VA Aid and Attendance for Nursing Home Care in Hawaii

VA Aid and Attendance can put up to $29,093 a year toward a nursing home in Hawaii for a qualifying wartime veteran with no dependents. 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 In the state with among the highest long-term-care costs in the nation, that can offset tens of thousands of dollars 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 (the most recent state-level data, released 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; costs vary across the islands and rise as care needs grow.

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

VA Aid and Attendance is an increase added to a qualifying veteran's or survivor's basic VA pension when the person needs help with daily activities, is bedridden, lives in a nursing home due to physical or mental incapacity, or has severely limited eyesight.5 It is not a separate program; it is a higher monthly rate, most often on a VA pension.

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. The one monthly figure VA prints itself is $2,874, its penalty period rate, which 38 CFR 3.276(e)(1) defines as the one-dependent Aid and Attendance maximum divided by 12 and rounded down.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 single-veteran Aid and Attendance rate is $29,093 a year, so even at the ceiling the benefit pays part of that bill, not most of it.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, large recurring care expenses can actually help a veteran qualify even when their income appears too high at first glance.1

Here is how it works: only the portion of unreimbursed medical expenses (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: because a single veteran pays about $196,735 a year for a private nursing home room out of pocket,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, the veteran can receive the full single-veteran maximum of $29,093 a year.1

Nursing home fees, including the meals and lodging the facility charges, count as UMEs. So do 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 recognized wartime period (World War II, Korea, Vietnam, Gulf War/post-9/11). 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. The same 24-month rule reaches an officer who started active duty after October 16, 1981 and had not previously served on active duty for at least 24 months.
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. The nursing-home and SSDI/SSI branches stand on their own, so a wartime veteran under 65 who receives SSI qualifies without any adjudicated permanent-and-total rating.
3. Net worth under $163,699 (for 2026): VA's net-worth calculation adds together the assets and the annual income of the veteran and their dependents, so a family comparing assets alone against the limit will get the wrong answer. What it leaves out matters just as much: assets do not include the primary home, one personal vehicle, 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: requires help with daily activities (bathing, dressing, feeding), is bedridden, is a patient in a nursing home due to mental or physical incapacity, or has severely limited vision.

The VA also applies a 36-month look-back on asset transfers for less than fair market value. Transfers made on or after October 18, 2018 that fall within this window can trigger a penalty period.5,1

Surviving spouses of qualifying wartime veterans may be eligible for the Survivors Pension with Aid and Attendance, at a maximum of $18,697 a year for a surviving spouse with no dependents.1

The $90/Month Nursing-Home Pension Cap

This is one of the most important planning facts for families weighing both VA pension and Medicaid.

When a single veteran with no spouse or dependent children is receiving Medicaid-covered nursing facility care, federal law generally 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)).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 The veteran keeps that $90 as personal funds, and by statute the Medicaid payment to the facility cannot be reduced by it, so it is not a contribution toward nursing home costs.3

What this means practically: if a veteran with no spouse or child enters 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. Given how high Hawaii's nursing home costs run, families who plan to use Aid and Attendance before Medicaid coverage begins, or who will pay privately for part of the stay, should coordinate both applications carefully before the veteran enters a Medicaid-funded facility.6

An accredited VA representative or elder law attorney can help families map out the timing to preserve as much benefit as possible.

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.6 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 a nursing-facility resident's countable income 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, and the paperwork depends on which benefit it is added to. 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, the one most nursing home families use; VA's condition for it is "You may be eligible for this benefit if you get a VA pension."7

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance). A medical examiner fills out the examination information section of this form, documenting the veteran's need for help with daily activities.7
• VA Form 21P-527EZ (Application for Veterans Pension). This is the wartime, means-tested pension application, so it is filed by a wartime veteran pursuing Aid and Attendance through the pension route who is not already receiving a VA pension. A veteran who receives VA disability compensation and wants Aid and Attendance added to that compensation is on the other route, which runs through Form 21-2680.7
• VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance). A veteran who is already a nursing home patient also needs this form, which a nursing home official uses to verify that the veteran is a patient in a qualifying facility.7

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.7

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.7

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 preparing VA claims, filing 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

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 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.