VA Aid & Attendance for In-Home Care in North Dakota

VA Aid and Attendance is one of the most overlooked ways to pay for in-home care in North Dakota. 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 a family member who provides the care. With in-home care costs adding up quickly, that steady payment can change what is affordable.

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

• Key Takeaways
• How Much In-Home Care Costs in North Dakota
• How VA Aid and Attendance Helps Pay for Home Care in North Dakota
• How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in North Dakota
• Who Qualifies
• Using Aid and Attendance to Pay a Family Caregiver
• How Aid and Attendance Works with North Dakota Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much In-Home Care Costs in North Dakota

In-home care is a major expense. In its 2025 Cost of Care Survey, CareScout (the successor to the Genworth survey) combined the former homemaker and home health aide categories into a single non-medical caregiver service. In North Dakota that runs about $77,792 a year, or about $34.00 an hour on the survey's basis of 44 hours of care a week for 52 weeks, down about 15 percent from the 2024 survey. That sits a little under the national median of about $35 an hour, roughly $80,080 a year on the same basis. The survey also prices in-home skilled nursing separately: a private duty nurse runs about $4,420 a year in North Dakota, which is about $85 an hour at just 1 hour a week for 52 weeks.2

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.

How VA Aid and Attendance Helps Pay for Home Care in North Dakota

Aid and Attendance is a higher pension rate for veterans and surviving spouses who need another person's help with daily activities such as bathing, feeding, and dressing.1 The award is paid monthly as part of your VA pension, and you arrange the care yourself. Many North Dakota families put it directly toward a home health aide, a homemaker, or a family caregiver.

Read those figures as ceilings, not as checks. The VA sets the payment on the difference between your income for VA purposes and the rate that applies to you, so a household with countable income receives less than the number above; the VA publishes the rates annually, and a monthly payment is the yearly award divided by 12.1 That is why the deduction in the next section matters so much: lowering the income the VA counts raises the check.

The VA does not run or provide the care itself, and it does not pick your aide or agency. It pays the benefit, and you arrange the care. A North Dakota veteran with one dependent and little countable income could see close to $2,874 a month, enough to cover a meaningful share of a part-time aide or homemaker.1

How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in North Dakota

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 meet limits set by Congress. Because the benefit is keyed to your income for VA purposes, lowering that income is what opens the door.1

What you pay an in-home attendant for help with daily activities and household tasks is a deductible medical expense. 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 spouse or child, rising with dependents to $1,141 for a veteran with one dependent, though it is never figured on the aid-and-attendance or housebound increase.1 The expenses also have to be unreimbursed, so whatever insurance or another program pays back does not count.1

Three conditions apply to in-home attendant care specifically. The attendant has to provide health care or custodial care. The payments have to be commensurate with the number of hours the attendant actually attends to the person, so an open-ended monthly sum unrelated to hours worked will not hold up. And the attendant has to be a health care provider, unless the veteran 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 veteran requires the health care or custodial care the attendant provides.1 Those last two exceptions are what let a family hire a non-clinical aide, or a relative, and still deduct the bill.

Say a veteran with no dependents pays $34,000 a year for an aide. Subtract the $872 floor, and about $33,128 can be deducted from countable income. That deduction can take a veteran who looked "over income" and bring them within the limit, and because the payment is the gap between countable income and the rate, a lower countable income also means a larger monthly check.1 So if your income looks too high on paper, apply anyway once care costs are in the picture.

Who Qualifies

To qualify for Aid and Attendance, the veteran must:5

• Not have received a dishonorable discharge.5
• Meet the wartime service requirement. The VA lists three service paths, and which one applies turns on when service began. For active duty that started before September 8, 1980: at least 90 days of active duty with at least one day during a wartime period. For enlisted service that started after September 7, 1980: 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. For an officer who started on active duty after October 16, 1981: the veteran must not have previously served on active duty for at least 24 months.5,1
• 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 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.5
• Need aid and attendance under the criteria at 38 CFR 3.352(a), such as being unable to dress or undress, keep clean and presentable, feed oneself, or attend to the wants of nature, or needing regular care to stay safe from the hazards of daily life. Being bedridden qualifies, as does being a patient in a nursing home because of a loss of mental or physical abilities related to a disability, as does eyesight of 5/200 or less in both eyes or a visual field contracted to 5 degrees or less.5
• Have a net worth below $163,699. The VA's net-worth calculation is the sum of the claimant's and their dependents' assets and their annual income, so comparing assets alone against the limit gives the wrong answer.5 Assets exclude the primary residence, a vehicle, and basic home items such as appliances.1

The VA applies a 3-year look-back on assets transferred for less than fair market value before you file.5 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 North Dakota families want a son, daughter, or other relative to provide the care. The pension arrives as cash, so it can go toward paying that person, and what you pay an in-home attendant counts as a deductible medical expense on the conditions set out above, as long as the payments track the hours the attendant actually works.1 One limit is worth knowing before you plan around it: VA Pension and Aid and Attendance prohibit paying a spouse for the care.3

There is a separate VA program built for this, and it is the one place a spouse can be paid. Veteran-Directed Care (VDC) is a VA Geriatrics and Extended Care program, separate from VA Pension and Aid and Attendance, that gives the veteran a flexible budget to hire and supervise their own workers, including family, friends, and neighbors; unlike VA Pension and Aid and Attendance, VDC has no prohibition on paying a spouse.3 A financial management services provider helps the veteran handle the employer side of hiring. Enrolled veterans qualify if they are eligible for community care, meet the clinical criteria for the service, and it is available where they live; the veteran works with a person-centered options counselor at an Aging and Disability Network Agency, such as an Area Agency on Aging.3

