VA Aid and Attendance can help pay for in-home care in New Hampshire. It is an increase to a VA pension, or for some veterans to monthly VA compensation, for veterans and surviving spouses who need help with everyday activities. On the pension route it raises the pension's yearly ceiling rather than arriving as a second payment. A non-medical caregiver at home costs a median $40 an hour in New Hampshire, well above the national median, so it pays to know exactly how far the benefit reaches.

In This Guide

How Much In-Home Care Costs in New Hampshire

In-home care in New Hampshire costs well above the national median. According to CareScout's 2025 Cost of Care Survey (conducted by CareScout, a Genworth subsidiary, and released March 2, 2026), a non-medical caregiver at home in New Hampshire has a median cost of $40 an hour, or $91,520 a year. Nationally the median is about $35 an hour, roughly $80,080 a year at 44 hours a week. As of the 2025 survey, homemaker and home health aide services are reported together as that single non-medical caregiver category. Skilled nursing at home costs far more: CareScout puts a New Hampshire private-duty nurse at $195 an hour, against $90 an hour nationally.

These are industry-survey medians, not government figures, and costs vary widely within the state and rise as care needs grow. Because home care is priced by the hour, your own bill depends on how many hours of care your loved one needs.

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

Aid and Attendance is an increased monthly pension payment added to a VA pension, for a pensioner who meets at least one of the VA's aid-and-attendance tests, such as needing another person's help with daily activities like bathing, feeding, and dressing.

The VA publishes these ceilings as yearly Maximum Annual Pension Rates (MAPRs), but pays the pension monthly. The monthly amount is figured by subtracting your countable income from the MAPR, dividing by 12, and rounding down to the whole dollar (38 CFR 3.273 and 3.29(b)).

Who Yearly maximum (MAPR)
Veteran with no dependents $29,093
Veteran with one dependent $34,488
Surviving spouse with no dependents $18,697

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. Even the highest of these three ceilings, $34,488 a year for a veteran with one dependent, is well under New Hampshire's $91,520 median annual cost for a non-medical caregiver at home, so even the full ceiling would cover only part of that median cost.,

How In-Home Care Costs Lower Your Countable Income

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, you can lower that income by deducting unreimbursed medical expenses.

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. The VA puts the floor at $1,141 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, which can open the door to a pension 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, with at least one day during wartime
  • 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 meets this test without a permanent-and-total rating
  • Meet at least one of the VA's aid-and-attendance requirements: needing another person to help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large portion of the day in bed, because of illness; being a patient in a nursing home due to the loss of mental or physical abilities related to a disability; or having limited eyesight (even with glasses or contact lenses, 5/200 or less in both eyes, or a visual field contracted to 5 degrees or less). In judging the need for help, the VA weighs factors listed at 38 CFR 3.352(a), such as being unable to dress, feed oneself, or stay safe from the hazards of daily life; not every factor has to be found
  • Have yearly family income and net worth within the limits Congress sets, with a net worth limit of $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 36-month (3-year) look-back to the period just before it receives your pension claim: transferring an asset for less than fair market value during that window, where keeping the asset would have put your net worth over the limit, can bring a penalty period of up to 5 years. A surviving spouse may qualify through Survivors Pension, which has its own Aid and Attendance rate ($18,697 a year with no dependents) and the same $163,699 net worth limit.

Using Aid and Attendance to Pay a Family Caregiver for In-Home Care in New Hampshire

If a son, daughter, or other relative provides the care, two VA rules matter. For the VA to deduct what you pay that relative 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. A relative doing the caregiving does not count against the claim itself: under 38 CFR 3.352(c), care provided by a relative or another member of the household will not prevent the VA from granting the Aid and Attendance allowance.

