VA Aid and Attendance for North Dakota Assisted Living: What It Pays

VA Aid and Attendance for assisted living in North Dakota gives qualifying veterans and surviving spouses a monthly benefit that can be used to help pay for care. North Dakota assisted living costs are below the national median, which means Aid and Attendance covers a meaningful share of actual bills. It is worth checking even if your family assumes its income is too high, because care costs can lower the income VA counts.1

This guide explains what assisted living costs in North Dakota, how Aid and Attendance can help offset those costs, how care expenses can improve eligibility, and how to apply with free help from the state.

In This Guide

• Key Takeaways
• How Much Assisted Living Costs in North Dakota
• How Aid and Attendance Helps Pay for Assisted Living in North Dakota
• How North Dakota Assisted Living Costs Lower Your Countable Income for Aid and Attendance
• Who Qualifies
• How Aid and Attendance Works with North Dakota Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much Assisted Living Costs in North Dakota

North Dakota assisted living costs sit well below the national median. According to the CareScout 2025 Cost of Care Survey (the successor to the Genworth survey, released in 2026), the median cost of assisted living in North Dakota is about $4,729 per month (roughly $56,745 per year for 12 months of care in a private one bedroom), down about 11 percent from the 2024 survey and well below the national median of approximately $74,400 per year. Measured over the longer 2022 to 2025 window rather than year over year, it is down about 8 percent.2

These are industry-survey medians, not government figures: costs vary by region within the state and rise as care needs grow, so the actual monthly bill depends on the facility, its location, and the level of care required.2

North Dakota also operates one state veterans home, the North Dakota Veterans Home in Lisbon, which has served honorably discharged veterans and their spouses since 1893. The Home's own site lists 98 Basic Care beds and 52 Skilled Care beds (a North Dakota Department of Veterans Affairs page gives different counts). The Basic Care unit is designed for residents who care for their own needs independently: it requires total independence with personal care needs such as bathing, dressing, eating, walking, toileting, and transferring, with medical and nursing supervision available. Read that requirement closely before treating the unit as an alternative to private assisted living. A veteran who already needs hands-on help with daily activities is looking instead at the Home's Skilled Care unit. Either way, admission follows North Dakota law, including a state residency requirement, and needs approval from the Home's board of admissions.5

How Aid and Attendance Helps Pay for Assisted Living in North Dakota

VA Aid and Attendance is a pension benefit for veterans and surviving spouses who need help with daily activities. The VA pays it as a monthly cash benefit that can be applied to any care-related expense, including assisted living.1

2026 Pension Ceilings with Aid and Attendance

VA publishes these as annual figures, but pension is paid monthly: under 38 CFR 3.273, VA subtracts countable income from the applicable annual rate and divides what is left by 12, and under 38 CFR 3.29(b) a result that is not a whole dollar is rounded down.1 The Maximum Annual Pension Rate is a ceiling rather than a payment: the VA pays the difference between your income for VA purposes and that limit.1 A pension paid at the full $34,488 ceiling would cover roughly 61 percent of the $56,745 North Dakota median annual assisted living cost. Combined with Social Security or other income, many North Dakota families can make assisted living work.2

How North Dakota Assisted Living Costs Lower Your Countable Income for Aid and Attendance

A feature of Aid and Attendance that surprises many families: the cost of assisted living can help you qualify for the benefit.

VA pension is needs-based: to be eligible, your yearly family income and net worth have to meet limits set by Congress. Because the benefit is keyed to your income for VA purposes, you can lower that income by deducting unreimbursed medical expenses (UMEs), but only the portion above 5 percent of your Maximum Annual Pension Rate (MAPR). Health insurance premiums count as UMEs; under 38 CFR 3.278, payments for health, medical, hospitalization, and long-term care insurance premiums are medical expenses, as are premiums for Medicare Parts A, B, and D.1

