VA Aid and Attendance for Nursing Home Care in Hawaii

VA Aid and Attendance tops out at $29,093 a year in 2026 for a qualifying wartime veteran with no dependents, well short of a Hawaii nursing home bill. For a surviving spouse with no dependents, the maximum is $18,697 a year.1 Those are ceilings, not payments: VA pays the difference between a claimant's income for VA purposes and the limit.1 Hawaii has among the highest long-term care costs in the nation, and a private nursing home room there runs about $196,735 a year.2

In This Guide

• How much a nursing home costs in Hawaii
• How Aid and Attendance helps pay for it
• How nursing home costs lower your countable income
• Who qualifies
• The nursing-home pension cap for Medicaid residents
• How Aid and Attendance works with Hawaii Medicaid (Med-QUEST)
• How to apply and get help
• Frequently asked questions

How Much a Nursing Home Costs in Hawaii

Per the CareScout 2025 Cost of Care Survey (rates collected from providers July through November 2025 and published March 2026), a private room in a Hawaii nursing home costs about $196,735 a year, roughly $16,395 a month. Hawaii's long-term-care costs are among the highest in the nation and were the fastest-rising in the country: between 2022 and 2025, the cost of a private nursing home room rose 34.4 percent and a semi-private room rose 44.9 percent. Both room types run well above the national medians of about $114,975 for a semi-private room and $129,575 for a private room.2

These are industry-survey medians, not government figures, and CareScout cautions that actual costs may vary with individual care needs, provider availability, and local market conditions.2

How VA Aid and Attendance Helps Pay for Nursing Home Care in Hawaii

VA Aid and Attendance is an increase added to the amount of a monthly VA pension for a qualifying veteran or survivor who meets at least one of VA's aid-and-attendance need criteria, listed under Who Qualifies below.5 VA's application form describes it as Aid and Attendance benefits "that will be added to your monthly compensation or pension benefits."6

VA publishes these rates as annual maximums, but it pays pension monthly. Under 38 CFR 3.273, VA works out the monthly payment by subtracting countable income from the annual rate and dividing what is left by 12. One monthly figure VA itself publishes is its penalty period rate, $2,874, which 38 CFR 3.276(e)(1) defines as the Aid and Attendance maximum for a veteran with one dependent, divided by 12 and rounded down to the nearest whole dollar.1

Each of these is a ceiling rather than a payment. VA pays the difference between the claimant's income for VA purposes and the limit, so a claimant with countable income receives less than the figure shown.1

A private room in a Hawaii nursing home runs about $196,735 a year.2 The maximum Aid and Attendance rate for a veteran with no dependents is $29,093 a year, so even the full ceiling is far less than that bill.1

How Nursing Home Costs Lower Your Countable Income

VA pension, including its Aid and Attendance increase, is a needs-based benefit: to be eligible, a veteran's yearly family income and net worth have to be within limits Congress sets. Because the benefit is keyed to income for VA purposes, a claimant can lower that income by deducting unreimbursed medical expenses (UMEs), and payments to a nursing home are medical expenses.1

Here is how it works: only the portion of UMEs that exceeds 5 percent of the applicable Maximum Annual Pension Rate (MAPR) is deductible from countable income. For 2026, the annual floor works out like this:1

• $872 a year for a veteran with no spouse or child, which is how the VA states it1
• A higher floor for a veteran with a spouse or child, because the 5 percent is taken on the larger MAPR that includes family members; the floor never counts the aid-and-attendance or housebound increase1

Example: for a veteran with no spouse or child who pays about $196,735 a year out of pocket for a private nursing home room,2 nearly the entire bill (everything above the $872 floor) counts as a deductible unreimbursed medical expense.1 When that deduction is larger than the veteran's income, countable income falls to zero, and because VA pays the maximum rate less countable income, a veteran who meets every other requirement can receive the full no-dependent maximum of $29,093 a year.1

Under 38 CFR 3.278(d)(1), payments to nursing homes, including the cost of meals and lodging the facility charges, are medical expenses, and they must be unreimbursed to be deducted. So are insurance premiums: 38 CFR 3.278 names health, medical, hospitalization, and long-term care insurance premiums as medical expenses, and lists premiums for Medicare Parts A, B, and D and for long-term care insurance among them.1

