If your loved one is a veteran in Iowa, the VA offers more senior care benefits than most families realize. VA benefits can cover home-based medical care, nursing homes, and an Aid and Attendance pension, paid monthly, worth up to $29,093 a year for a veteran with no dependents (up to $34,488 with one dependent). The challenge usually isn't eligibility. It's knowing what to ask for.

In This Guide

What VA Benefits Cover Senior Care in Iowa

The VA offers multiple long-term care programs. Access isn't automatic once a veteran is enrolled: VA also has to conclude the veteran needs that specific service for their ongoing treatment and personal care, and the service, or a space in the care setting, has to be available near them. VA may also consider other factors, like the veteran's service-connected disability status or insurance coverage.

Start with the veteran's VA social worker or case manager, who handles the extended care application (VA Form 10-10EC) that sets a Community Living Center copay and can help locate and arrange VA respite care.

How Your Priority Group Affects Access and Cost

When a veteran enrolls in VA health care, the VA assigns them to one of eight priority groups based on their military service history, disability rating, income, and other factors. The VA assigns veterans with service-connected disabilities the highest priority, and a veteran with a service-connected disability rated 10% or higher pays no copay for outpatient care and no copay for inpatient care. Care related to a VA-rated service-connected disability requires no copay no matter what the veteran's disability rating is or what priority group they are in. Long-term care is priced on its own terms. Some veterans don't have to pay copays at all (they're "exempt") because of their disability rating, income level, or special eligibility factors. For a veteran who isn't exempt, no copay is owed for geriatric care or extended care for the first 21 days of care in a 12-month period, and starting on the 22nd day the VA bases the copay on the level of care being received and the financial information the veteran provides on the Application for Extended Care Services (VA Form 10-10EC).

Home Based Primary Care (HBPC)

A VA doctor leads a health care team that provides services such as nursing care, physical therapy, and help with daily tasks in the veteran's home.

Adult Day Health Care

Veterans attend a structured daytime program that provides social activities, companionship, and recreation, as well as care and support. VA counts attending one as a form of respite for the family caregiver, whether VA or a community adult day health care center provides it.

Community Living Centers (VA Nursing Homes)

Community Living Centers are VA-run nursing centers, designed to feel like home, that provide nursing-home-level care. There are over 100 CLCs nationwide, most on or near a VA medical center campus.

Most CLC stays are short ones after a hospital discharge. CLCs provide 24-hour skilled nursing care; some also offer dementia care, respite care, and palliative and hospice care, but not every CLC provides every service.

Community Nursing Home Program

The VA contracts with community (non-VA) nursing homes so veterans can get nursing home care near home. VA says whether its benefits help pay for nursing home care depends on the veteran's income and the level of their service-connected disability, and the extended care copay rules above still apply.

Respite Care

All enrolled veterans are eligible for VA respite care if they meet the clinical criteria for the service and it is available, but when a community agency, an adult day health care center, or a nursing home provides the respite, the veteran also has to meet community care eligibility. Through the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC), eligible Primary Family Caregivers receive at least 30 days of respite care per year. Respite comes as Home Respite Care, where a substitute caregiver comes to the house or the veteran attends an adult day health care program, or Nursing Home Respite Care, where VA pays for the veteran to stay in a CLC or community nursing home while the family is out of town for a few days. Either kind should be scheduled in advance, and services vary by location. VA's 2026 copay page describes overnight respite and daily respite as each available up to 30 days a calendar year.

Respite isn't always free. A veteran with a compensable service-connected disability, or with annual income below the amount set in the federal pension statute (38 U.S.C. 1521(b)), owes no extended care copay. A veteran who isn't exempt owes nothing for the first 21 days of extended care in a 12-month period, and after that up to $97 a day for institutional respite or $15 a day for non-institutional respite, only to the extent they have available resources. Ask the veteran's VA social worker or case manager for the copay. For caregiver support and referrals, the VA Caregiver Support Line is 1-855-260-3274, Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.

Not sure which VA program fits your family's situation? Chat with Brevy to get a personalized recommendation.

The Iowa Veterans Home

The Iowa Veterans Home (IVH) in Marshalltown is one of three operational areas managed by the Iowa Department of Veterans Affairs (IDVA), which is headquartered at the home. IVH describes itself as the fifth-largest state-owned nursing facility for veterans in the nation and one of the largest state-run veterans homes in the country.

