VA Aid and Attendance for Nursing Home Care in Maryland

VA Aid and Attendance can pay a qualifying wartime veteran up to $29,093 a year toward nursing home care in Maryland, about $2,424 a month. A surviving spouse's maximum is $18,697 a year, about $1,558 a month.1 Maryland nursing home costs rank among the highest in the country, and most families paying those bills have never heard of this benefit. This guide explains what Aid and Attendance pays, who qualifies, how it interacts with Maryland Medicaid, and where to get free, accredited help applying.

In This Guide

• How much a nursing home costs in Maryland
• 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 Maryland Medicaid
• How to apply and get free help
• Frequently asked questions

How Much a Nursing Home Costs in Maryland

Per the CareScout 2025 Cost of Care Survey (the most recent state-level data, released March 2026), a semi-private room in a Maryland nursing home costs about $155,125 a year (roughly $12,927 a month), and a private room runs about $173,375 a year (roughly $14,448 a month). Both figures sit well above the national medians, and the Washington-DC and Baltimore suburbs tend to run higher than rural Maryland.2

These are industry-survey medians, not government figures, and costs vary within the state and rise as care needs increase.2 At those rates, nursing home care in Maryland quickly becomes one of the most expensive ongoing costs a family can face, and VA Aid and Attendance can provide meaningful monthly relief.

How VA Aid and Attendance Helps Pay for a Nursing Home in Maryland

VA Aid and Attendance is a higher VA pension rate for those who need help with daily activities (such as bathing, dressing, eating, or adjusting prosthetic devices) or who live in a nursing home due to physical or mental incapacity.5 It is not a separate program; it is a higher pension rate.

For 2026, the Maximum Annual Pension Rate (MAPR) with Aid and Attendance is the maximum amount of pension payable, and the VA pays the difference between countable income and the applicable ceiling. VA publishes annual rates; a monthly amount is the yearly award divided by 12, so the monthly figures below are approximate:1

These are VA pension payments sent to the veteran or surviving spouse, not direct payments to the facility. The money can be applied toward nursing home costs or other care expenses. The VA does not run or pay for private nursing homes; Aid and Attendance is a monthly cash benefit.

How Nursing Home Costs Lower Your Countable Income

VA pension, including its Aid and Attendance increase, is a needs-based benefit. To be eligible, the veteran's yearly family income and net worth must meet limits set by Congress. Because the benefit is keyed to income for VA purposes, large recurring care expenses can actually help a veteran qualify.1

Only the portion of unreimbursed medical expenses (UMEs) that exceeds 5% of the applicable Maximum Annual Pension Rate (MAPR) is deductible from countable income. For 2026, those annual floors are:1

• $872 a year for a veteran with no spouse or child1
• Higher for a veteran with dependents, because the floor tracks the veteran's own pension rate, which never includes the Aid and Attendance increase1

Example: because a Maryland veteran pays roughly $155,125 a year out of pocket for a semi-private nursing home room,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 maximum Aid and Attendance rate, up to $29,093 a year (about $2,424 a month).1 Out-of-pocket nursing home fees count toward those UMEs, as do health, medical, hospitalization, and long-term care insurance premiums, which 38 CFR 3.278 treats as medical expenses along with premiums for Medicare Parts A, B, and D.1

Who Qualifies

To qualify for VA pension with Aid and Attendance, a veteran must not have received a dishonorable discharge, and must meet the service, status, net worth, and care-need requirements below:5

1. Wartime service. The requirement turns on when the veteran started active duty, not on which war, and VA lists three paths into it. Those who started before September 8, 1980 need at least 90 days of active duty with at least one day during a recognized wartime period (World War II, the Korean War, the Vietnam War, or the Gulf War/post-9/11 era). Those who started as an enlisted person after September 7, 1980 generally need at least 24 months, or the full period for which they were called or ordered to active duty (with some exceptions), again with at least one day during wartime. Those who started as an officer after October 16, 1981 must not have previously served on active duty for at least 24 months.5,1
2. Age or status. At least one of these, not just the first two: 65 or older; a permanent and total disability; a patient in a nursing home for long-term care because of a disability; or getting Social Security Disability Insurance or Supplemental Security Income. An adjudicated permanent-and-total rating is not the only disability route: a wartime veteran under 65 who receives SSI meets this test without one.5
3. Net worth under $163,699 (for 2026). VA's net worth calculation combines the claimant's and their dependents' assets and their annual income; the primary residence, a vehicle, and basic home items are excluded. Comparing assets alone against the limit gives the wrong answer.5
4. Need for aid and attendance. The veteran must require help with daily activities, be largely confined to bed, be a nursing home patient due to mental or physical incapacity, or have severely limited vision (5/200 or less in both eyes, or a visual field contracted to 5 degrees).

