VA Aid and Attendance for Nursing Home Care in Hawaii

VA Aid and Attendance can put up to $2,424 a month toward a nursing home in Hawaii for a qualifying wartime veteran, and surviving spouses may receive up to $1,558 a month.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 free 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 pension rate.

For 2026, the maximum monthly rates are:1

Against a Hawaii nursing home running about $16,395 a month for a private room,2 Aid and Attendance at the single-veteran rate covers roughly 15 percent of the cost. That still amounts to nearly $29,000 a year, funds that meaningfully extend the period before Medicaid is needed.1

How Nursing Home Costs Lower Your Countable Income

VA pension, including its Aid and Attendance increase, is a needs-based benefit. The VA pays the difference between a veteran's countable income and the applicable Maximum Annual Pension Rate (MAPR). Because the benefit is keyed to countable income, 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 MAPR is deductible from countable income. For 2026, those annual floors are:1

• $872 a year for a veteran with no dependents (5% of the $17,441 MAPR)1
• $1,141 a year for a veteran with one dependent (5% of the $22,839 MAPR)1

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 For most veterans in that situation, that wipes out countable income entirely, making them eligible for the full Aid and Attendance rate of $2,424/month.1

Nursing home fees (including meals and lodging charged by the facility) qualify as UMEs under 38 CFR 3.278, as do health insurance premiums and other out-of-pocket medical costs.

Who Qualifies

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

1. Wartime service: 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).
2. Age or disability: age 65 or older, OR permanently and totally disabled.
3. Net worth under $163,699 (for 2026): this limit combines assets and annual income; it excludes the primary home, vehicles, and basic household items.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

Surviving spouses of qualifying wartime veterans may be eligible for the Survivors Pension with Aid and Attendance at up to $1,558/month.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 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 enters a nursing home that Hawaii Med-QUEST is already paying for, the VA pension does not continue at the full Aid and Attendance rate. Given Hawaii's nation-leading nursing home costs, 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. Under general federal rules, VA pension (including the Aid and Attendance increase) is counted as income for Medicaid long-term-care eligibility, but the portion of that pension paid because of unreimbursed medical expenses is generally not counted toward the Medicaid income limit.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 Free Help

To apply for Aid and Attendance, you will need:7

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance). A physician completes this form, certifying the veteran's need for help with daily activities.
• VA Form 21P-527EZ (Application for Veterans Pension), if the veteran is not already receiving VA pension.
• VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance), which the nursing home completes when the veteran is already a resident.

You will typically also need supporting documents: a copy of the veteran's DD-214 or equivalent discharge papers, financial statements showing income and assets, and any existing VA claim number.7

Forms can be submitted online at va.gov, mailed to the VA, or filed through an accredited representative. Processing often takes three to six months.7

Free help in Hawaii: The State of Hawaii Office of Veterans' Services (OVS) provides Veterans Services Counselors across the islands who help veterans obtain VA pension and Aid and Attendance benefits at no cost. Veterans can reach OVS at (808) 433-0420.8 Visit dod.hawaii.gov/ovs for office information.

Never pay someone to file an initial VA claim. Accredited representatives are prohibited from charging fees for this service.

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.