Founded in 1887 as the Iowa Soldiers Home, IVH sits on a campus of more than 150 acres with five main resident care buildings and serves 400-plus residents. It provides professional long-term nursing and domiciliary (residential) care, a full continuum that includes independent living, skilled nursing, and long-term rehabilitative care.

IVH serves qualified Iowa veterans, their spouses, and Gold Star parents exclusively, and applicants must meet Iowa's residency requirements on the date they're admitted. Contact IDVA for current admission requirements, availability, and rates.

Aid and Attendance: Extra Monthly Cash for Care

The Aid and Attendance benefit is a monthly payment added to a VA pension for veterans (or, through Survivors Pension, surviving spouses) who need help with daily activities.,

2026 Rates

On the pension route, Aid and Attendance is paid as part of a VA pension, at a higher maximum rate than the basic pension rather than as a second payment on top of it. The VA sets these 2026 maximums, the Maximum Annual Pension Rate (MAPR), as yearly amounts in effect from December 1, 2025 through November 30, 2026. Each is a ceiling, not a payment: VA pays the MAPR less the veteran's countable income, and the monthly payment is that difference divided by 12, rounded down to the whole dollar.

Category Maximum Yearly Rate
Veteran, no dependents Up to $29,093
Veteran with 1 dependent Up to $34,488
Two veterans married to each other, both qualify for A&A Up to $46,143
Housebound (veteran, no dependents) Up to $21,313
Surviving spouse, no dependents Up to $18,697

Who Qualifies

To be eligible, the veteran must:

  • Meet the wartime service test by way of any one of three routes: started active duty before September 8, 1980 and served at least 90 days of active duty with at least one day during a wartime period; started active duty as an enlisted person after September 7, 1980 and served at least 24 months, or the full period for which they were called or ordered to active duty (with some exceptions), with at least one day during wartime; or was an officer who started active duty after October 16, 1981 and had not previously served on active duty for at least 24 months, with at least one day during wartime
  • Have no dishonorable discharge
  • Meet at least one of four alternatives, any single one of which satisfies the test: 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. A wartime veteran under 65 on SSI qualifies here without any adjudicated disability rating
  • Need help with daily activities such as bathing, dressing, or feeding, or have to stay in bed, or spend a large portion of the day in bed, because of illness, or be a patient in a nursing home due to the loss of mental or physical abilities related to a disability, or have limited eyesight (only 5/200 or less in both eyes even with glasses or contacts, or a visual field narrowed to 5 degrees or less)
  • Have a net worth below $163,699, the limit running December 1, 2025 through November 30, 2026. VA's net worth calculation includes the veteran's and their dependents' assets and their annual income for VA purposes, not counting the primary home, so comparing assets alone against that figure gives the wrong answer,

The VA enforces a 3-year look-back period on asset transfers for less than fair market value, with a penalty period that can last up to 5 years.

How to Apply

Apply using VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner must fill out to document the need for assistance. VA describes that form as the way to apply for Aid and Attendance benefits "that will be added to your monthly compensation or pension benefits," so it serves two routes: compensation and pension.

The steps here are the pension route, whose condition VA states as "You may be eligible for this benefit if you get a VA pension." On that route, a wartime veteran who isn't already receiving VA pension also submits Form 21P-527EZ (Application for Veterans Pension). For a veteran on VA disability compensation instead, Aid and Attendance is added to their monthly compensation, and 21-2680 covers that too.

Forms can be filed online at VA.gov, mailed to the VA Pension Intake Center, or filed in person at a VA regional office, and an accredited representative can help you file.

Don't do this alone. The Iowa Department of Veterans Affairs tells veterans to start local with their county veteran affairs or veterans service office, and VA says the services an accredited VSO representative provides on your VA benefit claims are always free.

For the full application walkthrough, see our VA Aid and Attendance guide.

Aid and Attendance isn't the only benefit worth claiming if the veteran owns their home. Iowa also has a Disabled Veteran Homestead Tax Credit, equal to the entire property tax on the homestead, for qualifying disabled veterans and certain survivors, claimed with the city or county assessor rather than the VA. Our guide to the Iowa disabled veteran property tax exemption explains who qualifies and how to apply.

Veteran-Directed Care

The Veteran-Directed Care (VDC) program gives veterans a flexible budget to hire their own caregivers, including family members. The veteran (or their representative) decides who provides care, what services to purchase, and how to manage the budget, and VA medical centers deliver the program through aging and disability network agencies such as Area Agencies on Aging.

