VA Aid and Attendance for In-Home Care in Montana

VA Aid and Attendance can help pay for in-home care in Montana, turning a monthly VA pension into real money toward an aide, a homemaker, or a family caregiver. If your loved one is a wartime veteran who needs help with daily activities, this benefit can cover a meaningful share of the cost of staying at home. The hard part is usually knowing it exists and how to claim it.

This guide walks through what in-home care costs in Montana, how much Aid and Attendance pays, how your care costs can actually help you qualify, and where to get free help applying.

In This Guide

• Key Takeaways
• How Much In-Home Care Costs in Montana
• How Aid and Attendance Helps Pay for In-Home Care in Montana
• How Montana In-Home Care Costs Lower Your Countable Income for Aid and Attendance
• Who Qualifies
• Using Aid and Attendance to Pay a Family Caregiver
• How Aid and Attendance Works with Montana Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much In-Home Care Costs in Montana

In-home care is often the most affordable way to get help, but the bills still add up. In its 2025 Cost of Care Survey, CareScout combined the old homemaker and home-health-aide categories into a single non-medical caregiver service, with a national median of about $35 an hour, or roughly $80,080 a year at 44 hours of care a week. Montana's in-home care costs run at or above that national line.2 These are industry-survey medians, not government figures, and costs vary across the state and rise as care needs grow.

For many Montana families, that is well beyond what a fixed retirement income can absorb on its own. This is where Aid and Attendance comes in.

How Aid and Attendance Helps Pay for In-Home Care in Montana

Aid and Attendance is an increased monthly VA pension for wartime veterans and surviving spouses who need help with everyday activities.3 It is paid as monthly cash, which means the family decides how to spend it, including on a home health aide, a homemaker, or a family caregiver.1 The VA sets the maximums as annual amounts, and a monthly payment is the yearly award divided by 12, which is how the figures below are figured.1

The maximum is a ceiling rather than a payment: the VA pays the difference between your income for VA purposes and that ceiling, so a veteran with other income receives less than the full amount.1 Even at the full $29,093 a year, the award covers part of a Montana in-home care bill rather than all of it.1

How Montana In-Home Care Costs Lower Your Countable Income for Aid and Attendance

VA Pension, including the Aid and Attendance increase, is needs-based: to be eligible, your yearly family income and net worth have to meet limits Congress sets.1 The VA then pays the difference between your income for VA purposes and the yearly ceiling called the Maximum Annual Pension Rate (MAPR), so the lower that income, the more the VA pays.1

Here is the part families miss: unreimbursed medical expenses lower the income the VA counts. Payments to an in-home attendant for help with the activities of daily living, and with instrumental activities of daily living, are medical expenses as long as the attendant provides health care or custodial care, and the payments have to be commensurate with the number of hours the attendant attends to the person. The attendant has to be a health care provider unless the individual needs aid and attendance or is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that, because of a physical, mental, developmental, or cognitive disorder, the individual requires the health care or custodial care the attendant provides.1 You can only deduct the portion of those expenses that exceeds 5% of your applicable MAPR, figured excluding the aid-and-attendance increase. For 2026 that floor is $872 a year for a veteran with no spouse or child and $1,141 a year for a veteran with one dependent.1

Think of it in annual terms. Where the VA counts in-home care as an unreimbursed medical expense, only the first $872 of that yearly cost is not deductible for a veteran with no spouse or child. Everything above that floor reduces the income the VA counts. With in-home care running about $80,080 a year at the national median, and Montana at or above that line, those costs can wipe out most or all of a veteran's countable income, which is exactly how someone whose income looked too high ends up qualifying.1,2

Who Qualifies

To be eligible for Aid and Attendance, the veteran must:3

• Not have received a dishonorable discharge.
• Meet VA's wartime service test, which VA lists as three paths. A veteran who started active duty before September 8, 1980 needs at least 90 days of active duty with at least one day during a wartime period. A veteran who started active duty as an enlisted person after September 7, 1980 needs at least 24 months (with some exceptions), or the full period for which they were called or ordered to active duty, with at least one day during wartime. A veteran who started active duty as an officer after October 16, 1981 and had not previously served on active duty for at least 24 months meets the service test on that path.
• Meet at least one of four tests, any one of which is enough: be at least 65 years old; 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.
• Meet one of the aid-and-attendance care tests. These include needing regular help to dress or undress, to keep clean and presentable, to feed oneself, or to attend to the wants of nature; needing frequent adjustment of a prosthetic or orthopedic appliance; needing care or assistance on a regular basis to stay safe from the hazards of daily life; or being bedridden; or being a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or having eyesight of 5/200 or less in both eyes, or a visual field contracted to 5 degrees or less.
• Have a net worth below $163,699 for 2026. VA's net worth calculation adds together the claimant's and their dependents' assets and their annual income, so income counts as well as assets; the primary home and a vehicle are excluded, along with basic home items.3

The VA also applies a 3-year look-back on assets transferred for less than fair market value.3 Surviving spouses of wartime veterans can qualify under the survivor pension.

