VA Aid and Attendance for In-Home Care in Maryland

VA Aid and Attendance can help pay for in-home care in Maryland, as an increased monthly payment added to a VA pension.1 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, and the in-home care bills themselves can help them qualify by lowering the income VA counts.2

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
• When a Family Member Provides the Care
• 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 Maryland, in-home care from a non-medical caregiver runs about $80,080 a year, or $35 an hour, based on 44 hours of care a week over 52 weeks, per the CareScout 2025 Cost of Care Survey. That is exactly the national median: Maryland's assisted living and nursing homes cost more than the national medians, but its in-home care does not.3 Beginning with its 2025 survey, CareScout merged its former separate homemaker and home health aide categories into this single non-medical caregiver figure, so 2025 numbers don't compare like-for-like with older ones. These are industry-survey medians, not government figures, and CareScout gathers its rates by metropolitan area, so an agency near you may charge more or less than the statewide median.3

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

Aid and Attendance is an increased monthly VA pension payment for wartime veterans and surviving spouses who need help with everyday activities.1 On the pension route it works as a higher yearly ceiling rather than a second check: the Aid and Attendance rate replaces the basic pension rate.4

Two things to know about those numbers. VA publishes them as annual rates but pays pension monthly: under 38 CFR 3.273, VA subtracts countable income from the annual rate and divides what is left by 12. And each rate is a maximum, not a check: VA pays the difference between the claimant's income for VA purposes and that limit.2

At the full $29,093 a year for a veteran with no dependents, the benefit covers a meaningful share of the $80,080 a year that in-home care costs in Maryland at the survey's 44-hour week.2,3 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 $29,093 a year and covers less of the bill.2

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.2 The lower the income the VA counts, the better your chances.

Payments to an in-home attendant who helps with daily activities count as unreimbursed medical expenses, as long as the attendant provides health care or custodial care and the pay matches the hours worked. The attendant normally has to be a health care provider, but not when the person receiving care needs Aid and Attendance or is housebound, or when a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that a physical, mental, developmental, or cognitive disorder means the person needs the care the attendant provides.2 Those expenses lower the income the VA counts, but 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.2

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.2 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.3

Who Qualifies

To be eligible for Aid and Attendance, the veteran must:1

• Have qualifying wartime service: if active duty started before September 8, 1980, at least 90 days with at least one day during a wartime period; if active duty started as an enlisted person after September 7, 1980, generally at least 24 months or the full period called or ordered to active duty, with at least one day during wartime; or, for an officer who started after October 16, 1981 without 24 months of earlier active duty, at least one day during wartime
• 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
• Meet at least one care-need test: need another person's help with daily activities such as bathing, dressing, or feeding; have to stay in bed, or spend a large portion of the day in bed, because of illness; be a nursing home patient because of lost mental or physical abilities related to a disability; or have very limited eyesight (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 for 2026 (VA's calculation counts the claimant's and their dependents' assets and annual income, and excludes the primary home and a car)1

The VA also applies a 3-year look-back on assets transferred for less than fair market value.1 Surviving spouses have their own Aid and Attendance rates under VA's Survivors Pension, shown in the table above.2

When a Family Member Provides the Care

Care from a relative does not rule the benefit out. VA's rule is that aid and attendance provided by a relative or another member of the household does not prevent VA from granting the allowance.1

There is also a separate VA program built for this. Veteran-Directed Care gives an enrolled veteran a flexible budget, managed by the veteran or a representative, to hire and supervise their own workers, and those workers can include family, friends, or neighbors.5 VA medical centers run it through aging and disability network agencies, such as area agencies on aging, whose options counselor helps with assessment and care planning and arranges fiscal management services.5 A veteran is eligible if they are eligible for community care, meet the clinical criteria, and the program is available, so ask your VA medical center whether it is offered in your area.5

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.6 Maryland Medicaid long-term services and supports, administered by the Maryland Department of Health's Medical Assistance program, has its own income and asset rules. 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 an Aid and Attendance amount VA is still paying at the full rate can count at that stage. How Maryland treats a full-rate amount at that step is something to confirm with the Maryland Department of Health's Medical Assistance program. 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. They are not necessarily the only ones: federal rules also let a state deduct, for up to six months, an amount to maintain the home when a physician certifies the resident is likely to return, and this guide has no source on whether Maryland offers it, so ask the Medical Assistance program. Section 435.725 covers people in medical institutions and intermediate care facilities. It does not say how the same income is treated for someone getting home and community-based waiver services at home, so a family planning in-home care should ask the Medical Assistance program about that directly.6

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.6

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.4 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 and you meet at least 1 of these requirements." On that route, a wartime veteran who is not already receiving VA pension also files VA Form 21P-527EZ (Application for Veterans Pension). In-home care costs go on VA Form 21P-8416 (Medical Expense Report), which is for medical expenses you paid and weren't reimbursed for and don't expect to be.4 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.4

Do not do this alone. The Maryland Department of Veterans and Military Families (DVMF) Service Program offers free help from VA-accredited Benefits Specialists, who help veterans, dependents, and survivors apply for benefits. DVMF lists 16 Veteran Benefits Office locations; its Baltimore regional office is at 31 Hopkins Plaza, Room 3020, on 410-230-4444 ext. 16450 or 800-446-4926 ext. 6450. DVMF recommends appointments, but its page is not consistent about access: it says offices are open Monday through Friday, 8:00am to 4:00pm, by appointment only, yet also mentions walking into an MVA branch, and it lists at least one office open only one morning a week. Call the office you plan to visit before you go. DVMF says an appointment can include a review of the veteran's military separation discharge document and, if the discharge paperwork supports the claim, submitting the pension claim itself.7 DVMF says its services are always free and warns veterans to be cautious of unaccredited organizations that charge fees for claims help.7 Maryland also has a state property tax exemption on the home of a disabled veteran; our guide to the Maryland disabled veteran property tax exemption covers who qualifies and how to file.8

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.