There is also a VA program built for this. Veteran-Directed Care (VDC), part of the VA's home and community based services, gives an enrolled veteran a flexible budget, managed by the veteran or a representative, to hire and supervise their own workers, and those workers can include family, friends, or neighbors. An enrolled veteran is eligible if they are eligible for community care, meet the clinical criteria for the service, and VDC is available. VA medical centers deliver it through aging and disability network agencies, such as area agencies on aging, where an options counselor helps plan the care and arranges fiscal management services. Ask your VA medical center whether VDC 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 veteran without a spouse or child, a surviving spouse without a child, or a surviving child who is receiving Medicaid-covered nursing home care 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)). The statute's definition of the nursing facility the cap runs on leaves out a State home for which the VA makes per diem payments for nursing home care (38 U.S.C. 5503(d)(1)(B)), so a stay in such a home is outside the $90 cap. Whether a particular New Hampshire veterans home falls in that exclusion depends on whether the VA makes that payment for its care, so check with an accredited Veterans Services Officer rather than assume the cap applies. 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 (DHHS Medical Assistance Manual 619.01) 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 the 8 states SSA lists as using at least one eligibility criterion more restrictive than SSI (the 209(b) states), 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, New Hampshire works out what a nursing facility resident pays toward care under its own cost-of-care instructions. Those instructions and the state's rule name 42 CFR 435.733(c) as their federal authority, the post-eligibility section for states using more restrictive requirements than SSI, and that section says income disregarded in determining eligibility must be considered at this step. The worker starts from the resident's income, then subtracts either the $90 VA nursing facility pension or the $93 personal needs allowance; any income allocated under the state's allocation-of-income rules; the resident's own health insurance premiums (including Medicare Part B), coinsurance and deductibles; necessary care that Medicaid does not cover; unpaid prior medical debt the resident still owes; continuing SSI benefits; and, when a physician has verified the stay will last 3 months or less and the resident is expected to return home, an allowance to keep up the home. Only then is the VA Aid and Attendance allowance added back, and the result is what the resident must apply toward the cost of care. So for a nursing facility resident whose pension has not been reduced to the federal $90 cap (for example, a veteran who has a spouse or a child), Aid and Attendance does count toward the resident's share, but only after every one of those deductions. It does not reach a pension already capped at $90, which the worker subtracts before anything is added back. Those instructions cover nursing facility care. For care at home through Choices for Independence and other home- and community-based services, New Hampshire's rule (He-W 854.12(b)) says the Aid and Attendance allowance shall be applied to the cost of care, so ask a DHHS caseworker how the rest of that calculation works for your household before you budget. 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: 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 assist veterans who live in New Hampshire, and their dependents, in securing the state and federal benefits they may be entitled to, and state law (RSA 110-B:85) charges the Division's director with running a statewide structure that helps veterans and family members identify eligibility, file claims, and coordinate benefits with other agencies. No one can lawfully charge you to prepare or file a VA benefits application. The main office is in Manchester at 275 Chestnut Street, Room 517 ((603) 624-9230 or NH toll-free 1-800-622-9230). The Division says visits are by appointment only and booked through (603) 624-9230, though the same page also says individual sites manage their own schedules while officers are in the field. Service officers meet veterans at sites around the state, including the VA Medical Center in Manchester, the Readiness Center in Nashua, the Gibson Center for Senior Services in North Conway, and the Readiness Center in Portsmouth; the Division lists its Tilton site as starting back up in January 2027.

Frequently Asked Questions

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

It can help in two ways. The pension, including the Aid and Attendance increase, is paid monthly. And what you pay an in-home attendant who provides health care or custodial care can count as an unreimbursed medical expense, which lowers your income for VA purposes and so can raise the pension the VA pays.

How much does Aid and Attendance pay toward home care?

The 2026 maximum annual pension rate with Aid and Attendance is $29,093 a year for a veteran with no dependents, $34,488 with one dependent, and $18,697 for a surviving spouse with no dependents. 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?

It can be worth it. 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?

What you pay a daughter who provides your care can count as a deductible medical expense on the 38 CFR 3.278(d)(2) terms above: she has to provide health care or custodial care, the payments have to be commensurate with the hours she works, and unless she is a health care provider, you must need Aid and Attendance or be housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist must state in writing that you require the care she provides. Her doing the caregiving does not count against the claim itself: care provided by a relative will not prevent the VA from granting the Aid and Attendance allowance. Veteran-Directed Care is another route: its flexible budget lets an enrolled veteran hire family, friends, or neighbors as their own workers. Ask your VA medical center 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 can generally do at any time after the VA issues notice of its decision, but timing matters: a Supplemental Claim received more than one year after that notice takes an effective date no earlier than the date the VA receives it. If you switch to a Supplemental Claim after that year has run, your claim is no longer treated as continuously pursued unless the VA grants an extension of the 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. You elect one of these reviews, not two at the same time: under 38 CFR 3.2500(b), once you have filed one you cannot file for a different one on the same claim or issue while that review is pending final adjudication, so the choice is worth getting right the first time. A Higher-Level Review or Board Appeal generally has to be elected within one year of the date on your decision letter, but there are exceptions: in a simultaneously contested claim, where several people claim a benefit only one of them can receive, the only route is a Board appeal filed within 60 days. Take the deadline from your decision letter rather than assuming twelve months. New Hampshire's Division of Veterans Services, whose director by statute supervises a statewide structure that helps veterans review claims decisions for appeals, can help with the review, so you do not have to handle an appeal alone.

Compare Care Settings in New Hampshire

See how Aid and Attendance works in other care settings:

Learn More

VA BenefitsVA Aid and Attendance in New HampshireVA Aid and Attendance in New Hampshire for 2026: who qualifies, up to $2,874 a month for a veteran with a spouse, how to apply, and where to get help in NH. VA BenefitsVA Benefits for Senior Care in New HampshireA guide to VA senior care benefits in New Hampshire: home care, nursing homes, Aid and Attendance, the state veterans home, and how to access them in 2026. Care TypesHome Care vs Home Health in New HampshireHome care vs. home health in New Hampshire: home health is skilled care Medicare covers under RSA 151:2; home care is non-medical help it won't pay for. VA BenefitsHow VA Aid and Attendance Pays for Assisted LivingHow VA Aid and Attendance helps pay for assisted living: the 2026 annual pension limits, the medical-expense rule, who qualifies, and how to apply. VA BenefitsVA Benefits for Senior Care: A Complete GuideA complete guide to VA benefits for senior care: long-term care, Aid and Attendance, pensions, DIC, and home grants for older veterans and surviving spouses.
Your next step 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.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.