VA Aid and Attendance for Nursing Home Care in Maryland

VA Aid and Attendance can add up to $2,424 a month toward nursing home care in Maryland for a qualifying wartime veteran, and surviving spouses may receive up to $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 an increase 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.5 It is not a separate program; it is a higher pension rate.

For 2026, the maximum monthly Aid and Attendance rates are: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. The VA pays the difference between your countable income for VA purposes and the applicable Maximum Annual Pension Rate (MAPR). Because the benefit is keyed to countable income, 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 MAPR is deductible from countable income. For 2026, those annual floors are:1

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

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 full Aid and Attendance rate of $2,424/month.1 Nursing home fees (including meals and lodging charged by the facility) qualify as UMEs under 38 CFR 3.278, as do health insurance premiums and other out-of-pocket medical costs.

Who Qualifies

To qualify for VA pension with Aid and Attendance, a veteran must meet all of the following:5

1. 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). Those who entered active duty after September 7, 1980 generally need 24 months of continuous active duty or the full period called to active duty.5
2. Age or disability. Age 65 or older, OR permanently and totally disabled.
3. Net worth under $163,699 (for 2026). This combines assets and annual income, excluding the primary home, vehicles, and basic household items.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 at up to $1,558/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 The veteran keeps that $90 as a personal allowance, and by statute (38 U.S.C. 5503(d)(4)) the Medicaid payment to the facility cannot be reduced by it, so it is not a contribution toward the cost of care.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. 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

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.7

How to Apply and Get Free Help

To apply for Aid and Attendance, you will need two VA forms:8

• 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.8

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.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.