Who Qualifies

To receive VA Aid and Attendance, a veteran must meet all of the following:5

1. Wartime service, with no dishonorable discharge: a veteran who started active duty before September 8, 1980 needs at least 90 days of active duty, with at least one day during a wartime period VA recognizes (World War II, the Korean conflict, the Vietnam War era and the Gulf War, which has no end date set yet, are among them). A veteran who started active duty as an enlisted person after September 7, 1980 generally needs at least 24 months, or the full period for which 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 also qualifies on service, with at least one day during wartime.5
2. Age, disability, or care status: the veteran must meet at least one of four conditions, any single one of which is enough: being at least 65 years old; having a permanent and total disability; being a patient in a nursing home for long-term care because of a disability; or getting Social Security Disability Insurance or Supplemental Security Income. Each branch stands on its own, so a wartime veteran under 65 who gets SSI meets this condition without a permanent and total disability.5
3. Yearly family income and net worth within the limits Congress sets, with net worth at or below $163,699 (December 1, 2025 to November 30, 2026): VA's net-worth calculation includes the assets and the income for VA purposes of the veteran and their dependents, so income counts toward the limit, not assets alone. What it leaves out matters just as much: assets do not include the primary home, your car, or basic home items like appliances you would not take with you if you moved, so the house you live in does not push you over the limit. What does count is counted net of debt, because assets are the fair market value of the real and personal property owned minus the amount of any mortgages, and VA may subtract unreimbursed medical and educational expenses when it assesses income for VA purposes and net worth. For a married veteran this is a household test rather than an individual one, because net worth includes the spouse's.5
4. Need for aid and attendance: at least one of these must be true: the veteran needs another person to help with daily activities like bathing, feeding and dressing; has to stay in bed, or spend a large portion of the day in bed, because of illness; is a patient in a nursing home due to the loss of mental or physical abilities related to a disability; or has limited eyesight (even with glasses or contact lenses, only 5/200 or less in both eyes, or concentric contraction of the visual field to 5 degrees or less).5

The VA also applies a 36-month look-back on asset transfers for less than fair market value, and the window never reaches back before October 18, 2018. A transfer inside it draws a penalty period only if the asset, had it been kept, would have pushed net worth over the limit, and the penalty can't run longer than 5 years.5,1

VA's Survivors Pension has its own Aid and Attendance rate: a maximum of $18,697 a year for a surviving spouse with no dependents, and $22,304 a year with one dependent child.1

The $90/Month Nursing-Home Pension Cap

When a veteran who has neither a spouse nor a child is covered by a Medicaid plan for nursing facility care, federal law limits VA pension, including the Aid and Attendance amount, to no more than $90 per month for any period after the month of admission (38 U.S.C. 5503(d)(2)). The same limit applies to a surviving spouse with no child (38 U.S.C. 5503(d)(5)(A)).3 VA's own regulation, 38 CFR 3.551(i), instead keys the cap to the period after the month in which Medicaid payments begin, so if Med-QUEST approval came months after admission, confirm with VA which month your reduction starts.3 That cap turns on a defined term rather than the everyday sense of a nursing home: for purposes of that subsection, 38 U.S.C. 5503(d)(1)(B) defines "nursing facility" as one described in section 1919 of the Social Security Act "other than a facility that is a State home with respect to which the Secretary makes per diem payments for nursing home care pursuant to section 1741(a) of this title," so if the facility is a State veterans home, have that checked against the statutory definition rather than assume the cap applies.3 By statute the Medicaid payment to the facility cannot be reduced by that $90,3 and VA says that where it awards the $90 rate the facility can't count it as income toward the cost of care and the beneficiary keeps the full $90 for personal expenses.7

What this means practically: if a veteran with no spouse or child is in a nursing facility that Hawaii Med-QUEST is paying for, other than a State veterans home that receives VA per diem, the VA pension does not continue at the full Aid and Attendance rate once the cap takes effect. The order and timing of applying for each program matter and depend on Hawaii's Medicaid rules, so before applying, talk to a VA-accredited representative (a Veterans Service Officer, accredited agent, or accredited attorney) or an elder law attorney.7

