VA Aid and Attendance for Memory Care in North Dakota

VA Aid and Attendance can raise a wartime veteran's maximum VA pension to $29,093 a year, money that can go toward memory care in North Dakota.1 Many veteran families never realize the money is there. It's a monthly cash benefit, paid directly to the veteran or surviving spouse, that you can spend on the cost of a dementia care community. When a parent's Alzheimer's or dementia means they need a secure setting and around-the-clock supervision, that benefit can be the difference between affording the right care and settling for less.

This guide walks through what Aid and Attendance pays in 2026, why veterans with dementia so often qualify, how memory care costs can actually help you qualify, who's eligible, how it works alongside North Dakota Medicaid, and how to apply with free help.

In This Guide

• Key Takeaways
• How Much Memory Care Costs in North Dakota
• How Aid and Attendance Helps Pay for Memory Care in North Dakota
• Why Veterans With Dementia Often Qualify
• How Memory Care Costs Lower Your Countable Income for Aid and Attendance in North Dakota
• 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 Memory Care Costs in North Dakota

In North Dakota, memory care isn't a license of its own. It's a service a facility gets approved to provide inside an existing license: a basic care facility or unit that admits only residents with Alzheimer's, dementia, or special memory care needs must have written approval from the Department of Health and Human Services before it provides that care.5 No survey publishes a North Dakota memory-care median either. The closest published benchmark is standard assisted living, which runs about $4,729 a month ($56,745 a year) for a private one-bedroom in the CareScout 2025 Cost of Care Survey, well below the national median.2

Ask each community for its all-in monthly memory care rate in writing. The state's rule separates a secured facility or unit, which uses restricting devices to keep residents from leaving freely, from an unsecured one, so ask which kind you're looking at, how staff are trained for dementia care, and how the community plans for wandering.5 Whatever the bill comes to, Aid and Attendance is one of the benefits that can help pay it.

How Aid and Attendance Helps Pay for Memory Care in North Dakota

Aid and Attendance is an increased rate of the VA pension paid to veterans, and surviving spouses, who need help with daily activities.1 VA benefit payments are tax-free, and the pension is paid to the veteran or surviving spouse, so you can apply it straight to a memory care bill.3

Here are the 2026 maximum annual pension rates, at the basic level and with Aid and Attendance, effective December 1, 2025 through November 30, 2026:1

The VA publishes these rates as annual amounts. Pension is paid monthly, and the monthly rate is the maximum minus the income the VA counts, divided by 12 and rounded down to the whole dollar.1

Set the rates against the cost of care. Even at the full $29,093 a year, Aid and Attendance covers part of a North Dakota memory care bill, not all of it: standard assisted living alone has a median of $56,745 a year here.1,2 The benefit doesn't have to cover the whole cost to be worth claiming, and it stacks with Social Security, a private pension, or family contributions, though income the VA counts is the same income that reduces the award, so run the arithmetic on your own household rather than assuming the maximum.

One thing to be clear about: the VA does not run memory care facilities and does not pay a community directly. Aid and Attendance pays the veteran, and the family uses that money toward care.

Why Veterans With Dementia Often Qualify

Aid and Attendance is keyed to a care need, and the claimant must meet at least one of four tests: needing another person's help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large part of the day in bed, because of illness; being a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or very limited eyesight (5/200 or less in both eyes even with glasses or contacts, or a visual field of 5 degrees or less).4 In judging the need for help, the VA also weighs a physical or mental incapacity that requires care or assistance on a regular basis to protect the person from the hazards of daily life, and the need has to be regular, not constant.4

That is exactly the situation a veteran with Alzheimer's or another dementia is usually in. As the disease progresses, a person needs help with daily tasks and supervision to stay safe, which is the very reason a family turns to memory care. There is no separate dementia rule and no diagnosis that automatically grants the benefit, but the functional need that dementia creates is the kind of need Aid and Attendance is meant to address. A medical examiner documents that need on the application.

How Memory Care Costs Lower Your Countable Income for Aid and Attendance in North Dakota

This is the part most families miss, and it's where memory care and Aid and Attendance fit together in a way that surprises people.

The VA pension is needs-based: to be eligible, your yearly family income and net worth have to meet limits set by Congress.1 Because the benefit is keyed to your income for VA purposes, you can lower that income by deducting unreimbursed medical expenses.

Under the VA's rule for a care facility other than a nursing home, which covers assisted living and memory care, the fees can count as those medical expenses, on that rule's own conditions.1 Payments for help with daily activities count when the resident is receiving health 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 person needs to be in a protected environment (38 CFR 3.278(d)(3)).1 Meals and lodging count too when the facility provides or contracts for that care, or a clinician states in writing that the person must live in the facility to receive it. The facility must be licensed if the state requires its type to be, and a residential one must be staffed 24 hours a day with care providers.1 Dementia care, delivered in a protected setting, often fits these conditions, but check each one rather than assuming the whole bill is deductible.