Using Aid and Attendance to Pay a Family Caregiver

Many families want a son, daughter, or spouse to provide the care. The pension is paid to the veteran as monthly cash, so the family can put it toward a relative who provides the care.1 What the VA does gate is the medical-expense deduction described above: payments to an in-home attendant lower countable income only on the conditions in that section, and only in an amount commensurate with the hours the attendant actually works.1

There is also a separate VA program built for this. Veteran-Directed Care gives a veteran a flexible budget to hire their own caregivers, including family members, with help from an Aging and Disability Network agency and a financial management service that handles payroll.4 Veterans in the program may hire family, friends, or neighbors, including a spouse; unlike VA Pension and Aid and Attendance, Veteran-Directed Care carries no prohibition on paying a spouse to provide the care.4 Ask your VA medical center's social work team whether it is available in your area.

How Aid and Attendance Works with Montana Medicaid

VA Aid and Attendance and Montana Medicaid are separate programs that a senior needing long-term care may use together, but they interact through income rules.5 Montana Medicaid for long-term care is administered by the Montana Department of Public Health and Human Services Senior and Long Term Care Division. Montana Medicaid looks at the VA money in two separate steps. At the eligibility step, states apply SSI income methodologies to the aged, blind, and disabled Medicaid groups (42 CFR 435.601), and under those methodologies VA aid and attendance and housebound allowances are not income (SSA POMS SI 00830.308), so the base VA pension counts toward the income limit while the Aid and Attendance portion generally does not. That exclusion applies at the eligibility step only: once a person is eligible and living in a nursing facility or another medical institution, income that was disregarded in determining eligibility has to be counted in the share-of-cost calculation (42 CFR 435.725), so the Aid and Attendance amount does count toward what the resident owes the facility.5 That calculation is not a simple handover of income. Under 42 CFR 435.725(c) the agency has to deduct five amounts first, in this fixed order: (1) a personal needs allowance, (2) a maintenance allowance for a spouse still at home, (3) a maintenance allowance for other family members at home, (4) incurred expenses for medical or remedial care that no third party will pay, including Medicare and other health-insurance premiums, deductibles, and coinsurance, and (5) any SSI or state supplement the person keeps receiving. Those are deductions the agency must make, not benefits a family applies for, and the amounts are set at the state level, so ask DPHHS for Montana's figures. Section 435.725 covers people in institutions. Someone receiving Medicaid home and community-based waiver services while living at home also has a post-eligibility calculation, but it runs under a separate federal rule that sets the maintenance allowance differently, so ask DPHHS what a waiver participant is allowed to keep instead of assuming the nursing-home figures apply.

Because these rules are technical and turn on a household's exact circumstances, a Montana family should confirm the treatment of any VA pension income with the Department of Public Health and Human Services or an accredited Veteran Service Officer before relying on it.5

How to Apply and Get Free Help

Apply using VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner fills out to document the care need. That form covers Aid and Attendance added to either monthly pension or monthly compensation benefits.6 The steps here are the pension route, the one VA describes for people who get a VA pension: a wartime veteran going that route who is not already receiving a VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), which is the means-tested wartime pension application.6 You can apply online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office, and an accredited representative can file for you. Asked how long a decision takes, the VA's own answer is "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.6

Do not do this alone. The Montana Veteran Affairs Division staffs nationally accredited Veteran Service Officers who prepare and submit VA pension and Aid and Attendance claims at no charge, operating statewide through nine Veteran Service Offices in Belgrade, Billings, Butte, Great Falls, Havre, Helena, Kalispell, Miles City, and Missoula.7 You can find your nearest office and its phone number through the Division's Veteran Services Program page at veterans.mt.gov.7

If Your Claim Is Denied

A denial is not the end of the road. If the VA denies the claim or grants less than expected, the veteran or surviving spouse has three decision-review options after that initial decision: file a Supplemental Claim with new and relevant evidence the VA did not have when it reviewed the case before, request a Higher-Level Review by a higher-level reviewer with no new evidence submitted, or file a Board Appeal to the Board of Veterans' Appeals for review by a Veterans Law Judge.8 A Higher-Level Review or a Board Appeal must be requested within one year of the date the VA issues notice of its decision for most VA benefits. Certain VA benefits have time limits shorter than one year, and the decision letter itself states the deadline, so check it rather than assuming you have the full year. A Supplemental Claim can still be filed after that year, but file inside the year anyway: a Supplemental Claim the VA receives more than one year after the date on the decision notice takes an effective date no earlier than the day the VA receives it, unless the VA grants an extension of the one-year period for good cause, so a late filing can cost back pay reaching to the original claim date.8 The same accredited Montana Veteran Affairs Division officers who file the original claim also handle the appeals process, at no cost to the veteran.7

Compare Care Settings in Montana

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 Montana
• How Aid and Attendance Pays for a Nursing Home in Montana
• How Aid and Attendance Pays for Memory Care in Montana

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.