VA Benefits You Can Use for Senior Care in Maryland

Aid and Attendance can pay up to $29,093 a year, and it is only one of six VA programs that help pay for senior care in Maryland.1 If your loved one is a veteran, the hard part usually isn't qualifying. It's knowing what to ask for.

Arranging care while a parent's needs are escalating is stressful enough without decoding a benefits system on top of it. This guide covers every VA program that helps pay for or provide senior care, how to access each one in Maryland, and what happens when VA care isn't enough on its own.

In This Guide

• Key Takeaways
• VA Long-Term Care Benefits for Maryland Seniors
• Charlotte Hall Veterans Home
• Aid and Attendance
• Veteran-Directed Care
• Community Care (MISSION Act)
• How VA Senior Care Benefits Work with Medicare and Medicaid in Maryland
• How to Get Started
• Frequently Asked Questions
• Next Steps

VA Long-Term Care Benefits for Maryland Seniors

The VA offers multiple long-term care programs.2 Access isn't automatic once a veteran is enrolled: VA also has to conclude the veteran needs that specific service for their ongoing treatment and personal care, and the service, or a space in the care setting, has to be available near them. VA may also weigh other factors, like the veteran's service-connected disability status or insurance coverage.6

Here is how that gate works in practice. Once a veteran enrolls, the VA assigns them to 1 of 8 priority groups based on service history, disability rating, income, and Medicaid status.7 A veteran with a service-connected disability rated 50% or higher lands in Priority Group 1 and generally pays no copays, while other enrolled veterans can still access many of these programs depending on their group, a clinician's judgment that the care is needed, and local availability.7 Maryland veterans access these programs through the VA Maryland Health Care System.

Home Based Primary Care (HBPC)

A VA physician supervises a health care team that visits the veteran at home.2 HBPC is designed for veterans with complex medical needs who have difficulty getting to a clinic regularly. Its services include nursing care, physical therapy, and help with daily tasks.2

This isn't the same as home health care through Medicare. HBPC provides ongoing, coordinated primary care at home, not just short-term skilled visits.

Adult Day Health Care

Veterans attend a structured daytime program that provides social activities, companionship, recreation, care, and support.2 It also gives family caregivers reliable daytime respite.

Community Living Centers (VA Nursing Homes)

Community Living Centers are VA nursing centers designed to feel like home, providing nursing-home-level care.2 Maryland veterans can access CLC care through the VA Maryland Health Care System.

Community Nursing Home Program

The VA contracts with community (non-VA) nursing homes so veterans can get nursing home care near home.2 Arranging the bed and paying for it are two different things. The VA covers some long-term care services under a veteran's standard health benefits and a copay can still apply to a covered service, while services VA health care doesn't cover are paid through Medicaid, Medicare, or private insurance. Extended care carries no copay for the first 21 days of care in a 12-month period; starting on the 22nd day, the VA bases the copay on the level of care and the financial information the veteran provides on the Application for Extended Care Services (VA Form 10-10EC). Some veterans owe no copays at all: VA exempts them based on their disability rating, income level, or special eligibility factors.6 This option matters in Maryland, where the VA's own nursing beds sit near Baltimore and Perry Point and a veteran on the Eastern Shore or in Western Maryland may be hours away. To request it, ask the veteran's VA social worker or the VA Maryland Health Care System's geriatrics and extended care team to arrange a placement close to home.2

Respite Care

Through its Program of Comprehensive Assistance for Family Caregivers, the VA provides eligible primary family caregivers at least 30 days of respite care per year.8 Respite can be in-home (a substitute caregiver, or an adult day health program) or a short stay in a Community Living Center or community nursing home; VA lists overnight and daily respite as each available up to 30 days a calendar year. Any enrolled veteran who meets the clinical criteria can use it where it's available, with two conditions. Respite from a community agency, adult day health center, or nursing home also requires community care eligibility. And after the first 21 days of extended care in a 12-month period, a copay can apply (up to $97 a day for institutional respite, $15 for non-institutional respite or adult day health care) unless the veteran is exempt, for example because of a compensable service-connected disability. Ask the VA social worker about the copay before booking a long stay.8 The VA Caregiver Support Line, 1-855-260-3274, answers weekdays, 8:00 a.m. to 8:00 p.m. Eastern Time.9

Charlotte Hall Veterans Home

The Charlotte Hall Veterans Home sits on a 126-acre campus in St. Mary's County.3 It is the assisted living and skilled nursing facility for veterans run by the Maryland Department of Veterans and Military Families (MDVMF), has been in operation since 1985, and is Medicare and Medicaid certified.

