Aid and Attendance can pay up to $29,093 a year (about $2,424 a month), and it is only one of six VA programs that help pay for senior care in Maryland. 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

VA Long-Term Care Benefits for Maryland Seniors

The VA offers multiple long-term care programs. 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.

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. 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. 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. HBPC is designed for veterans with complex medical needs who have difficulty getting to a clinic regularly. The team typically includes a doctor, nurse, social worker, and may include rehabilitation therapists and a dietitian.

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. For veterans who qualify, it's one of the best programs the VA offers.

Adult Day Health Care

Veterans attend a structured daytime program that provides social activities, companionship, recreation, care, and support. It also gives family caregivers reliable daytime respite. Programs may be at VA facilities or contracted community adult day centers.

Community Living Centers (VA Nursing Homes)

Community Living Centers are VA nursing centers designed to feel like home, providing nursing-home-level care. They are located at and near larger VA medical centers. Maryland veterans can access CLC care through the VA Maryland Health Care System.

CLCs serve veterans who need short-term rehabilitation (after surgery or hospitalization), long-term nursing care, hospice care, or respite care.

Community Nursing Home Program

The VA contracts with community (non-VA) nursing homes so veterans can get nursing home care near home. 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. 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.

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. Respite can be in-home, where a substitute caregiver comes to the house or the veteran attends an adult day health program, or facility-based, where the veteran stays temporarily in a Community Living Center or community nursing home (nursing home respite is capped at 30 days per calendar year). All enrolled veterans are eligible if they meet the clinical criteria, though services vary by location and availability. Contact the VA Caregiver Support Line at 1-855-260-3274.

Not sure which VA program fits your family's situation? Chat with Brevy to get a personalized recommendation.

Charlotte Hall Veterans Home

The Charlotte Hall Veterans Home sits on a 126-acre campus in St. Mary's County. 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.

To be eligible, 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. Certain reserve-component members who meet the legal residence requirements, and certain non-veteran spouses of eligible veterans, may also be admitted.

Cost is based on the resident's resources. Assisted living residents generally pay a percentage of their monthly net income, while skilled nursing costs depend on personal resources, long-term care insurance, Medicare, and Medicaid eligibility. 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.

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.

2026 Rates

Category Annual Maximum About Per Month
Veteran alone Up to $29,093 about $2,424
Veteran with spouse Up to $34,488 $2,874
Two married veterans Up to $46,143 about $3,845
Surviving spouse Up to $18,697 about $1,558
Housebound (veteran alone) Up to $21,313 about $1,776

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; a monthly amount is the yearly award divided by 12.

Who Qualifies

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

  • Have served during a wartime period (at least 90 days of active duty with at least 1 day during a wartime period)
  • 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 Income
  • Need help with daily activities such as bathing, dressing, or feeding, or be bedridden or in a nursing home due to incapacity
  • 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.

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.

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. 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. Asked how long a decision takes, the VA answers, "It depends." It works claims in the order it receives them, unless a claim qualifies for priority processing.

Here is why most families work with an accredited specialist rather than filing alone: the Maryland Department of Veterans and Military Families provides free, accredited help with VA claims, and its specialists know the documentation that keeps a claim from stalling.

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. The veteran (or their representative) decides who provides care, what services to purchase, and how to manage the budget.

Unlike Medicaid consumer-directed programs, VDC has no blanket prohibition on hiring a spouse. A person-centered options counselor at an Aging and Disability Network Agency, such as a local Area Agency on Aging, assesses the veteran's care needs and helps set the size of the budget, and a financial management services provider then handles payroll and the employer responsibilities of hiring workers. 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.

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 options counselor and financial management provider who set up the budget.

Community Care Through the MISSION Act

The MISSION Act (2018) expanded when veterans can receive care from community (non-VA) providers. 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. Beyond that, you may be eligible for community care if:

  • The VA can't offer an appointment within 20 days (primary care/mental health) or 28 days (specialty care)
  • The drive to a VA facility exceeds 30 minutes (primary care) or 60 minutes (specialty care)
  • The care you need isn't available at your VA facility
  • Community care is in your best medical interest

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.

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, and when they do, the MISSION Act can be the difference between getting timely care and waiting months.

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 often receive VA pension and Medicaid at once., What the two never do is coordinate. VA and Medicare don't pay each other, you pick which benefit to use every time you get care, and VA health coverage isn't creditable coverage for Medicare Part B. Put Part B off because you have the VA, and the late-enrollment penalty follows you for life, growing with every year you delayed.

  • VA + Medicare: Many veterans use both. Medicare covers care from non-VA providers, while VA covers care at VA facilities. You can't bill both for the same service, but having both gives you more options.
  • 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. 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 or other medical institution, income disregarded in determining eligibility must be counted in the post-eligibility share-of-cost calculation (42 CFR 435.725), so the Aid and Attendance amount does count at that stage. Before any of it reaches the facility, 42 CFR 435.725(c) requires Maryland to deduct five amounts from the resident's income, in the order the regulation sets them out: (1) a personal needs allowance the resident keeps for clothing and other personal needs; (2) for a resident with only a spouse at home, an amount for that spouse's maintenance needs; (3) for a resident with a family at home, an amount for the family's maintenance needs; (4) incurred expenses for medical or remedial care that no third party will pay; and (5) any SSI and state supplementary payments the resident keeps receiving. All five are deductions the state has to make, not benefits a family applies for. That section covers people in medical institutions and intermediate care facilities, so it does not set this calculation for someone receiving home and community-based waiver services, whose share of cost is governed by separate rules.
  • 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.