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 of up to 5 years.5 Surviving spouses of wartime veterans may qualify for the Survivors Pension with Aid and Attendance, capped at $18,697 a year (about $1,558 a month) under similar rules.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 covered by a Medicaid plan for 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, under 38 U.S.C. 5503(d)(2).3 By statute (38 U.S.C. 5503(d)(3)) the Medicaid payment to the facility cannot be reduced by the pension the veteran is permitted to keep, so the retained $90 is not offset against the facility's Medicaid payment.3 That federal subsection caps the pension; it does not address Maryland's Medicaid personal needs allowance, which is a separate deduction set by the state's own post-eligibility rules. Whether the $90 comes in addition to that allowance or instead of it is governed by Maryland's rule, so check it rather than adding the two together.3

This cap applies only to a single veteran with no dependents in a Medicaid-funded nursing facility. It does not apply to veterans paying privately or to veterans with a spouse or dependent child. It also reaches a narrower set of buildings than the words suggest: for purposes of the subsection, a nursing facility is one described in section 1919 of the Social Security Act, "other than a facility that is a State home with respect to which the Secretary makes per diem payments for nursing home care pursuant to section 1741(a) of this title" (38 U.S.C. 5503(d)(1)(B)), so a Medicaid-covered veteran in a State veterans home drawing that per diem falls outside the $90 cap. Have the per diem question checked with VA rather than assuming the cap applies to a given state home.3 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 map out the timing to avoid losing benefits.

How VA Aid and Attendance Works with Maryland Medicaid for Nursing Home Care

VA pension with Aid and Attendance and Maryland Medicaid (Medical Assistance, administered by the Maryland Department of Health) are separate programs with different income and asset rules. A senior may qualify for and receive both at the same time, but they interact.7

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. The precise treatment depends on the specific Medicaid category and how Maryland applies the rules to an individual's situation. That exclusion governs eligibility only. Once someone is eligible and living in a nursing facility, income that was disregarded in determining eligibility becomes part of the income from which the required post-eligibility deductions are made, and it can raise what the resident owes the facility where 42 CFR 435.725 governs. That rule is titled "Post-eligibility treatment of income of institutionalized individuals in SSI States," and it reaches only "individuals in medical institutions and intermediate care facilities." Maryland is not one of the eight 209(b) states that apply their own eligibility criteria, but the rule still does not settle the share of cost for home- and community-based waiver services, where the state's own rule controls. The deductions are bounded, not open-ended: the agency deducts "Amounts for incurred expenses for medical or remedial care that are not subject to payment by a third party," and care recognized under State law but not covered under the State plan is "subject to reasonable limits the agency may establish."6 (For a single veteran with no dependents whose nursing home stay is Medicaid-funded, the $90 cap described above applies instead, and that $90 is not a contribution toward the cost of care.3) Families should confirm the exact effect with the Maryland Medicaid program (Maryland Health Connection or a local Department of Social Services) or an accredited benefits counselor before relying on it.7

How to Apply and Get Free Help

Aid and Attendance is an increase VA adds to your monthly compensation or pension benefits, so which forms you file depends on which benefit you already have or are seeking. The steps here are the pension route, and VA's condition for it is that "you get a VA pension."8

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner must complete, documenting the need for assistance. This is also the form used when Aid and Attendance is added to monthly VA compensation rather than to a pension.8
• VA Form 21P-527EZ (Application for Veterans Pension), the wartime, means-tested pension application. A wartime veteran pursuing the pension route who is not already receiving a VA pension files this one. A veteran who receives VA disability compensation rather than a pension does not file it.8

Forms can be submitted 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. Asked how long a decision takes, VA answers, "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.8

Free help in Maryland: The Maryland Department of Veterans and Military Families (MDVMF) Service and Benefits Program provides free, accredited help through VA-accredited benefits specialists at its service offices, by appointment. MDVMF asks veterans to find the DVMF Service Office nearest them and call that office directly to make an appointment; its Baltimore regional office, at 31 Hopkins Plaza, Room 3020, takes calls at 410-230-4444 ext. 16453 or 800-446-4926 ext. 6450. Those are one office's details, not a statewide line; start at veterans.maryland.gov to find yours. An appointment can include submitting a pension or Aid and Attendance claim if the veteran's discharge paperwork supports it, so bring the DD-214. The department emphasizes that veterans should never have to pay to access the benefits they earned.4

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 In-Home Care 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.