workers, including family, friends, or neighbors.7 Enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and VDC is available. VA medical centers deliver it through local aging and disability network agencies, whose options counselor helps plan the care and arranges fiscal management services.7

How Aid and Attendance Works with Hawaii Medicaid

For a Hawaii senior who needs long-term care, Aid and Attendance and Hawaii Medicaid (Med-QUEST) are separate programs that can interact.8 Medicaid looks at the VA money in two separate steps. Hawaii is one of the eight Section 209(b) states, which use at least one Medicaid eligibility criterion more restrictive than SSI, so when it decides financial eligibility it is not automatically bound by the SSI rule that the aid and attendance allowance is not income. Hawaii's own regulation answers the question instead: HAR §17-1724.1-39 lists the VA aid and attendance and housebound allowances as exempt unearned income when Med-QUEST decides the financial eligibility of a MAGI-excepted applicant. Confirm with Med-QUEST which eligibility category applies to you.8

The second step comes after eligibility. For someone who is eligible and living in a nursing facility, the federal post-eligibility rule that reaches Hawaii (42 CFR 435.733) says income disregarded at eligibility must be considered, and the agency deducts, in order, a personal needs allowance, amounts for the maintenance needs of a spouse or family at home, incurred expenses for medical or remedial care that no third party pays, and the full amount of any SSI and SSP benefits the individual continues to receive. Hawaii's HAR §17-1724.1-63 applies countable income toward the cost share of long-term care for a MAGI-excepted individual who meets institutional level of care, is determined eligible for long-term care services, and resides in a nursing facility or medical facility: after a personal needs allowance, the maintenance needs of a community spouse and dependent family members, and incurred medical expenses the medical assistance program does not cover are deducted, the income left, rounded down to the whole dollar, is the cost share. Hawaii's regulation does not say in terms whether the Aid and Attendance amount it exempts at eligibility is part of that countable income, so ask Med-QUEST how it treats the allowance in your case. If you receive Med-QUEST long-term care services at home, ask Med-QUEST whether a cost share applies to you.8 One federal rule matters if a home-care plan ever turns into a nursing-home stay: for a veteran with no spouse or child, or a surviving spouse with no child, whose nursing-facility care Medicaid covers, the pension is capped at $90 a month after the month of admission. That cap does not reach a State home for which VA pays a nursing-home per diem, so check a particular stay with an accredited Veteran Service Officer.8 Hawaii administers Medicaid long-term care through Med-QUEST, and because the exact income and asset treatment depends on the specific program and current limits, veterans should confirm details with Med-QUEST and a Hawaii benefits counselor before relying on any particular outcome.8

How to Apply and Get Help

Aid and Attendance is an increase added to a monthly VA payment, so which form you file depends on which payment you receive. Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner fills out to document the need for help, is the form VA points to for aid and attendance that will be added to your monthly compensation or pension benefits, so it is not limited to pensioners. The steps below are the pension route, and VA states its condition plainly: you may be eligible for this benefit if you get a VA pension. On that route, a wartime veteran who is not already receiving a VA pension also files Form 21P-527EZ (Application for Veterans Pension), which is the wartime, means-tested pension application.5 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. On how long a decision takes, VA's answer is "It depends." It processes claims in the order it receives them, unless a claim requires priority processing. If you are still gathering paperwork, 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.5

Do not do this alone. The State of Hawaii Office of Veterans' Services (OVS) provides VA claims assistance to veterans, dependents, and survivors, and its listed services include preparing VA claims, filing VA appeals, representing veterans at VA hearings, and reviewing medical service records.6 OVS staffs Veterans Services Counselors at offices across the islands, and each office has its own phone number: 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. Offices are open weekdays from 7:45am to 4:30pm, closed for lunch from noon to 1:00pm, and every office other than Tripler lists itself as by appointment only, so call ahead.6

Compare Care Settings in Hawaii

Aid and Attendance and VA's medical-expense rules work differently in each care setting. See how they apply to the others:

• How Aid and Attendance Pays for Assisted Living in Hawaii
• How Aid and Attendance Pays for a Nursing Home 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.