Through an options counselor, the local agency provides a facilitated assessment and care planning, arranges fiscal management services, and gives the veteran ongoing counseling and support. All enrolled veterans are eligible for VDC if they are eligible for community care, meet the clinical criteria for the service, and it is available. This is a good option for veterans who want control over their care and prefer family members as caregivers.

Because VDC is offered only where it is available, ask the veteran's VA medical center whether a local agency runs it in your part of Iowa.

Community Care Through the MISSION Act

The VA MISSION Act of 2018 has, since 2019, let an enrolled veteran get care from a community (non-VA) provider at VA's expense. Two requirements always apply: the veteran must be enrolled in or eligible for VA health care, and must have approval from their VA health care team before getting care from a community provider (urgent and emergency care are among the exceptions). At least one of several further conditions must also be true, including:

  • The VA can't schedule an appointment within 20 days and a 30-minute average drive for primary care, mental health care, and non-institutional extended care services, or within 28 days and a 60-minute average drive for specialty care; failing either limit is enough, though the wait-time limit doesn't count if you agree to a later date
  • The care you need isn't available at any VA health facility
  • You and your VA provider agree that care from an in-network community provider is in your best medical interest

In 2025, the VA streamlined the "best medical interest" pathway under the Dole Act (the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act), removing an extra review step so eligible veterans can access community care faster.

Can a Veteran Use VA and Medicaid at the Same Time?

Yes, but the interaction is genuinely complex and depends on each family's income, assets, and care setting, so it is worth getting in-person help before you apply.

VA benefits don't replace Medicare or Medicaid, a veteran doesn't have to enroll in Medicare to keep VA health care, and a veteran or surviving spouse can receive VA pension and Medicaid at the same time., VA doesn't bill Medicare, and the two generally can't pay for the same items or services, so you choose which benefit to use each time you get care. If VA authorizes a non-VA hospital stay but not every service in it, Medicare may pay for the Medicare-covered services VA didn't authorize. If you delay Part B while relying on VA care and later have to sign up, you'll pay a penalty that grows every year you waited and that you keep paying for life.

  • VA + Medicare: Holding both is normal. Medicare pays for Medicare-covered items and services, while VA pays for VA-authorized care in a VA or non-VA facility.
  • VA + Medicaid: When the VA determines pension eligibility, it subtracts unreimbursed medical expenses from countable income, but only the portion above 5% of the Maximum Annual Pension Rate. Federal rule (38 CFR 3.278) treats payments to hospitals, nursing homes, medical foster homes, and inpatient treatment centers as medical expenses, along with payments for help with daily activities from an in-home attendant who provides health care or custodial care. On the Medicaid side, Iowa HHS's Medicaid income manual treats a payment for aid and attendance or housebound allowance as not income but a third-party medical resource, so it isn't counted as income at eligibility; any portion of a VA pension payment not attributable to aid and attendance or unusual medical expenses is counted as unearned income. The allowance isn't free of Medicaid, though. If a member is in a nursing facility, or gets in-home health-related care for the same need the allowance covers, Iowa adds the allowance to the client participation owed. For a veteran with neither spouse nor child (or a surviving spouse with no child) in Medicaid-covered nursing-facility care, federal law caps the pension at $90 a month after the month of admission, and the Medicaid payment to the facility can't be reduced by that pension., VA's regulation instead starts it after the month Medicaid payments begin, so check which date VA applied. Iowa's nursing-facility add-back describes a resident whose pension hasn't been cut to that cap, such as a veteran with a spouse or child. For a pensioner with no spouse or dependent, Iowa's manual instead excludes $90 of the VA pension as income for eligibility and client participation, starting the month after entering the institution. Whether the cap reaches the Iowa Veterans Home depends on whether VA pays the home a per diem, so ask a County Veterans Service Officer. Iowa HHS also runs the state's HCBS Elderly (E) Waiver, which provides services for elderly persons and requires an applicant to be at least 65 years of age.

Because VA pension and Medicaid rules can offset or reduce one another, a senior weighing both should get advice specific to their situation from a County Veterans Service Officer and Iowa HHS before applying.

How to Get Started with VA Senior Care Benefits in Iowa

1
Step 1

Confirm VA health care enrollment

If the veteran isn't already enrolled in VA health care, apply at va.gov/health-care/how-to-apply. The VA assigns a priority group (1-8) based on service-connected disabilities, income, and other factors.