An assisted living bill counts through its own branch of that regulation, 38 CFR 3.278(d)(3), which covers a care facility other than a nursing home. Payments for health care provided by a health care provider are medical expenses. Payments for help with activities of daily living and instrumental activities of daily living count even when the person giving that help is not a health care provider, but only if the resident is receiving health care or custodial care in the facility and either 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 resident needs to be in a protected environment.1 Meals and lodging have a separate test: they count if the facility provides or contracts for health care or custodial care for the resident, or a clinician states in writing that the resident must live in the facility to receive that care from a third-party provider, family, or friends.1 The community must also be licensed if North Dakota requires licensure for that type of facility and, if residential, staffed 24 hours a day with care providers, who do not have to be licensed.1

The 5-percent floor for 2026:1

• $872 for a veteran with no spouse or child, in the VA's own words: "If you have medical expenses, you may deduct only the amount that's above 5% of your MAPR amount ($872 for a Veteran with no spouse or child)."
• Higher for a veteran with dependents, because the floor is keyed to the MAPR that includes increased pension for family members, though never to the aid-and-attendance or housebound increase (38 CFR 3.272)

Only the portion of qualifying expenses above that floor is deductible. But if your loved one is paying $4,729 a month for assisted living, that is $56,745 a year,2 so the share of the bill that meets the conditions above will typically dwarf the floor and can reduce countable income enough to qualify a veteran who initially appeared to earn too much. The whole invoice is not automatically deductible: ask the community to itemize what it charges for care, and have a service officer confirm what to report.1

Who Qualifies

To qualify for VA Aid and Attendance, a veteran must not have received a dishonorable discharge, and must meet all four requirements below:3

• Wartime service: VA lists three paths, and at least one must be true. A veteran who started active duty before September 8, 1980 served at least 90 days of active duty with at least one day during a recognized wartime period (VA's list runs from the Mexican Border period and World War I through World War II, the Korean conflict, the Vietnam War era, and the Gulf War, which began August 2, 1990 and has no end date set yet); a veteran who started active duty as an enlisted person after September 7, 1980 served at least 24 months, or the full period for which they were called or ordered to active duty (with some exceptions), with at least one day during wartime; or a veteran who started active duty as an officer after October 16, 1981 had not previously served on active duty for at least 24 months, again with at least one day during wartime
• Age or disability: at least one of these must be true: age 65 or older; a permanent and total disability; a patient in a nursing home for long-term care because of a disability; or getting Social Security Disability Insurance or Supplemental Security Income
• Need for aid and attendance under the VA's criteria: needing help with daily activities such as dressing, feeding, or keeping clean and presentable; needing frequent adjustment of a prosthetic or orthopedic appliance; being unable to attend to the wants of nature; needing care or assistance on a regular basis to stay safe from hazards in daily surroundings; being bedridden; being a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or eyesight of 5/200 or less in both eyes, or a visual field contracted to 5 degrees or less
• Net worth under $163,699: VA's calculation includes your and your dependents' assets and annual income3 but excludes the primary residence, the car, and basic home items such as appliances1

The VA also enforces a three-year look-back on asset transfers. If an asset was transferred for less than fair market value in the 36 months before VA receives the claim, and keeping it would have pushed net worth over the limit, VA can assess a penalty period of up to 5 years.3

How Aid and Attendance Works with North Dakota Medicaid

VA Aid and Attendance and North Dakota Medicaid long-term care are separate programs administered by different agencies. North Dakota Health and Human Services administers the state's Medicaid long-term care program, which provides nursing facility services to Medicaid-eligible residents who need regular or daily services of a licensed nurse; whether a person is eligible is decided under North Dakota's own income and asset rules, so check those with North Dakota HHS.6