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.

How to Get Started

1
Step 1

Confirm VA health care enrollment

If the veteran isn't already enrolled in VA health care, apply at va.gov/health-care/apply. The VA assigns a priority group (1-8) based on military service history, disability rating, income, whether the veteran qualifies for Medicaid, and other benefits the veteran receives, and whether a veteran owes copays turns on their disability rating, income, and other special eligibility factors.

2
Step 2

Get free, accredited help

Rather than filing alone, work with the Maryland Department of Veterans and Military Families (MDVMF) Service and Benefits Program, which provides accredited assistance at no cost to the veteran. MDVMF tells veterans to find the DVMF Service Office nearest them and call that office directly to make an appointment; Service Program offices are open Monday through Friday, 8:00am to 4:00pm, by appointment only. Its Baltimore regional office is at 31 Hopkins Plaza, Room 3020, and takes calls at 410-230-4444 ext. 16453 or 800-446-4926 ext. 6450. That is one office's contact information, not a statewide line, so call the office nearest you. Bring the DD-214: an appointment can include submitting a disability compensation or pension claim, but only if the discharge paperwork supports the claim.

3
Step 3

Gather the veteran's records

You'll need the DD-214 (discharge papers), medical records documenting the need for care, and financial information. If you can't find the DD-214, the National Personnel Records Center can provide copies (request through va.gov).

Frequently Asked Questions

Do you have to be service-connected disabled to get VA long-term care?

Not for all programs. Veterans with a service-connected disability rated 50% or higher fall into the VA's highest priority group and generally pay no copays for care, and a veteran rated 70% or more service-connected may be entitled to fully covered nursing home care at Maryland's Charlotte Hall Veterans Home. Other enrolled veterans can access many programs too, depending on their priority group and available resources. Aid and Attendance doesn't require a service-connected disability at all; it requires wartime service, need for help with daily activities, and any one of four alternatives: being 65 or older, having a permanent and total disability, being a patient in a nursing home for long-term care because of a disability, or getting SSDI or SSI.

Can a veteran's spouse live in the Charlotte Hall Veterans Home?

In some cases, yes. Certain non-veteran spouses of eligible veterans may also be admitted to the Charlotte Hall Veterans Home. Contact the home's Veterans Service Officer at 301-884-8171 ext. 5112 for current admission policies.

How long does it take to get Aid and Attendance approved?

The VA's own answer is "It depends." It works these claims in the order it receives them, unless a claim qualifies for priority processing. Working with a Maryland Department of Veterans and Military Families benefits specialist can speed up the process and reduce the chance of errors that cause delays. You can apply while your loved one is already receiving care.

What if the Aid and Attendance claim is denied?

A denial isn't the end of the road. If the VA denies the claim, you can ask it to review the decision, and you can add new evidence, such as an updated medical exam or clearer documentation of the veteran's need for help with daily activities, to support a fresh look. The Maryland Department of Veterans and Military Families can help you respond and file the review at no cost, the same way it helps with the original claim. Their specialists can also tell you which review path fits your situation and how long you have to act.

Does the VA pay for assisted living?

The VA doesn't directly operate assisted living facilities, but Aid and Attendance is paid to the veteran as an increase to the monthly VA pension, and the household can put that money toward assisted living. The cost of the care itself can also count as a deductible medical expense when VA calculates the award, but only if the veteran is receiving health care or custodial care in the facility and either needs aid and attendance, is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist has stated in writing that they need to be in a protected environment. Veteran-Directed Care is a different tool: its flexible budget is for hiring and supervising workers who help a veteran live at home or in their community, so ask the VA social worker making the referral whether it fits an assisted living plan. And Maryland's own Charlotte Hall Veterans Home runs a 126-bed assisted living program for eligible veterans.

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. 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

VA BenefitsVA Aid and Attendance in MarylandVA Aid and Attendance in Maryland for 2026: who qualifies, monthly rates up to $2,874, how to apply, and free help from the MDVMF Service and Benefits Program. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. Care TypesAssisted Living in MarylandAssisted living in Maryland runs about $7,172/month. What an Assisted Living Program is, its care levels, what it costs, and how Medicaid and SOAR can help. Care TypesNursing Homes in MarylandNursing homes in Maryland in 2026: what a skilled nursing facility costs, how to check a facility's quality, and how Maryland Medicaid pays for long-term care. Care TypesMemory Care in MarylandMemory care in Maryland is an Assisted Living Program's Alzheimer's Special Care Unit. See the Disclosure Form, what it costs, and how to vet a place.
Your next step Find personalized help navigating VA senior care benefits 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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