VA Aid and Attendance is one of the most overlooked ways to pay for in-home care in New Hampshire. It is a monthly cash benefit added to a VA pension for veterans and surviving spouses who need help with everyday activities, and the money can go straight toward a home health aide, a homemaker, or even a family member who provides the care. With New Hampshire's care costs among the highest in the country, that monthly payment can make the difference between staying home and moving into a facility.

This guide explains what in-home care costs here, 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

How Much In-Home Care Costs in New Hampshire

New Hampshire's in-home care costs are among the highest in the country. According to the Genworth/CareScout 2024 Cost of Care Survey, a home health aide in New Hampshire runs about $89,232 a year, and homemaker services run about $86,944 a year, each based on roughly 44 hours of care a week.

These are survey medians, not government figures, and the real number depends on how many hours of care your loved one needs. A few hours a day costs far less than around-the-clock help. But even part-time care adds up quickly, which is why a steady monthly benefit matters so much.

How Aid and Attendance Helps Pay for In-Home Care

Aid and Attendance is an increased monthly pension for veterans and surviving spouses who need another person's help with daily activities. The payment arrives as tax-free cash, and you decide how to spend it. Many New Hampshire families put it directly toward a home health aide, a homemaker, or a family caregiver.

Who Monthly Amount
Veteran alone Up to $2,424
Veteran with one dependent Up to $2,874
Surviving spouse Up to $1,558

The VA does not run or provide the care itself, and it does not tell you which agency or aide to use. It pays the benefit, and you arrange the care. For a veteran with a spouse, up to $2,874 a month can cover a meaningful share of a part-time aide or homemaker in New Hampshire.

How In-Home Care Costs Lower Your Countable Income

Here is the part many families miss. VA pension, including the Aid and Attendance increase, is a needs-based benefit: the VA pays the difference between your countable income and a yearly limit called the Maximum Annual Pension Rate (MAPR). The lower your countable income, the larger your payment.

When you have a genuine care need, your ongoing in-home care costs count as unreimbursed medical expenses (UMEs) that you can deduct from your income. Only the portion of those costs above 5% of your annual MAPR is deductible. For 2026, that floor is $872 a year for a veteran with no dependents and $1,141 a year for a veteran with one dependent.

Say a veteran with no dependents pays $30,000 a year for an aide. Subtract the $872 floor, and about $29,128 can be deducted from countable income. That deduction can take a veteran who looked "over income" and bring them within the limit, often unlocking a large monthly payment. This is why families who assume they earn too much should still apply once care costs are in the picture.

Who Qualifies

To qualify for Aid and Attendance, the veteran must:

  • Have served at least 90 days of active duty with at least one day during a wartime period
  • Be 65 or older, or be permanently and totally disabled
  • Need help with daily activities such as bathing, dressing, or feeding, or be housebound or in a protected setting due to disability
  • Have a net worth below $163,699 (this combines assets and annual income and excludes your primary home and vehicle)

The VA applies a 3-year look-back on assets transferred for less than fair market value before you file. A surviving spouse can qualify under the survivor's pension using the same care-need and net-worth tests.

Using Aid and Attendance to Pay a Family Caregiver

Many New Hampshire families want a son, daughter, or other relative to provide the care. Aid and Attendance cash can be used to pay that person, since you control how the benefit is spent.

There is also a separate VA program built for this. Veteran-Directed Care (VDC) gives the veteran a flexible monthly budget to hire their own caregivers, including family members, and unlike many Medicaid programs there is no blanket rule against hiring a spouse. A financial management service handles payroll and taxes. VDC is offered through participating VA medical centers, so ask your VA social worker whether it is available in your area.

How Aid and Attendance Works with New Hampshire Medicaid

Aid and Attendance and New Hampshire Medicaid long-term care are separate programs run by different agencies, and they interact. The VA pays Aid and Attendance federally; New Hampshire's Medicaid benefits, including nursing facility care and the home- and community-based Choices for Independence (CFI) waiver, are run by the NH Department of Health and Human Services (DHHS), which sets its own income and asset limits.

A veteran may qualify for both. But under federal rules, a single veteran with no dependents who is receiving Medicaid-funded nursing home care generally has the VA pension reduced to a small monthly personal-needs amount for as long as that institutional coverage lasts. Because Medicaid counts income and assets, Aid and Attendance payments can also affect Medicaid eligibility or your share of cost. The exact treatment depends on your household, so confirm with a NH DHHS caseworker and an accredited Veterans Service Officer before relying on both.

How to Apply and Get Free Help

You apply with two forms: VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), completed with a doctor, and VA Form 21P-527EZ (Application for Veterans Pension) if you are not already receiving a pension. You can file online at va.gov, by mail, or through an accredited representative. Processing often takes three to six months.

Do not do this alone, and do not pay anyone to file. New Hampshire's Division of Veterans Services, part of the Department of Military Affairs and Veterans Services, provides free, accredited help with VA pension and Aid and Attendance claims for state residents and their dependents. The main office is in Manchester at 275 Chestnut Street, Room 517 ((603) 624-9230 or toll-free 1-800-622-9230), with service officers at additional sites including the Manchester VA Medical Center, Nashua, North Conway, Portsmouth, and the New Hampshire Veterans Home in Tilton.

Frequently Asked Questions

Yes. Aid and Attendance arrives as tax-free monthly cash, and you choose how to spend it. Many New Hampshire families use it to pay a home health aide, a homemaker, or a family caregiver. The VA does not arrange or provide the care itself.

It pays up to $2,424 a month for a veteran, up to $2,874 with a spouse, and up to $1,558 for a surviving spouse. The exact amount depends on your countable income, since the VA pays the difference between that income and the annual pension limit.

Often, yes. Your ongoing in-home care costs count as unreimbursed medical expenses and can be deducted from your countable income, but only the portion above 5% of your annual pension limit ($872 a year for a single veteran, $1,141 with one dependent). Large care bills can bring an "over income" veteran within the limit.

Yes. Because you control how Aid and Attendance is spent, you can pay a family caregiver. The Veteran-Directed Care program also lets a veteran hire their own caregivers, including relatives, using a flexible budget. Ask your VA medical center social worker whether it is available locally.

Compare Care Settings in New Hampshire

Aid and Attendance can help pay for any care setting. See how it works for the others:

Learn More

Find personalized help using VA benefits to pay for in-home care in New Hampshire 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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