VA Aid and Attendance for Memory Care in Maryland

VA Aid and Attendance raises the most VA pension a Maryland veteran with no dependents can receive to $29,093 a year, a real help for a family facing memory care costs.1 Aid and Attendance is an increased monthly payment added to a VA pension, and VA's care-need test counts mental as well as physical incapacity, which matters for a veteran living with Alzheimer's or another dementia.2 VA benefits are exempt from federal income tax.3

In This Guide

• Key Takeaways
• How Much Memory Care Costs in Maryland
• How VA Aid and Attendance Helps Pay for Memory Care in Maryland
• How the Care-Need Test Applies to Dementia
• How Memory Care Costs Lower Your Countable Income
• Who Qualifies
• How Aid and Attendance Works with Maryland Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much Memory Care Costs in Maryland

Standard assisted living in Maryland has a median cost of $7,172 a month ($86,070 a year), based on the CareScout 2025 Cost of Care Survey, an industry survey rather than a government figure.4 Memory care is a specialized form of assisted living, and residents pay for the room or apartment and may need to pay extra for any special care.5

In Maryland, memory care is provided inside a licensed assisted living program that runs a Department-approved Alzheimer's Special Care Unit, a secured or separated unit designed for people with dementia.6 The state requires awake overnight staff on these units and at least 6 hours of advanced cognitive impairment training for staff who provide personal care there, and each program must disclose the unit's fee structure in writing to the family before admission.6 Ask for that written description early, since it is where the unit's fee structure is set out.6

How VA Aid and Attendance Helps Pay for Memory Care in Maryland

Aid and Attendance is an increase to the VA pension paid to veterans, and surviving spouses, who need help with daily activities.2 It isn't a separate check: on the pension route, the Aid and Attendance rate is a higher Maximum Annual Pension Rate that replaces the basic rate rather than paying on top of it.7

Here's what the 2026 rates look like, effective December 1, 2025 through November 30, 2026:1

VA publishes these as annual rates, but pension is paid monthly: under 38 CFR 3.273, VA reduces the applicable annual rate by the beneficiary's countable income and divides the remainder by 12.1 These figures are ceilings, not checks: the Maximum Annual Pension Rate is the maximum amount of pension payable, and VA pays the difference between the claimant's income for VA purposes and that limit.1

Because a claimant with countable income receives the rate less that income, every dollar of income VA counts lowers the award, so run the arithmetic on your own household rather than assuming the maximum.1

How the Care-Need Test Applies to Dementia

VA's care-need test asks what a person can't do safely without help, and it counts mental as well as physical incapacity.2

To qualify on care need, at least one of these must be true: you need another person to help with daily activities like bathing, feeding, and dressing; you have to stay in bed, or spend a large portion of the day in bed, because of illness; you're a patient in a nursing home due to the loss of mental or physical abilities related to a disability; or you have limited eyesight (even with glasses or contacts, 5/200 or less in both eyes, or a visual field narrowed to 5 degrees or less).2 In weighing the need, VA also considers a mental or physical incapacity that requires regular care or assistance to protect you from the hazards of your daily environment, and the evidence only has to show a need for regular aid, not constant aid.2 Not every listed condition has to be found, and the decision must rest on the actual need for personal assistance from others.2

On VA Form 21-2680, a medical examiner fills out the examination section to document that need.7

How Memory Care Costs Lower Your Countable Income

The VA pension is needs-based: to be eligible, the veteran's yearly family income and net worth have to meet limits set by Congress.1 Because the benefit is keyed to income for VA purposes, lowering the income the VA counts is what brings a family inside those limits, and you lower it by deducting unreimbursed medical expenses.

A memory care unit is a care facility other than a nursing home, and VA's rule for that kind of facility (38 CFR 3.278(d)(3)) makes its fees deductible on specific conditions rather than automatically.1 Payments for assistance with daily activities count as medical expenses if the resident is receiving health care or custodial care in the facility and either needs Aid and Attendance or has a written statement from a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist that, because of a cognitive or other disorder, they need to be in a protected environment.1 The meals-and-lodging part of the bill counts too if the facility provides or contracts for that health or custodial care, or if a clinician states in writing that the person must live there to receive it.1 The facility must be licensed where Maryland requires it and, if residential, staffed with care providers 24 hours a day.1 Because that rule names cognitive disorders, a clinician's written statement about the need for a protected environment is worth putting in the claim file.1

There's one more rule to know: only the portion of those expenses above 5% of the applicable Maximum Annual Pension Rate (MAPR) is deductible.1 For 2026, that 5% 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 Maryland's median assisted living cost alone is $86,070 a year, far above that floor.4 So a veteran whose income looks too high to qualify on paper may still qualify once qualifying care costs above the floor are deducted from income for VA purposes.1

