VA Aid and Attendance can add up to $2,424 a month toward nursing home care in Maryland for eligible wartime veterans. Maryland nursing home costs rank among the highest in the country -- and most families paying those bills have never heard of this VA 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

A semi-private nursing home room in Maryland costs about $150,015 per year (roughly $12,501 per month), and a private room runs about $173,375 per year (roughly $14,448 per month), according to the Genworth/CareScout 2024 Cost of Care Survey. Both figures are well above the national medians of approximately $111,325 and $127,750. The Washington-DC and Baltimore suburbs tend to run even higher. These are industry-survey medians, not government figures, and costs vary within the state and rise as care needs increase.

At those rates, nursing home care in Maryland quickly becomes one of the most expensive ongoing costs a family can face. VA Aid and Attendance -- up to $2,424 a month -- can provide critical monthly relief.

How Aid and Attendance Helps Pay for It

VA Aid and Attendance is an increased monthly payment added to a veteran's basic VA pension 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.

For 2026, the Aid and Attendance rates are:

  • Veteran with no dependents: $2,424 per month ($29,093 per year)
  • Veteran with one dependent (such as a spouse): $2,874 per month ($34,488 per year)
  • Surviving spouse with no dependents: $1,558 per month ($18,697 per year)

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 Aid and Attendance, is needs-based. The VA pays the difference between your Maximum Annual Pension Rate (MAPR) and your countable income for VA purposes. Lower countable income means a larger payment.

The VA lets you subtract unreimbursed medical expenses -- including out-of-pocket nursing home costs -- from your countable income, but only the portion that exceeds 5% of your applicable MAPR.

For 2026, that threshold is:

  • $872 per year for a veteran with no dependents (5% of the $17,441 basic MAPR)
  • $1,141 per year for a veteran with one dependent (5% of the $22,839 basic MAPR)

Only the amount above those annual floors is deductible. Maryland's nursing home costs -- among the highest in the nation -- mean the threshold is virtually always exceeded by a wide margin, making this deduction especially powerful for Maryland veterans paying privately.

Example (annual): A single veteran has $30,000 in annual income and $130,000 in annual out-of-pocket nursing home costs. Subtracting the $872 floor leaves $129,128 deductible -- far more than the $30,000 in income. Countable income is $0, and the veteran qualifies for the full $29,093/year ($2,424/month) Aid and Attendance rate.

Who Qualifies

To qualify for VA pension with Aid and Attendance, a veteran must meet all of the following:

Wartime service. 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. Gulf War service requires 24 months of continuous active duty or the full period called to active duty.

Age or disability. Age 65 or older, OR permanently and totally disabled.

Net worth under $163,699. This combines assets and annual income, excluding the primary home, vehicles, and basic household items. A 3-year look-back applies to asset transfers for less than fair market value on or after October 18, 2018; penalties can extend up to 5 years.

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 severe vision impairment (5/200 or less in both eyes, or visual field contracted to 5 degrees).

Surviving spouses of wartime veterans may qualify for the Survivors Pension with Aid and Attendance under similar rules.

The $90/Month Nursing-Home Pension Cap

A critical federal rule applies when a single veteran with no spouse or dependent children is covered by Medicaid for nursing facility care: the VA reduces that veteran's pension to no more than $90 per month for any period after the month of admission to the nursing facility.

This rule comes from 38 U.S.C. 5503(d)(2) and its implementing regulation at 38 CFR 3.551. The $90/month is a personal allowance -- not a payment toward care -- while Maryland Medicaid covers the facility. 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.

How Aid and Attendance Works with Maryland Medicaid

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.

Under general federal rules, VA pension is treated as income for Medicaid except for the portion attributable to unreimbursed medical expenses (and, where applicable, the Aid and Attendance amount), which is excluded. The precise treatment depends on the specific Medicaid category and how Maryland applies the rules to an individual's situation. 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.

How to Apply and Get Free Help

To apply for Aid and Attendance, you will need two VA forms:

  • VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) -- completed by a physician documenting the need for assistance.
  • VA Form 21P-527EZ (Application for Veterans Pension) -- required if the veteran is not already receiving a VA pension.

Forms can be submitted online at va.gov, mailed, or filed through an accredited representative. Processing often takes three to six months.

Free help in Maryland: The Maryland Department of Veterans and Military Families (MDVMF) Service Program provides free, accredited help through VA-accredited benefits specialists at offices statewide. Call 410-230-4444 ext. 16453 or toll-free 800-446-4926 ext. 6450, or visit veterans.maryland.gov. The department emphasizes that veterans should never have to pay to access the benefits they earned.

Frequently Asked Questions

Does being in a Maryland nursing home automatically qualify a veteran for Aid and Attendance?

Being in a nursing home due to mental or physical incapacity is one qualifying condition. But the veteran must also satisfy wartime service, age or disability, and net worth requirements. Placement alone does not create eligibility.

Can a Maryland veteran receive both Aid and Attendance and Maryland Medicaid?

Possibly, but it depends on the situation. For a single veteran with no dependents whose nursing home stay is Medicaid-funded, the VA pension is reduced to $90/month under federal law. The interaction is complex; confirm with MDVMF and Maryland Medicaid before applying.

Does the value of a Maryland home affect the VA net worth limit?

The primary residence is excluded from the VA's net worth calculation. The $163,699 limit applies to other assets combined with annual income. Consult an accredited VSO to assess your net worth situation before filing.

How long does Aid and Attendance take to start?

Processing typically takes three to six months or longer after the VA receives a complete application. Filing through an MDVMF benefits specialist helps ensure the file is complete, which reduces delays.

Compare Care Settings in Maryland

Aid and Attendance can help pay for any care setting. See how it works for the others:

Learn More

Find personalized help using VA benefits to pay for a nursing home in Maryland 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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