There's one rule to know: only the portion of those expenses above 5% of the applicable MAPR is deductible.1 For 2026, that 5% floor is $872 per year for a veteran with no spouse or child, and it rises with dependents, though never with the aid-and-attendance or housebound increase.1 Even North Dakota's median for standard assisted living, $56,745 a year, runs far above that floor, so a veteran whose income looks too high on paper may still qualify once qualifying care costs are deducted, because those costs can sharply reduce countable income.2,1

Who Qualifies

To be eligible for Aid and Attendance, the veteran must:4

• Have qualifying wartime service: how much service is needed depends on when active duty began. A veteran who started before September 8, 1980 needs at least 90 days of active duty; an enlisted veteran who started after September 7, 1980 generally needs at least 24 months or the full period called to active duty (a separate rule covers an officer who started after October 16, 1981 without 24 months of earlier active duty). Either way, at least one day must fall during a wartime period, such as World War II, the Korean conflict, the Vietnam era, or the Gulf War (August 2, 1990 to a future date set by law or presidential proclamation).
• Not have a dishonorable discharge.
• Meet at least one of four status 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, so a wartime veteran under 65 who receives SSI qualifies on that basis alone, with no disability rating.
• Meet at least one care-need test: needing another person's help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large part of the day in bed, because of illness; being a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or very limited eyesight.
• Have a net worth under $163,699 for 2026, counting assets and annual income but excluding your primary residence, your car, and basic home items.4

Note that you do not need a service-connected disability to qualify.4 The VA also applies a 3-year look-back on assets transferred for less than fair market value before you file, with a penalty period that can run up to five years, so don't give away or move assets to qualify without getting advice first.4

How Aid and Attendance Works with North Dakota Medicaid

Aid and Attendance and North Dakota Medicaid are separate programs, run by different agencies, and a veteran or surviving spouse can be eligible for both.6 North Dakota Medicaid, administered by North Dakota Health and Human Services, covers long-term care, including nursing facility services, for eligible low-income residents who meet the state's income and asset limits.6

If your loved one later moves to a nursing facility on Medicaid, one federal rule matters a great deal. When Medicaid covers nursing facility care for a veteran with no spouse or child, or a surviving spouse with no child, the VA can pay no more than $90 a month in pension, Aid and Attendance included, for any period after the month Medicaid payments begin, and that $90 may not be used to reduce what Medicaid pays the facility.6 That $90 is a cap on the pension, not a Medicaid personal needs allowance. North Dakota's own post-eligibility rule lets $90 of VA improved pension be disregarded for a veteran or surviving spouse with neither spouse nor child in a Medicaid-approved nursing facility, and how that combines with the state's other deductions is set by the same rule, so ask North Dakota HHS rather than adding amounts together.6 The cap doesn't apply to a veteran with a spouse or child, or a surviving spouse with a child. It also doesn't reach a State home for which the VA pays a nursing-home per diem; in such a State veterans home, pension above $90 counts as income only toward the home's cost of the veteran's care. Whether a stay in a particular North Dakota state veterans home falls under that exception is something to check with an accredited Veteran Service Officer rather than assume.6

Where the pension keeps being paid in full, for example to a beneficiary with a spouse or dependents, eligibility is only the first step. Federal rules say income disregarded when eligibility was decided must be considered again when a nursing-facility resident's share of the cost of care is figured, so the Aid and Attendance amount is considered at that step too. How North Dakota treats a full-rate Aid and Attendance amount there is a question to put to North Dakota HHS before you budget.6 Not all of a resident's income reaches the facility. North Dakota's rule allows six deductions, in this order: the nursing care income level, amounts for a spouse's or family member's maintenance needs, health insurance premiums, long-term care insurance premiums for the resident or spouse, documented medical or remedial care expenses no third party pays (including Medicaid and Medicare), and the cost of a guardian or conservator, capped at 5% of countable gross monthly income. What the resident applies to the cost of care is what remains after all six.6 That rule covers nursing facilities and similar institutional settings, not home- and community-based waiver services, so someone getting waiver services at home should ask North Dakota HHS how Aid and Attendance is treated in their case.6 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

You apply for Aid and Attendance with two VA forms:7

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), with the examination information section filled out by a medical examiner documenting the need for help.
• VA Form 21P-527EZ (Application for Veterans Pension), if the veteran isn't already receiving a VA pension.

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.7 Asked how long a decision takes, the VA's Aid and Attendance page answers, "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.7 You can apply while your loved one is already living in memory care.

Don't 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 help with VA benefits to veterans and their dependents.8 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, 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, though one officer may serve more than one county, so yours may not have an office inside your own county. State law also gives a newly appointed county officer up to twelve months to become accredited, so ask whether yours is accredited before they prepare a federal claim.8 You can find your local service officer through the NDDVA website at veterans.nd.gov.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 In-Home 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.