How Aid and Attendance Works with North Dakota Medicaid

Aid and Attendance and North Dakota Medicaid long-term care are separate programs administered by different agencies, the U.S. Department of Veterans Affairs and North Dakota Health and Human Services, and a veteran or surviving spouse can be eligible for both.6

One federal rule dominates the nursing-home case. When an unmarried veteran or surviving spouse with no dependents is receiving Medicaid-covered nursing home care, no pension or survivors pension above $90 a month may be paid for any period after the month the Medicaid payments begin (38 CFR 3.551, implementing 38 U.S.C. 5503(d)).6 That rule caps the pension. It is not a personal needs allowance, and it does not by itself set one; each state's post-eligibility treatment of income decides that, so the $90 must never be assumed to sit on top of a state's personal needs allowance and the two must never be added into a combined figure.6

North Dakota's own rule addresses the $90 directly, and it treats the money as a disregard rather than as a personal needs allowance. Under N.D. Admin. Code § 75-02-02.1-38.1, "Post-eligibility treatment of income," the income that "may be disregarded" includes, "For so long as 38 U.S.C. 5503 remains effective, ninety dollars of veterans administration improved pensions paid to a veteran, or a surviving spouse of a veteran, who has neither spouse nor child, and who resides in a Medicaid-approved nursing facility."6 How that disregard combines with any other allowance North Dakota applies is set by that same state rule, so confirm it with North Dakota Health and Human Services rather than assuming the amounts add.6

North Dakota Medicaid does cover long-term care, including nursing facility services, for eligible residents who meet the state's income and asset limits. Where the pension keeps being paid, because you have a spouse or dependents, say, eligibility is only the first step: income that was disregarded in determining eligibility must be considered in the share-of-cost calculation, so the Aid and Attendance amount does count toward what you owe toward the cost of care in a nursing facility.6 Before any of that income reaches the facility, federal Medicaid rules require the agency to deduct five amounts in this order: a personal needs allowance for you, an amount for the maintenance needs of a spouse still at home, an amount for the maintenance needs of other family members at home, incurred medical or remedial care expenses Medicaid does not cover, and any SSI and state supplement payments you keep receiving.6 Those are deductions North Dakota must make, not benefits you apply for.6 If you are staying at home on a home- and community-based waiver instead, you have a share of cost too, but it is figured under a separate federal rule, so ask North Dakota HHS how yours is set rather than reading the nursing-facility arithmetic across.6 Note that this is a different rulebook from the VA one: the unreimbursed-medical-expense deduction described earlier lowers the income the VA counts, not the income Medicaid counts. Because the rules interact in complex ways and depend on marital status, dependents, and unreimbursed medical expenses, confirm your 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 this guide is about: the VA's own condition is that you may be eligible for Aid and Attendance if you get a VA pension. Everyone on that route files VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner fills out. That same form also covers Aid and Attendance that will be added to monthly compensation, so a veteran who receives VA disability compensation rather than a pension uses it too, and does not use the pension application below. 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. If you are still gathering your information, you can submit VA Form 21-0966 (Intent to File) first: submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive.7 You can file online at VA.gov, by mail to the VA Pension Intake Center, in person at a VA regional office, or through an accredited representative. 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.7

Do not do this alone. North Dakota veterans and their dependents can get free help with VA benefits through the North Dakota Department of Veterans Affairs (NDDVA) and the County and Tribal Veterans Service Officers it trains and supports.4 NDDVA says county service officers provide free, professional assistance with health care, compensation, pensions, long-term care, and burial benefits, with all services provided at no cost to veterans and their dependents, and it describes tribal service officers the same way. Every North Dakota county is legally required to appoint and fund a service officer under NDCC 37-14-18 and 37-14-19. Find your local service officer through the NDDVA website at veterans.nd.gov.4

What if your claim is denied? A denial is not the end. After an initial VA decision you have three decision review options: a Supplemental Claim (file new and relevant evidence the VA did not have before), a Higher-Level Review (a higher-level reviewer looks at the case, with no new evidence submitted), or a Board Appeal (a Veterans Law Judge at the Board of Veterans' Appeals reviews the case). The menu narrows after that: following a Higher-Level Review decision your options are a Supplemental Claim or a Board Appeal, and following a Board decision, a Supplemental Claim or an appeal to the U.S. Court of Appeals for Veterans Claims, which must be filed within 120 days of the date on the Board's decision letter. For most VA benefits, a Higher-Level Review or a Board Appeal has to be elected within one year of the date the VA issues notice of its decision, though some types of VA benefits have time limits shorter than one year and your decision letter tells you which deadline is yours; a Supplemental Claim can be filed at any time after that notice, though the VA recommends filing within one year to keep your effective date. That recommendation carries real money. A Supplemental Claim the VA receives 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)), and continuous pursuit of the claim is broken unless the VA grants an extension of the one-year period for good cause (38 CFR 3.109(b)), so filing late can cost back pay running all the way to your original claim date. File inside the year even though the door stays open. An accredited attorney, claims agent, or Veterans Service Organization representative can help you request a review, and the VA's search tool finds one.8

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 Assisted Living in North Dakota
• How Aid and Attendance Pays for a Nursing Home 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.