VA Aid and Attendance can help pay for in-home care in New Hampshire. It is a monthly increase added to a VA pension, or for some veterans to monthly VA compensation, 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 an in-home attendant. 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 CareScout's 2025 Cost of Care Survey (the successor to the Genworth Cost of Care Survey, released in 2026), in-home care runs about $35 an hour nationally, or roughly $80,080 a year for 44 hours of care a week. As of the 2025 survey, homemaker and home health aide services are reported together as a single non-medical caregiver category. New Hampshire is consistently one of the most expensive states in the country for senior care, so families here should generally expect to pay more than the national figure.

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 in New Hampshire

Aid and Attendance is an increased monthly pension for veterans and surviving spouses who need another person's help with daily activities. The payment goes to the veteran, and the family decides how to spend it. Many New Hampshire households put it directly toward a home health aide, a homemaker, or an in-home attendant.

The VA publishes these ceilings as yearly Maximum Annual Pension Rates (MAPRs); the check that arrives each month is the yearly award divided by 12.

Who Yearly maximum (MAPR) Per month (yearly ÷ 12)
Veteran alone $29,093 About $2,424
Veteran with one dependent $34,488 About $2,874
Surviving spouse $18,697 About $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. These figures cap the whole pension rather than describing the check: the VA sets the payment at the difference between your income for VA purposes and the MAPR, so a veteran with other income receives less. At the top of the range, about $2,874 a month for a veteran with one dependent covers 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: to be eligible, your yearly family income and net worth have to fall within limits Congress sets. Because the benefit is keyed to your income for VA purposes, lowering that income is what brings many families into range.

What you pay an in-home attendant counts as an unreimbursed medical expense (UME) that you can deduct from your income. The rule that governs it is 38 CFR 3.278(d)(2): payments for assistance with activities of daily living and instrumental activities of daily living by an in-home attendant are medical expenses as long as the attendant provides health care or custodial care, and the payments must be commensurate with the number of hours the provider attends to the person. The attendant must be a health care provider unless the person needs Aid and Attendance or is housebound, or unless 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 person requires the care the attendant provides.

Only the portion of those costs above 5% of your annual pension limit (MAPR) is deductible, and that floor is figured excluding the Aid and Attendance and housebound increases. For 2026 it is $872 a year for a veteran with no spouse or child, and it rises for a veteran with dependents.

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 a discharge that is not dishonorable
  • Meet the wartime service requirement, which the VA states as three paths turning on when service started: active duty beginning before September 8, 1980 means at least 90 days of active duty with at least one day during a wartime period; enlisted service beginning after September 7, 1980 means at least 24 months (with some exceptions), or the full period for which the veteran was called or ordered to active duty, with at least one day during wartime; and service that began as an officer after October 16, 1981 counts where the veteran had not previously served on active duty for at least 24 months
  • Meet at least one of four age or disability tests: 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. Any single branch is enough, so a wartime veteran under 65 who receives SSI qualifies without a permanent-and-total rating
  • Meet one of the aid-and-attendance need tests at 38 CFR 3.352(a): being unable to dress or undress or to stay ordinarily clean and presentable, needing frequent adjustment of a prosthetic or orthopedic appliance, being unable to feed oneself, being unable to attend to the wants of nature, or 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 limited eyesight (5/200 or less in both eyes, or a visual field contracted to 5 degrees or less)
  • Have a net worth below $163,699 (the calculation combines the claimant's and dependents' assets and income for VA purposes; assets exclude the primary residence, the car, and basic home items such as appliances)

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 for In-Home Care in New Hampshire

Many New Hampshire families want a son, daughter, or other relative to provide the care. The pension is paid to the veteran, so a family can direct it to that relative. For the VA to deduct those payments as a medical expense, the 38 CFR 3.278(d)(2) terms above apply: the attendant has to provide health care or custodial care, the payments have to be commensurate with the hours worked, and an attendant who is not a health care provider qualifies only if the veteran needs Aid and Attendance or is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that the veteran requires the care that attendant provides. One relative is treated differently: VA Pension and Aid and Attendance prohibit paying a spouse to provide the care.

There is also a separate VA program built for this. Veteran-Directed Care (VDC) gives the veteran a flexible budget to hire their own workers, including family, friends, or neighbors, and unlike VA Pension and Aid and Attendance it has no prohibition on paying a spouse. A financial management services provider helps the veteran handle the employer responsibilities. 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, though the combination changes if care later moves into a nursing home. Under federal rules, a single veteran with no dependents receiving Medicaid-covered nursing home care generally has the VA pension capped: no pension in excess of $90 a month is paid for any period after the month Medicaid payments begin (38 CFR 3.551(i), implementing 38 U.S.C. 5503(d)). That federal rule caps the pension; it does not set New Hampshire's Medicaid personal needs allowance, and in New Hampshire the two do not add together. The state's cost-of-care instructions tell the worker to subtract one of the following: the $90 nursing facility pension or a $93 personal needs allowance. So a resident entitled to the $90 keeps it instead of the state allowance, not on top of it, and the two figures should never be added into a combined number.

