VA Aid and Attendance for Nursing Home Care in Maryland

VA Aid and Attendance can pay a qualifying wartime veteran in a Maryland nursing home up to $29,093 a year. For a surviving spouse with no dependents, the Aid and Attendance ceiling is $18,697 a year.1 Maryland's semi-private nursing home median is the 11th highest among the states.2 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, released March 2, 2026 from rates gathered between July and November 2025, a semi-private room in a Maryland nursing home costs about $155,125 a year (roughly $12,927 a month, or $425 a day), and a private room runs about $173,375 a year (roughly $14,448 a month, or $475 a day). Both sit above the national medians; the semi-private figure is the 11th highest among the states, and the private-room figure is tied for 12th.2

These are industry-survey medians, not government figures, and CareScout collects its rates at the metropolitan-area level, so a given facility's price can sit above or below them.2

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 are nursing home patients because of the loss of mental or physical abilities related to a disability.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 these ceilings as annual amounts, effective December 1, 2025 through November 30, 2026.1

Pension is paid monthly, and federal regulation sets the arithmetic: under 38 CFR 3.273, VA subtracts countable income from the applicable annual rate and divides what is left by 12, and under 38 CFR 3.29(b) a result that is not a whole dollar is rounded down.1

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: a Maryland veteran with no dependents who pays the median $155,125 a year out of pocket for a semi-private nursing home room2 can deduct nearly the entire bill (everything above the $872 floor) as an unreimbursed medical expense, because payments to nursing homes, including the meals and lodging they charge, are medical expenses under 38 CFR 3.278(d)(1).1 If the veteran's income is smaller than that deduction, countable income falls to zero, and the pension can reach the full Aid and Attendance ceiling of $29,093 a year, as long as the other eligibility tests below are met.1 Insurance premiums count too: 38 CFR 3.278 treats health, medical, hospitalization, and long-term care insurance premiums 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 (VA's list runs from the Mexican Border period and World War I through World War II, the Korean conflict, the Vietnam War era, and the Gulf War, which began August 2, 1990 and has no end date set yet). Those who started as an enlisted person after September 7, 1980 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, and also need at least one day during wartime.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, and it includes a spouse's net worth; the primary residence, the claimant's car, and basic home items are excluded. Comparing assets alone against the limit gives the wrong answer.5
4. Need for aid and attendance. At least one of these must be true: the veteran needs another person's help with daily activities like bathing, feeding, and dressing; has to stay in bed, or spend a large part of the day in bed, because of illness; is a nursing home patient because of the loss of mental or physical abilities related to a disability; or has severely limited eyesight (5/200 or less in both eyes even with glasses or contacts, or a visual field contracted to 5 degrees or less).5

The VA also applies a 36-month look-back on asset transfers for less than fair market value. A transfer made on or after October 18, 2018 within that window can trigger a penalty period of up to 5 years if the asset, had it been kept, would have pushed net worth over the limit.5,1 For a surviving spouse, VA publishes a separate Survivors Pension rate table, and its 2026 Aid and Attendance ceiling for a surviving spouse with no dependents is $18,697 a year.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 VA's own implementing regulation, 38 CFR 3.551(i), instead caps the pension for any period after the month in which the Medicaid payments begin. When Medicaid starts paying in the month of admission, those are the same month; when Medicaid approval comes months later, confirm with VA which month your reduction runs from. If VA pays more than $90 because it failed to reduce the pension in time, the veteran is not liable to repay it unless the delay came from willfully concealing information VA needed (38 U.S.C. 5503(d)(4)).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 reaches a veteran with neither a spouse nor a child, and federal law applies the same rule to a surviving spouse with no child and to a child entitled to pension, in each case only while Medicaid covers the nursing-facility care. It does not apply to a veteran paying privately or to a veteran with a spouse or 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 Outside the cap doesn't mean untouched: under 42 U.S.C. 1396a(r)(1)(B), for a Medicaid-eligible veteran with no spouse or child (or a surviving spouse with no child) in a State veterans home that receives that VA per diem, any pension over $90 a month, including Aid and Attendance, is counted as income only for the purpose of applying that excess to the home's cost of nursing home care.6,7 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.7 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.6,7

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, federal rules require income disregarded at eligibility to be considered in the post-eligibility calculation (42 CFR 435.725 in an SSI-methodology state like Maryland, and 42 CFR 435.832 for someone eligible as medically needy), so an Aid and Attendance amount VA is still paying at the full rate can raise what the resident owes the facility. The first of those rules 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."7 A state's own post-eligibility rules can exempt the Aid and Attendance portion from patient liability, and our sources don't establish how Maryland treats a full-rate Aid and Attendance amount at this step, so don't assume it either way.6,7 (For a single veteran with no dependents whose nursing home stay is Medicaid-funded, outside a State veterans home that receives VA per diem, 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.6

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 too.8
• VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance), which a nursing home official uses to verify that the veteran is a patient in a qualifying extended care facility. A nursing home resident needs this one as well.8
• VA Form 21P-8416 (Medical Expense Report), for reporting the unreimbursed medical expenses, such as nursing home fees, that lower income for VA purposes.8

Still gathering paperwork? VA Form 21-0966 (Intent to File) can secure the earliest possible effective date for any retroactive payments while you finish the claim.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 & Military Families (DVMF) Service Program provides free help from VA-accredited Benefits Specialists, open to any veteran, service member, or family member living in Maryland. DVMF lists 16 Veteran Benefits Office locations; its Baltimore regional office, at 31 Hopkins Plaza, Room 3020, lists 410-230-4444 ext. 16450 and 800-446-4926 ext. 6450. Those are one office's details, not a statewide line; start at veterans.maryland.gov to find yours. DVMF recommends appointments but its page is not consistent about walk-ins, and some offices keep limited hours (Rosedale is staffed only on Wednesdays, 9 a.m. to 1 p.m.), so call the specific office before you go. An appointment can include a review of the veteran's military separation (discharge) document and submission of a disability compensation or pension claim if that paperwork supports it. Asked whether a veteran pays for its services, DVMF answers never: all of them are free.4 For the pension claim itself, VA says a veteran will need to submit, or give VA permission to gather, a DD214 or other separation documents, service treatment records, and any medical evidence related to the illness or injury.9

Compare Care Settings in Maryland

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

• 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.