Who Qualifies

To be eligible for Aid and Attendance, the veteran must:2

• Have wartime service and a discharge that is not dishonorable: if you started active duty before September 8, 1980, at least 90 days of active duty with at least one day during a wartime period (such as WWII, Korea, Vietnam, or the Gulf War, which runs through a future date not yet set). If you started active duty as an enlisted person after September 7, 1980, at least 24 months or the full period you were called or ordered to serve (with some exceptions), with at least one day during wartime. If you were an officer who started active duty after October 16, 1981 and had not previously served on active duty for at least 24 months, at least one day during wartime.
• Meet at least one of four age or disability tests: 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. Any one of the four satisfies this test on its own, so a wartime veteran under 65 who receives SSI meets it without an adjudicated disability rating.
• Need aid and attendance: needing another person's help with daily activities like bathing, feeding, and dressing; having to stay in bed for much of the day because of illness; being a nursing home patient due to lost mental or physical abilities related to a disability; or limited eyesight (5/200 or less in both eyes even with glasses or contacts, or a visual field of 5 degrees or less). VA also weighs a physical or mental incapacity that requires regular care to protect you from everyday hazards.
• Have yearly family income and net worth within the limits Congress sets, with net worth under $163,699 for 2026. VA's net-worth calculation is not assets alone: it combines the claimant's and their dependents' assets and annual income, while excluding the primary home, a vehicle, and basic household items.2

Note that you do not need a service-connected disability to qualify.2 The VA also applies a 3-year look-back to the 36 months before it receives the claim: a transfer for less than fair market value of an asset that would otherwise have pushed net worth over the limit can draw a penalty period of up to five years, so don't give away or move assets to qualify without getting advice first.2

How Aid and Attendance Works with Maryland Medicaid

Aid and Attendance and Maryland Medicaid interact, so a family paying for memory care should know how.8

In Maryland, the VA pension with Aid and Attendance and Maryland Medicaid are separate programs with different rules. 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 considered in the post-eligibility calculation of what the resident's own income contributes (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 Aid and Attendance 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: 42 CFR 435.725(d) lets a state also deduct, for a single person or couple and for up to 6 months, an amount to maintain the home when a physician certifies a likely return within that period, and no source we hold says whether Maryland offers it. That section covers people in medical institutions and intermediate care facilities, so it does not settle how the same income is treated for someone receiving home and community-based waiver services. The precise treatment depends on the specific Medicaid category and how Maryland applies the rules to an individual's situation.8

Because the two programs use different income and asset tests, confirm the exact effect on benefits with Maryland Medicaid (through Maryland Health Connection or your local Department of Social Services) or an accredited benefits counselor before relying on the combination.8

How to Apply and Get Free Help

The steps below are the pension route, the one this guide's rates and expense rules describe. VA's own condition for it is that you may be eligible for this benefit if you get a VA pension and meet at least one of the care-need requirements. VA Form 21-2680 also covers Aid and Attendance added to monthly disability compensation, so a veteran who already receives compensation should confirm with an accredited representative which route fits.7

These VA forms carry a pension-route claim for a memory care resident:7

• 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 need for help.
• VA Form 21P-527EZ (Application for Veterans Pension), for a wartime veteran pursuing the pension route who isn't already receiving a VA pension. On the pension route, Aid and Attendance raises the maximum pension rate rather than arriving as a second payment on top of it.
• VA Form 21P-8416 (Medical Expense Report), for reporting medical expenses you paid and weren't reimbursed for and don't expect to be.

If you're still gathering paperwork, you can submit VA Form 21-0966 (Intent to File) first. VA says submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive.7

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.7 On how long a decision takes, VA's own answer is "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.7

Don't do this alone. The Maryland Department of Veterans & Military Families (DVMF) Service Program has VA-accredited Benefits Specialists who help veterans, dependents, and survivors apply for benefits, and DVMF says its services are 100% free. An appointment includes a review of the veteran's military separation discharge document, and a pension claim can be submitted there if the discharge paperwork supports it, so have that paperwork with you. DVMF lists 16 Veteran Benefits Office locations, and its page is not consistent about walk-ins versus appointments (some offices keep limited hours), so call the specific office before you visit. Its Baltimore regional office is at 31 Hopkins Plaza, Room 3020, and can be reached at 410-230-4444 ext. 16450 or 800-446-4926 ext. 6450; those are that one office's details, not a statewide line.9 DVMF also warns veterans to be cautious of unaccredited organizations that charge fees for claims help.9

Compare Care Settings in Maryland

See how Aid and Attendance works with other care settings in Maryland:

• 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 In-Home 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.