2
Step 2

Get free help

Iowa has 99 County Veterans Services offices, each with one or more accredited County Veteran Services Officer (CVSO), and VA states that the services an accredited VSO representative provides on your VA benefit claims are always free; an accredited attorney or claims agent, by contrast, can charge fees. Reach the Iowa Department of Veterans Affairs at 515-252-4698.

3
Step 3

Gather the Aid and Attendance paperwork

A medical examiner completes VA Form 21-2680, a nursing home official completes Form 21-0779 for a nursing-home resident, and unreimbursed medical expenses go on Form 21P-8416. An Intent to File (Form 21-0966) can secure the earliest possible effective date while you gather the rest.

Frequently Asked Questions

Do you have to be service-connected disabled to get VA long-term care?

Not for all programs. The VA offers its long-term care services to veterans signed up for VA health care, though VA also has to conclude the veteran needs the specific service and it has to be available nearby. A service-connected rating still matters for cost. A veteran with a compensable service-connected disability, at any compensable rating and not only at 70 percent, is not subject to VA's extended-care copayments under 38 CFR 17.111(f). Aid and Attendance doesn't require a service-connected disability at all. It rides on a VA pension, so it requires wartime service, no dishonorable discharge, yearly income and net worth within the limits Congress sets, a need for aid and attendance such as help with daily activities, and any one of four things: being at least 65, having a permanent and total disability, being a patient in a nursing home for long-term care because of a disability, or receiving SSDI or SSI.

Can a veteran's spouse live in the Iowa Veterans Home?

In some cases, yes. By law, IVH may admit the dependent or surviving spouses of honorably discharged veterans, and a spouse must have been married to the veteran for at least a year before applying. Every applicant must need residential or nursing care, and goes on a waiting list if no bed is open. Contact IDVA for current admission policies.

How long does it take to get Aid and Attendance approved?

Asked how long a decision takes, VA answers "It depends." It works claims in the order it receives them, unless a claim requires priority processing. A County Veterans Service Officer or other accredited representative can help you file the claim.

Does the VA pay for assisted living?

Not directly. VA doesn't run, staff, or pay for assisted living facilities, though VA benefits may help pay for extra services there, such as visits from a VA provider. Aid and Attendance comes as a payment added to the monthly VA pension. Fees paid to an assisted living facility can also count as deductible medical expenses when VA calculates the award. Health care from a health care provider counts, and help with daily activities from anyone else counts if the veteran is receiving health care or custodial care there and either needs aid and attendance, is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist has stated in writing that they need to be in a protected environment. Meals and lodging have their own test. And if the veteran qualifies for Iowa Medicaid, the HCBS Elderly (E) Waiver provides services for elderly persons, with applicants required to be at least 65 years of age.

What if the VA denies an Aid and Attendance claim?

A denial isn't the end of the road. VA offers three decision reviews: a Supplemental Claim with new and relevant evidence, a Higher-Level Review, or a Board Appeal, and the last two must be requested within one year of the date on the decision letter. An accredited VSO representative can help you request a decision review, so take the denial letter to your County Veterans Service Officer, whose help on VA benefit claims is always free.

Next Steps

If you're caring for a veteran who needs help, start by contacting the Iowa Department of Veterans Affairs at (515) 252-4698 or your County Veterans Service Officer. An accredited representative there can help you file the claim.

Learn More

VA BenefitsVA benefits for senior care nationwideA complete guide to VA benefits for senior care: long-term care, Aid and Attendance, pensions, DIC, and home grants for older veterans and surviving spouses. VA BenefitsVA Aid and Attendance in IowaVA Aid and Attendance in Iowa for 2026: who qualifies, the $34,488 annual pension ceiling with a spouse, how to apply, and free help from county VSOs. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. Care TypesHome Care vs Home Health in IowaHome care vs. home health in Iowa: home health is skilled care Medicare and Iowa Medicaid cover; home care is non-medical help paid privately or by waiver. Care TypesNursing Homes in IowaNursing homes in Iowa in 2026: a semi-private room runs about $111,325 a year. How to check a facility's record, what it costs, and how Medicaid pays for care. Care TypesAssisted Living in IowaAssisted living in Iowa runs about $61,200 to $64,566 a year, below the national median. How certified programs work, what they cost, and where Medicaid helps.
Your next step Find personalized help navigating VA senior care benefits in Iowa at brevy.com.

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.

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