VA Aid and Attendance for Nursing Home Care in Montana

VA Aid and Attendance can lift an eligible wartime veteran's monthly VA pension to as much as $2,424 toward nursing home care in Montana. Montana nursing home costs run modestly below the national median, and the benefit arrives as monthly cash a family can put straight toward the bill. This guide explains what Aid and Attendance pays, who qualifies, how it interacts with Montana Medicaid, and how to get free help applying through the Montana Veteran Affairs Division.

In This Guide

• Key Takeaways
• How Much a Nursing Home Costs in Montana
• How VA Aid and Attendance Helps Pay for a Montana Nursing Home
• How Nursing Home Costs Lower Your Countable Income
• Who Qualifies
• The Nursing-Home Pension Cap
• How VA Aid and Attendance and Nursing Home Care Work with Montana Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much a Nursing Home Costs in Montana

A semi-private nursing home room carries a national median of about $114,975 per year (about $315 per day, or roughly $9,581 per month), and a private room a national median of about $129,575 per year (about $355 per day, roughly $10,798 per month), according to the CareScout 2025 Cost of Care Survey (released March 2026). We do not have a verified Montana-specific nursing home median for 2026, so these are the national figures. Montana's long-term care costs track broadly with these national medians, with nursing home care running modestly below the national line. These are industry-survey medians, not government figures, and costs vary within the state and rise as care needs increase.1

Even allowing for Montana running below the national line of close to $9,600 a month for a semi-private room, nursing home care is a major expense.1 A maximum VA pension with Aid and Attendance, $2,424 a month for a veteran with no dependents, can cover a meaningful share of that cost.2

How VA Aid and Attendance Helps Pay for a Montana Nursing Home

VA Aid and Attendance is a higher maximum VA pension rate for a veteran who meets at least one of four conditions: needing another person's help with daily activities (such as bathing, feeding, and dressing); having to stay in bed, or spend a large part of the day in bed, because of illness; being a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or having eyesight limited to 5/200 or less in both eyes, or a visual field contracted to 5 degrees or less. Any one of the four is enough on its own.6

For 2026, the maximum annual pension rates (MAPR) that include the Aid and Attendance increase are the figures below. The MAPR is a ceiling on the whole pension, not a flat payment: VA pays the difference between your income for VA purposes and that ceiling, so a household with countable income receives less than the maximum. The VA publishes the rates as yearly amounts, and a monthly payment is the yearly award divided by 12.2 That is why the deduction described in the next section matters as much as the rates themselves: a Montana nursing home bill is an unreimbursed medical expense, and subtracting it from the income the VA counts is what can carry a veteran with real income back up toward the ceiling.2

• Veteran with no dependents: $2,424 per month ($29,093 per year)2
• Veteran with one dependent (such as a spouse): $2,874 per month ($34,488 per year)2
• Surviving spouse with no dependents: $1,558 per month ($18,697 per year)2

These are VA pension payments sent to the veteran or surviving spouse, not direct payments to the nursing home. The money arrives as monthly cash and can be applied toward facility costs or other care expenses.

How Nursing Home Costs Lower Your Countable Income

VA pension, including Aid and Attendance, is needs-based. To be eligible, the veteran's yearly family income and net worth have to fall within limits set by Congress. Because the benefit is keyed to the income the VA counts, lowering that income is what can bring a veteran inside those limits.2

The VA lets you subtract unreimbursed medical expenses from the income it counts, and out-of-pocket nursing home charges count, but only the portion that exceeds 5% of your applicable MAPR.2

For 2026, that threshold is:

• $872 per year for a veteran with no spouse or child2
• Higher for a veteran with dependents, because the floor is figured from a MAPR that includes the increase for family members but never the aid-and-attendance or housebound increase2

Only the amount above that annual floor is deductible. For a nursing home the regulation is unusually clear about what counts: 38 CFR 3.278(d)(1) provides that payments to nursing homes, "including the cost of meals and lodging charged by such facilities, are medical expenses." There is no separate clinician-certification test for a nursing home, unlike the distinct tests the same regulation sets for in-home attendant care and for a care facility that is not a nursing home.2 Montana nursing home costs will typically exceed this threshold by a wide margin, substantially reducing or eliminating the income the VA counts.

Example (annual): A single veteran has $22,000 in annual income and $95,000 in annual out-of-pocket nursing home costs. Subtracting $872 leaves $94,128 deductible, far more than $22,000. The income the VA counts comes to $0, well inside the limit. Because the pension is the ceiling less countable income, a countable income of $0 means the full 2026 maximum pension rate with Aid and Attendance, $29,093 a year ($2,424 a month) for a veteran with no dependents.2

Who Qualifies

To qualify for VA pension with Aid and Attendance, a veteran must meet all of the following:6

Wartime service. The length of service required turns on when active duty started, not on which war. 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 recognized wartime period (World War II, the Korean conflict, the Vietnam War era, or the Gulf War). A veteran who started active duty as an enlisted person after September 7, 1980 generally needs at least 24 months, or the full period for which they were called or ordered to active duty, again with at least one day during wartime. A third branch covers an officer who started active duty after October 16, 1981 and had not previously served on active duty for at least 24 months.6