Medicaid counts income and assets, but it treats Aid and Attendance differently at each of its two steps. Under the general federal default, a state applies SSI income rules to the aged, blind, and disabled groups (42 CFR 435.601), and under SSA POMS SI 00830.308 the Aid and Attendance allowance is not income for SSI purposes. New Hampshire, however, is one of only 8 states that elected the more restrictive 209(b) option, so New Hampshire's own eligibility rule governs at that step and may differ from that SSI default; confirm how DHHS treats the Aid and Attendance amount before relying on it. After eligibility, for someone receiving care in a nursing facility or other medical institution, income that was disregarded at the eligibility step is counted in the share-of-cost calculation (42 CFR 435.725), so the Aid and Attendance amount generally counts toward your share of cost. Before that income reaches the facility, federal law requires the state to subtract five things from it, in this order: a personal needs allowance the resident keeps for clothing and other personal needs; an additional amount for the maintenance needs of a spouse still at home; an additional amount for the maintenance needs of other family members at home; amounts for incurred medical or remedial care expenses that Medicaid does not pay for; and the full amount of any SSI or state supplement payments the resident keeps receiving. Those are duties DHHS owes the resident, not options a family has to ask for. One New Hampshire wrinkle matters on the first of them: a nursing facility resident entitled to the VA nursing facility pension has that VA amount protected instead of the state's personal needs allowance, not on top of it, so the two are never added together. That share-of-cost rule is written for people in a nursing facility or other medical institution. Choices for Independence waiver services are governed by a separate federal post-eligibility rule, and the maintenance allowance a waiver participant keeps is set differently and is generally much larger, so ask DHHS which calculation applies to you before you budget for one. Because New Hampshire is a 209(b) state, confirm that treatment with DHHS rather than assuming the federal default settles it. 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

The steps below are the pension route, which is how most New Hampshire families reach this benefit: the VA's own condition is that you may be eligible for it if you get a VA pension. Two forms carry that route. VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner must fill out, is the form for Aid and Attendance that will be added to your monthly compensation or pension benefits, so it is not limited to pension claims. A wartime veteran pursuing the pension route who is not already receiving a VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application. You can file online at VA.gov, by mail to the VA Pension Intake Center, in person at a VA regional office, or with help from an accredited representative. If you are still gathering information, you can submit VA Form 21-0966 (Intent to File) first, which the VA says can secure the earliest possible effective date for any retroactive payments you may be eligible to receive. On how long a decision takes, the VA's answer is "It depends"; it processes claims in the order it receives them, unless a claim requires priority processing.

Do not do this alone. Veterans Services Officers at New Hampshire's Division of Veterans Services help state-resident veterans and their dependents file compensation and pension claims with the VA, and represent them through the claim process; the Division's own benefits guide says the service is free of charge. The main office is in Manchester at 275 Chestnut Street, Room 517 ((603) 624-9230 or NH toll-free 1-800-622-9230), and all appointments are scheduled through that office, including the ones service officers hold at other sites around the state: the VA Medical Center in Manchester, the Readiness Center in Nashua, the Gibson Center for Senior Services in North Conway, the Readiness Center in Portsmouth, and the New Hampshire Veterans Home in Tilton.

Frequently Asked Questions

Can Aid and Attendance be used to pay for in-home care in New Hampshire?

Yes. The pension, including the Aid and Attendance increase, is paid to the veteran each month, and the family chooses how to spend it. Many New Hampshire families use it to pay a home health aide, a homemaker, or an in-home attendant. The VA does not arrange or provide the care itself. Paying a spouse for the care is the exception: VA Pension and Aid and Attendance prohibit it.

How much does Aid and Attendance pay toward home care?

The 2026 maximum annual pension rate with Aid and Attendance is $29,093 for a veteran with no dependents (about $2,424 a month), $34,488 with one dependent (about $2,874), and $18,697 for a surviving spouse (about $1,558). Those are ceilings, not payment amounts: the VA pays the difference between your income for VA purposes and the MAPR.

My income seems too high. Should I still apply?

Often, yes. Payments to an in-home attendant count as unreimbursed medical expenses and can be deducted from your countable income, as long as the attendant provides health care or custodial care and the payments are commensurate with the hours the attendant works. Only the portion above 5% of your annual pension limit is deductible, and that floor is figured before any Aid and Attendance increase ($872 a year for a veteran with no spouse or child, and more if you have dependents). Large care bills can bring an "over income" veteran within the limit.

Can I pay my daughter to care for me with this benefit?

Yes. The pension is paid to the veteran, so it can go to a daughter who provides the care, and the VA deducts those payments as a medical expense on the 38 CFR 3.278(d)(2) terms above: care commensurate with the hours worked, and either a qualifying need for Aid and Attendance or housebound status or a clinician's written statement. A spouse is the exception, because VA Pension and Aid and Attendance prohibit paying one. The separate Veteran-Directed Care program lets a veteran hire their own workers, including a spouse, using a flexible budget. Ask your VA medical center social worker whether it is available locally.

What if my Aid and Attendance claim is denied?

After an initial decision, you have three options. You can file a Supplemental Claim with new and relevant evidence, which you may do at any time after the VA issues notice of its decision, though the VA recommends filing within one year to keep your effective date: a Supplemental Claim received more than one year after the date on the decision notice takes an effective date no earlier than the date the VA receives it (38 CFR 3.2500(h)(2)), unless the VA grants an extension of that year for good cause (38 CFR 3.109(b)). Filing late can therefore cost back pay reaching to your original claim date, even though the door stays open. You can also ask for a Higher-Level Review, where a higher-level reviewer looks at the case with no new evidence, or appeal to the Board of Veterans' Appeals for review by a Veterans Law Judge. For most VA benefits those two must be elected within one year of the date the VA issued notice of the decision, but certain VA benefits have time limits shorter than a year, so take the deadline from your decision letter rather than assuming twelve months. The same NH Division of Veterans Services officer who filed your claim can prepare and file the review for free, so you do not have to navigate an appeal alone.

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

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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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