Charlotte Hall offers a continuum of care: a 126-bed assisted living program, a 318-bed skilled nursing program, and memory care provided in secure units. The skilled nursing program includes a 16-bed Women's Unit.3

MDVMF's eligibility list says an applicant must be a Maryland veteran who served on full-time active duty in the U.S. Armed Forces (other than active duty for training) and was discharged or released under honorable conditions, and must be a Maryland resident at least 62 years of age or deemed disabled by the Social Security Administration or VA.3 Certain reserve-component members who meet the legal residence requirements, and certain non-veteran spouses of eligible veterans, may also be admitted.

The binding rule, in Maryland regulation COMAR chapter 35.04.01, is narrower. Residence is a clock: 90 days in Maryland before nursing home admission, but 2 years before assisted living admission to get the State subsidy, and a Maryland home of record on the DD-214 also counts. An applicant under 62 must be disabled, unable to work, and receiving Social Security or VA disability benefits, and a VA award must be 70 percent or higher with at least one award of 40 percent or more.3

Cost is based on the resident's resources. Assisted living residents pay 90% of their monthly net income, capped at the full monthly cost, while skilled nursing costs depend on personal resources, long-term care insurance, Medicare, and Medicaid eligibility.3 A veteran rated 70% or more service-connected may be entitled to fully covered nursing home care. To apply, contact Charlotte Hall's Veterans Service Officer at 301-884-8171 ext. 5112.3

VA Aid and Attendance

The Aid and Attendance pension is a monthly cash benefit for veterans (or surviving spouses) who need help with daily activities.1

2026 Rates

These are ceilings for the December 1, 2025 through November 30, 2026 period, not payments: the Maximum Annual Pension Rate is the most pension VA will pay, and VA pays the difference between the claimant's income for VA purposes and that limit, so an actual award is usually lower. VA publishes annual rates, and pension is paid monthly: the monthly rate is the ceiling minus countable income, divided by 12 and rounded down to the whole dollar.1

Who Qualifies

To be eligible, the veteran must not have a dishonorable discharge, and must:10

• Meet VA's wartime service rule: at least 90 days of active duty, with at least 1 day in wartime, if service began before September 8, 1980; enlisted service that began later generally needs 24 months or the full period called to active duty, with at least 1 day in wartime10
• Meet at least one of four alternatives: be 65 or older, 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 Income10
• Need another person's help with daily activities such as bathing, dressing, or feeding, have to stay in bed because of illness, be in a nursing home because of lost mental or physical abilities related to a disability, or have severely limited eyesight10
• Have a net worth below $163,699 for the December 1, 2025 through November 30, 2026 period. VA's net-worth calculation adds the claimant's and their dependents' assets to their annual income; the primary home and a vehicle are excluded.10

The VA enforces a 3-year look-back period on asset transfers for less than fair market value, with a penalty period that can run up to 5 years.10

How to Apply

VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) documents the need for aid and attendance, and it applies whether the benefit will be added to a monthly VA pension or to monthly VA compensation.11 The steps here are the pension route, because VA's condition is that you may be eligible for this benefit if you get a VA pension, so a wartime veteran pursuing the pension who is not already receiving one also files Form 21P-527EZ, the means-tested Application for Veterans Pension. A veteran who receives VA disability compensation rather than pension does not use 21P-527EZ. 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.11

You don't have to file alone. The Maryland Department of Veterans and Military Families provides free help from VA-accredited Benefits Specialists, and an appointment includes a review of the veteran's discharge documents and, if that paperwork supports it, submitting the pension claim.5

For the full application walkthrough, see our VA Aid and Attendance guide.

Veteran-Directed Care

The Veteran-Directed Care (VDC) program gives veterans a flexible budget to hire their own caregivers, including family members.12 The veteran (or their representative) decides who provides care, what services to purchase, and how to manage the budget.