Discharge, and one of four alternatives. The veteran must not have received a dishonorable discharge, and must meet at least one of these four: 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. Any one of the four is enough on its own, so a wartime veteran under 65 who receives SSI qualifies without an adjudicated permanent-and-total rating.6

Net worth under $163,699. This combines the claimant's and dependents' assets and income for VA purposes, and it takes in the spouse's net worth too.2 Assets exclude the primary residence, the car, and basic home items like appliances you would not take with you if you moved. What does count is the fair market value of real and personal property, minus any mortgages, and net worth is figured after the debt you owe. Deductible expenses, including medical costs you are not reimbursed for, come off the income side.6 A 3-year look-back applies to asset transfers for less than fair market value on or after October 18, 2018; penalties can extend up to 5 years.6

Need for aid and attendance. The veteran must need another person's help with daily activities, be bedridden, be a patient in a nursing home because of a loss of mental or physical abilities related to a disability, or have limited eyesight (5/200 or less in both eyes, or the visual field contracted to 5 degrees or less).6

Surviving spouses of wartime veterans may qualify for the Survivors Pension with Aid and Attendance under similar rules.

The $90/Month Nursing-Home Pension Cap

A critical federal rule applies when a single veteran with no spouse or dependent children is covered by Medicaid for nursing facility care: the VA reduces that veteran's pension to no more than $90 per month for any period after the month of admission to the nursing facility.3

This rule comes from 38 U.S.C. 5503(d)(2) and its implementing regulation at 38 CFR 3.551(i); the same subsection extends the cap to a surviving spouse who has no child.3 Federal law separately bars the facility's Medicaid payment from being reduced by the pension the veteran is allowed to keep (38 U.S.C. 5503(d)(3)), so the $90 stays with the veteran rather than going toward the bill. Whether it comes in addition to Montana's Medicaid personal needs allowance or instead of it is governed by Montana's own post-eligibility rules and varies from state to state, so do not assume the two amounts stack; ask DPHHS what applies in your case.4 The cap applies only in a Medicaid-funded nursing facility. It does not apply to veterans paying privately or to veterans with a spouse or dependent child. It also turns on a defined term: 38 U.S.C. 5503(d)(1)(B) defines the nursing facilities the cap reaches to exclude "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." So a Medicaid-covered veteran living in a state veterans home should have the stay checked against that definition rather than assume the $90 applies.4

How VA Aid and Attendance and Nursing Home Care Work with Montana Medicaid

VA Aid and Attendance and Montana Medicaid (administered by the Montana Department of Public Health and Human Services Senior and Long Term Care Division) are separate programs that a senior needing long-term care may use together, but they interact through income rules.7

Under the general federal rule, the base VA pension counts as income for Medicaid; the portion attributable to the Aid and Attendance allowance generally is not, because a state deciding whether an aged, blind, or disabled applicant is financially eligible applies SSI income methodologies, and under those methodologies VA aid and attendance and housebound allowances are not income (SSA POMS SI 00830.308). Montana is not one of the eight states SSA identifies as using eligibility criteria more restrictive than SSI, so that treatment is the one to expect here.3 That exclusion applies at the eligibility step only. For a resident of a medical institution or an intermediate care facility in an SSI state, which is the scope 42 CFR 435.725 sets for itself ("This section applies to the following individuals in medical institutions and intermediate care facilities"), income that was disregarded in determining eligibility must be considered in the share-of-cost calculation, so an Aid and Attendance amount disregarded at eligibility becomes part of the income from which the required deductions are made and can raise what the resident owes the facility. Those deductions are 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 the category covering care recognized under State law but not covered by the state Medicaid plan is "subject to reasonable limits the agency may establish." That federal section does not settle post-eligibility treatment in one of those more restrictive 209(b) states, or for home and community-based waiver services delivered at home, so a family using Montana waiver services should ask DPHHS which rule applies rather than assume the federal result.3 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 DPHHS or an accredited Veteran Service Officer before relying on it.7

How to Apply and Get Free Help

VA Form 21-2680 is the form used to apply for Aid and Attendance benefits "that will be added to your monthly compensation or pension benefits," so it serves two routes. The steps below are the pension route, the one this guide covers: VA's condition there is "You may be eligible for this benefit if you get a VA pension." A veteran whose Aid and Attendance would be added to monthly disability compensation instead files on the compensation side and does not use the pension application below.8

• 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 need for assistance.8
• VA Form 21P-527EZ (Application for Veterans Pension), filed by a wartime veteran pursuing the pension route who is not already receiving a VA pension.8
• VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance), which will also need to be filled out for a nursing home claim.8
• VA Form 21-0966 (Intent to File), which a claimant still gathering information can submit first. VA says "Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive."8

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, VA answers, "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.8

Free help in Montana: The Montana Veteran Affairs Division (MVAD), the state veterans agency administratively attached to the Montana Department of Military Affairs, staffs nationally accredited Veteran Service Officers at nine offices statewide (in Belgrade, Billings, Butte, Great Falls, Havre, Helena, Kalispell, Miles City, and Missoula) who prepare and file VA compensation and pension claims at no cost to the veteran. Visit veterans.mt.gov to contact your nearest office.5

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 In-Home Care 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.