One federal rule matters a great deal here, and it applies only in a nursing home. Under 38 U.S.C. 5503(d)(2), when a veteran who has neither a spouse nor a child is covered by a Medicaid plan for services furnished by a nursing facility, no VA pension above $90 a month may be paid for any period after the month of admission; the same rule applies to a surviving spouse with no child, and the facility's Medicaid payment may not be reduced by the amount the veteran keeps. VA's own regulation, 38 CFR 3.551(i), instead starts the cap after the month Medicaid payments begin, so if Medicaid approval comes after admission, confirm with VA which month the reduction runs from.7 That subsection caps the pension. It does not decide whether the $90 comes on top of North Dakota's Medicaid personal needs allowance or in place of it, which is a matter of North Dakota's own post-eligibility rules and must be checked with North Dakota Health and Human Services rather than assumed to stack.7 North Dakota's rule, N.D. Admin. Code § 75-02-02.1-38.1, lists ninety dollars of that pension among the income that may be disregarded for a veteran or surviving spouse with neither spouse nor child who lives in a Medicaid-approved nursing facility; how that disregard combines with the other deductions is set by the same rule, so confirm it with North Dakota HHS rather than assuming the amounts add.6 The cap is tied to nursing facility care, not to assisted living. The statute's definition of a nursing facility also leaves out a State home for which VA pays a per diem for nursing home care, so whether the cap reaches a stay at the Lisbon home depends on that payment; check it with an accredited service officer rather than assume the cap applies.6

Where the pension including Aid and Attendance keeps being paid, to a beneficiary with a spouse or dependents for instance, eligibility is only the first step. The federal rule that governs North Dakota's share-of-cost step for a nursing-facility resident, 42 CFR 435.733, says income disregarded in determining eligibility must be considered there too, so that pension income is reached when the state works out what the resident pays toward care. The sources Brevy holds do not show how North Dakota treats a full-rate Aid and Attendance amount at that step, so confirm it with North Dakota HHS.6 North Dakota's post-eligibility rule sets the deductions taken before that income goes toward care, in this order: the nursing care income level; amounts provided to a spouse or family member for maintenance needs; health insurance premiums; premiums for long-term care insurance carried by the resident or spouse; documented medical or remedial care expenses not subject to payment by any third party, including Medicaid and Medicare; and the cost of a guardian or conservator, up to 5 percent of countable gross monthly income. What the resident applies toward the cost of care is what remains after all six. Those are deductions the state takes, not benefits a family applies for. That rule covers nursing facilities and other institutional settings, not home- and community-based waiver services, and it does not say how Aid and Attendance is treated for someone receiving waiver services at home, so ask North Dakota HHS. Because the rules interact in complex ways depending on marital status, dependents, and unreimbursed medical expenses, families should confirm their specific situation with a VA-accredited service officer and North Dakota HHS before relying on both benefits.6

How to Apply and Get Free Help

The steps below are the pension route, the one that matters for most assisted living families: VA says you may be eligible for this benefit if you get a VA pension. Form 21-2680 also covers Aid and Attendance "that will be added to your monthly compensation or pension benefits," so a veteran who receives VA disability compensation rather than pension uses that form without filing the wartime pension application. On the pension route you need two forms:8

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance): a medical examiner fills out the examination section to document the need for assistance
• VA Form 21P-527EZ (Application for Veterans Pension): the pension claim itself, filed by a wartime veteran who is not already receiving a VA pension

If you are still gathering information, you can submit VA Form 21-0966 (Intent to File) 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." 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 attorney, claims agent, or Veterans Service Organization representative can file for you. Asked how long a decision takes, the VA answers "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.8

Do not do this alone. The North Dakota Department of Veterans Affairs (NDDVA) and the County and Tribal Veterans Service Officers it trains and supports provide free, professional help with pensions and long-term care benefits across the state, and all services are provided at no cost to veterans and their dependents. Every North Dakota county is legally required to appoint and fund a service officer under NDCC 37-14-18 and 37-14-19, though one officer may serve more than one county, so call before assuming there is an office in yours. Find a local service officer at veterans.nd.gov.4

Compare Care Settings in North Dakota

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

• How Aid and Attendance Pays for a Nursing Home in North Dakota
• How Aid and Attendance Pays for In-Home Care in North Dakota
• How Aid and Attendance Pays for Memory Care in North Dakota

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.