Veterans may also hire family, friends, and/or neighbors to provide services.12 VA medical centers deliver VDC through aging and disability network agencies, such as a local Area Agency on Aging or aging and disability resource center. Through an options counselor, the agency assesses the veteran's needs, plans the care and services, arranges fiscal management services, and provides ongoing counseling and support.12 All enrolled veterans qualify if they are eligible for community care, meet the clinical criteria for the service, and it is available in their area.12

To start VDC in Maryland, ask the veteran's VA Maryland Health Care System social worker or geriatrics and extended care team whether the program is offered locally; if it is, they connect the family with the local agency and its options counselor.12

Community Care Through the MISSION Act

The MISSION Act (2018) expanded when veterans can receive care from community (non-VA) providers.4 Two things are always required: the veteran has to be enrolled in or eligible for VA health care, and has to have approval from their VA health care team before getting care from a community provider, except in certain cases like urgent or emergency care.4 Beyond that, at least one of six conditions must apply, including:

• The VA can't schedule an appointment within 20 days (primary care/mental health) or 28 days (specialty care), unless you agreed to a later date
• The VA can't offer an appointment within a 30-minute (primary care) or 60-minute (specialty care) average drive time from home
• The VA doesn't provide the service you need at any VA health facility
• You and your VA provider agree that community care is in your best medical interest4

On May 19, 2025, the VA streamlined the "best medical interest" pathway by implementing language in the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (the "Dole Act," enacted January 2, 2025), removing a second-VA-doctor review step and giving eligible veterans faster access to community care.4

This matters most for Maryland veterans outside the Baltimore and Perry Point corridor. A veteran on the Eastern Shore or in far Western Maryland can easily exceed the 30-minute primary-care or 60-minute specialty-care drive-time standard (VA measures it as an average from home, using mapping software), and when they do, the MISSION Act can open the door to a closer community provider.4

How VA Senior Care Benefits Work with Medicare and Medicaid in Maryland

VA benefits don't replace Medicare or Medicaid, no one has to sign up for Medicare to keep VA health care, and a Maryland veteran or surviving spouse can qualify for and receive VA pension and Medicaid at the same time.13,14 They don't merge, though. Generally Medicare and the VA can't pay for the same service, so you pick which benefit to use every time you get care, and having the VA is no shield against Medicare's Part B late-enrollment penalty. Put Part B off because you have the VA, and if you later need to sign up, that penalty follows you for life, growing with every year you delayed.13

• VA + Medicare: Many veterans use both. Medicare pays for Medicare-covered services; the VA pays for care it authorizes, at a VA or non-VA facility. If the VA authorizes a non-VA hospital stay but not every service in it, Medicare may pay for the ones the VA didn't authorize.13
• VA + Medicaid: VA pension with Aid and Attendance and Maryland Medicaid long-term services and supports are separate programs with different income and asset tests.15 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 someone is eligible and living in a nursing facility or other medical institution, federal rules require income disregarded at eligibility to be considered in the post-eligibility share-of-cost calculation (42 CFR 435.725), so a full-rate Aid and Attendance amount can count at that stage; ask the Maryland Department of Health's Medical Assistance program how it treats that amount. Whatever counts doesn't all reach the facility: 42 CFR 435.725(c) requires Maryland to deduct a personal needs allowance, an amount for a spouse or family at home, medical expenses no third party will pay, and any SSI or state supplementary payment the resident still receives. These required deductions cover institutional care; they don't settle how home and community-based waiver services treat the same income.15 A federal cap changes the picture for a veteran with no spouse or child (or a surviving spouse with no child): once Medicaid covers their nursing-facility care, the VA pension is capped at $90 a month, and the facility's Medicaid payment can't be reduced by that $90 (38 U.S.C. 5503(d)).15 The cap doesn't reach a state veterans home that VA pays a nursing-home per diem for; there, that same veteran's pension above $90 a month, Aid and Attendance included, counts as income only toward the home's cost of nursing care (42 U.S.C. 1396a(r)(1)(B)).15 Whether a stay at Charlotte Hall falls in that exclusion depends on that per diem, and the statute and VA's regulation start the cap on different dates, so check both points with an accredited Veterans Service Officer.14
• Charlotte Hall Veterans Home weighs Medicare, Medicaid, long-term care insurance, and personal resources when setting skilled nursing costs, so these payment sources can layer together.3

Because the programs use different rules, confirm the exact effect on benefits with the Maryland Medicaid program (Maryland Health Connection or a local Department of Social Services) or an accredited benefits counselor before relying on it.15

How to Get Started

Next Steps

If you're caring for a veteran who needs help, start by finding the Maryland Department of Veterans and Military Families Service Office nearest you and calling that office directly; its Baltimore regional office answers at 800-446-4926 ext. 6450.5 They can assess which benefits apply and help you file.

Ask them about Maryland's own benefits while you have them, not just the federal ones. The state separately exempts qualifying disabled veterans from real property tax on the home they live in, and our guide to the Maryland disabled veteran property tax exemption covers who qualifies and how to claim it.

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.