How VA Aid and Attendance Works with Hawaii Medicaid for Nursing Home Care

For Hawaii seniors who need long-term care, VA 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.4 At the eligibility step, a state that uses SSI income methodologies does not treat the VA aid and attendance and housebound allowances as income. Hawaii is one of the eight 209(b) states, which use at least one Medicaid eligibility criterion more restrictive than SSI, so the SSI treatment does not carry over automatically.7,4 Hawaii's own regulation settles the point for the people it covers: HAR §17-1724.1-39 lists the VA aid and attendance allowance, the housebound allowance, and extra VA payments for unusual medical expenses as exempt unearned income when Med-QUEST decides the financial eligibility of a MAGI-excepted individual. Ask Med-QUEST which eligibility category applies to your family member.4

Once a person is eligible and living in a nursing facility, a second step sets the cost share, the amount the resident pays toward care. The federal rule that reaches Hawaii is 42 CFR 435.733, written for states with requirements more restrictive than SSI, and it says income that was disregarded in determining eligibility must be considered in this process. Hawaii's cost-share regulation, HAR §17-1724.1-63, applies the countable income of a MAGI-excepted individual who meets institutional level of care, is eligible for long-term care services and lives in a nursing facility to the cost share after deducting a personal needs allowance, amounts for the needs of a spouse and dependent family members at home, and incurred medical expenses the program does not cover. That regulation does not say in terms whether an Aid and Attendance amount exempt at eligibility is part of the countable income applied to the cost share, so ask Med-QUEST how a full-rate Aid and Attendance payment will be treated before you count on keeping it.4

Hawaii administers Medicaid long-term care through Med-QUEST. Because the exact income and asset treatment depends on the specific Med-QUEST program and current limits, veterans should confirm details with Med-QUEST and a Hawaii benefits counselor before relying on any particular outcome.4

How to Apply and Get Help

Aid and Attendance is claimed as an increase to a monthly VA benefit. VA Form 21-2680 covers Aid and Attendance that will be added to monthly compensation or pension benefits, so it serves both routes. The steps below are the pension route, where VA's condition is "You may be eligible for this benefit if you get a VA pension and you meet at least 1 of these requirements," meaning the aid-and-attendance need criteria listed under Who Qualifies.6,5

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance). A medical examiner must fill out the examination information section of this form, to document the need for assistance.6
• VA Form 21P-527EZ (Application for Veterans Pension). A wartime veteran on the pension route who is not already receiving VA pension also files this pension claim. A veteran who wants Aid and Attendance added to VA disability compensation instead is on the other route that Form 21-2680 serves.6
• VA 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, and a nursing home official uses it to verify that the veteran is a patient in a qualifying extended care facility.6

To have nursing home bills counted against income, report them on VA Form 21P-8416 (Medical Expense Report), which covers medical expenses you paid and weren't reimbursed for and don't expect to be. If you're still gathering paperwork, VA Form 21-0966 (Intent to File) can secure the earliest possible effective date for any retroactive payments.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. Asked 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.6

Help in Hawaii: The State of Hawaii Office of Veterans' Services (OVS) staffs Veterans Services Counselors at offices across the islands, on Oahu at Tripler Army Medical Center and the Daniel K. Akaka VA Clinic in Kapolei, on Hawaii island (Hilo and Kailua-Kona), on Kauai, and for Maui, Molokai and Lanai. Its listed services include assisting in the preparation of VA claims, helping individuals file VA appeals, representing veterans at VA hearings, and reviewing medical service records. Each office has its own phone number rather than a single statewide line; the Tripler office is at (808) 433-0420, and every office other than Tripler is listed as by appointment only.8 Visit dod.hawaii.gov/ovs for office information.

Never pay anyone a fee to file an initial claim. Federal law bars accredited attorneys and claims agents from charging for help before VA's initial decision, and VA-recognized Veterans Service Organization representatives always help free of charge.9

Compare Care Settings in Hawaii

Brevy's other Hawaii Aid and Attendance guides cover the remaining care settings:

• How Aid and Attendance Pays for Assisted Living 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.