VA Aid and Attendance for In-Home Care in Maryland

VA Aid and Attendance can help pay for in-home care in Maryland, turning a monthly VA pension into real money toward an aide, a homemaker, or a family caregiver. If your loved one is a wartime veteran who needs help with daily activities, this benefit can cover a meaningful share of the cost of staying at home. The hard part is usually knowing it exists and how to claim it.

This guide walks through what in-home care costs in Maryland, how much Aid and Attendance pays, how your care costs can actually help you qualify, and where to get free help applying.

In This Guide

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

How Much In-Home Care Costs in Maryland

In-home care is often the most affordable way to get help, but the bills add up fast. In Maryland, in-home care from a non-medical caregiver (the category that covers both personal-care aides and homemaker help) runs about $80,080 a year, based on roughly 44 hours of care a week, per the CareScout 2025 Cost of Care Survey.2 Beginning with its 2025 survey, CareScout merged its former separate home health aide and homemaker categories into this single figure. These are industry-survey medians, not government figures, and costs vary across the state, with the Washington-DC and Baltimore suburbs running higher than rural Maryland.

For many Maryland families, that is more than a fixed retirement income can absorb on its own. This is where Aid and Attendance comes in.

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

Aid and Attendance is an increased monthly VA pension for wartime veterans and surviving spouses who need help with everyday activities.4 It is paid as tax-free cash, which means the family decides how to spend it, including on a home health aide, a homemaker, or a family caregiver.

Two things to know about those numbers. VA publishes annual rates; a monthly amount is the yearly award divided by 12, so treat the monthly figures above as approximate. And each rate is a maximum, not a check: VA pays the difference between the claimant's income for VA purposes and that limit.1

At the full $29,093 a year for a veteran, about $2,424 a month, the benefit covers a meaningful share of in-home care in Maryland at the survey's 44-hour week.1,2 Read that as the top of the range: income the VA counts is the same income that reduces the award, so a household with other income is awarded less than $2,424 a month and covers less of the bill.1

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

VA Pension, including the Aid and Attendance increase, is needs-based: to be eligible, your yearly family income and net worth have to meet limits set by Congress.1 The lower the income the VA counts, the better your chances.

Here is the part families miss: unreimbursed medical expenses, including in-home care, lower the income the VA counts when there is a documented care need. You can only deduct the portion of those expenses that exceeds 5% of your applicable Maximum Annual Pension Rate (MAPR). For 2026 that floor is $872 a year for a veteran with no spouse or child, and it rises with dependents, though it never counts the Aid and Attendance increase.1

Think of it in annual terms. If a veteran with no spouse or child pays for in-home care, only the first $872 of that yearly cost is not deductible. Everything above that floor reduces the income the VA counts.1 With in-home care running about $80,080 a year in Maryland, those costs can wipe out most or all of a veteran's countable income, which is exactly how someone whose income looked too high ends up qualifying.2

Who Qualifies

To be eligible for Aid and Attendance, the veteran must:4

• Have served at least 90 days of active duty with at least one day during a wartime period
• Not have received a dishonorable discharge
• Meet at least one of these four, any 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
• 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
• Have a net worth below $163,699 for 2026 (VA's calculation counts the claimant's and their dependents' assets and annual income, and excludes the primary home and a car)4

The VA also applies a 3-year look-back on assets transferred for less than fair market value.4 Surviving spouses of wartime veterans can qualify under the survivor pension.

Using Aid and Attendance to Pay a Family Caregiver

Many families want a son, daughter, or spouse to provide the care. Aid and Attendance is paid as cash, so it can be used to compensate a family caregiver directly.

There is also a separate VA program built for this. Veteran-Directed Care gives a veteran a flexible budget to hire their own caregivers, including family members, with help from an Aging and Disability Network agency and a financial management service that handles payroll.3 Unlike some Medicaid programs, Veteran-Directed Care has no blanket ban on hiring a spouse.3 Ask your VA medical center's social work team whether it is available in your area.

How Aid and Attendance Works with Maryland Medicaid

For a Maryland senior who needs long-term care, the VA pension with Aid and Attendance and Maryland Medicaid are separate programs with different rules, and the two interact.5 Maryland Medicaid long-term services and supports, administered by the Maryland Department of Health's Medical Assistance program, has its own much stricter income and asset limits. At the eligibility step, Maryland applies SSI income rules, under which the Aid and Attendance allowance is not counted as income at all, so only the basic pension counts toward the income limit. That exclusion governs eligibility only: once a person is eligible and living in a nursing facility or other medical institution, income that was disregarded in determining eligibility must be counted in the post-eligibility share-of-cost calculation (42 CFR 435.725), so the Aid and Attendance amount does count at that stage. Before any of it reaches the facility, 42 CFR 435.725(c) requires Maryland to deduct five amounts from the resident's income, in the order the regulation sets them out: (1) a personal needs allowance the resident keeps for clothing and other personal needs; (2) for a resident with only a spouse at home, an amount for that spouse's maintenance needs; (3) for a resident with a family at home, an amount for the family's maintenance needs; (4) incurred expenses for medical or remedial care that no third party will pay; and (5) any SSI and state supplementary payments the resident keeps receiving. All five are deductions the state has to make, not benefits a family applies for. That section covers people in medical institutions and intermediate care facilities, so it does not set this calculation for someone receiving home and community-based waiver services, whose share of cost is governed by separate rules.5

Because the programs use different income and asset tests, a household should confirm the exact effect on benefits with the Maryland Medicaid program or an accredited benefits counselor before relying on it.5

How to Apply and Get Free Help

Apply using VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner must fill out to document the care need. VA describes that form as applying for Aid and Attendance that will be added to your monthly compensation or pension benefits, so it serves both routes.6 The steps here are the pension route, the one this guide is about: VA's condition is "You may be eligible for this benefit if you get a VA pension." On that route, a wartime veteran who is not already receiving VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application. A veteran whose Aid and Attendance would instead be added to monthly disability compensation does not use 21P-527EZ.6 You can file online at va.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office, and an accredited representative can help you file. If you are still gathering paperwork, you can submit VA Form 21-0966 (Intent to File) first, which VA says can secure the earliest possible effective date for any retroactive payments you may be eligible to receive. Asked how long a decision takes, VA's answer is "It depends"; it works claims in the order it receives them, unless a claim qualifies for priority processing.6

Do not do this alone. The Maryland Department of Veterans and Military Families Service and Benefits Program provides free, accredited help filing VA pension and Aid and Attendance claims through benefits specialists in its service offices. MDVMF asks veterans to find the DVMF Service Office nearest them and call that office directly to make an appointment; its Baltimore regional office is at 31 Hopkins Plaza, Room 3020, on 410-230-4444 ext. 16453 or 800-446-4926 ext. 6450. Offices are open Monday through Friday, 8:00am to 4:00pm, by appointment only. An appointment can include submitting the pension claim itself if the veteran's discharge paperwork supports it, so bring the DD-214.7 Their help is free, and the department warns veterans to be cautious of anyone who charges a fee or is not VA-accredited. While you have a specialist on the phone, ask about Maryland's property tax exemption for disabled veterans too, since a veteran receiving care at home still owns and occupies the kind of home the exemption applies to; our guide to the Maryland disabled veteran property tax exemption covers who qualifies and how to file.

Compare Care Settings in Maryland

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 Maryland
• How Aid and Attendance Pays for a Nursing Home in Maryland
• How Aid and Attendance Pays for Memory Care in Maryland

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.