VA Aid and Attendance can help a wartime veteran or surviving spouse pay for a nursing home in North Dakota, where a semi-private room now runs into six figures a year. It is a monthly pension benefit, not a nursing-home program, so the money goes to the veteran and can be applied to the bill. This guide explains how much the benefit pays, how nursing-home costs can actually lower your countable income, who qualifies, and the one rule that catches most families off guard: once Medicaid is paying for nursing-facility care, a veteran with neither a spouse nor a child has the VA pension capped at $90 a month.

In This Guide

How Much a Nursing Home Costs in North Dakota

Per the CareScout 2025 Cost of Care Survey (the successor to the Genworth survey, released in 2026 and the most recent state-level data), a semi-private nursing home room in North Dakota runs about $138,335 per year (roughly $11,528 per month), and a private room about $147,643 per year (roughly $12,304 per month), each priced on 365 days of care. Both figures now sit above the national medians of about $114,975 and $129,575, after a year-over-year jump of about 30 percent for the semi-private room and about 27 percent for the private room.

Those figures are why so many North Dakota families look at every benefit a veteran has earned. Aid and Attendance will not cover the full bill, but it can close a meaningful part of the gap and, in combination with Medicaid, change what a family can afford.

How Aid and Attendance Helps Pay for It

Aid and Attendance is an enhanced VA pension benefit. A veteran can qualify through needing another person's help with daily activities like bathing, feeding and dressing, or through being a patient in a nursing home because of the loss of mental or physical abilities related to a disability, among other routes. On the pension route it is not a second check: it is a higher Maximum Annual Pension Rate that replaces the basic rate. The money is paid to the veteran, who can use it toward nursing-home charges.

Category Annual Ceiling
Veteran, no dependents Up to $29,093
Veteran with one dependent Up to $34,488
Surviving spouse, no dependents Up to $18,697

These are 2026 rates, effective December 1, 2025 through November 30, 2026, and the VA publishes them as annual amounts. They are ceilings on the whole pension at the Aid and Attendance rate, not amounts paid on top of it, and the VA pays the difference between your income for VA purposes and the ceiling, so a household with countable income is awarded less than the maximum. Pension is paid monthly, and federal regulation sets the conversion: the VA subtracts your countable income from the annual ceiling, divides the remainder by 12, and rounds the result down to the whole dollar. Against a North Dakota semi-private nursing-home bill of about $138,335 a year, the $29,093 ceiling covers a real slice of the cost, and the benefit is more powerful once you understand how the care bill itself lowers your income for VA purposes.

How Nursing Home Costs Lower Your Countable Income

VA pension, including the Aid and Attendance increase, 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, and for a nursing home the regulation is unconditional. Under 38 CFR 3.278(d)(1), "Payments to hospitals, nursing homes, medical foster homes, and inpatient treatment centers ... including the cost of meals and lodging charged by such facilities, are medical expenses." There is no clinician certification to obtain and no separate test for the room-and-board part of the bill; those conditions belong to the same regulation's rules for in-home attendant care and for assisted living, not to a nursing home. The expenses do have to be unreimbursed to be deductible.

There is a floor. Only the portion of those expenses above 5% of your applicable Maximum Annual Pension Rate (MAPR) is deductible. The VA states the threshold as $872 for a veteran with no spouse or child; the floor rises with dependents, but it never includes the aid-and-attendance or housebound increase.

A nursing-home bill dwarfs that floor. On a $138,335-a-year semi-private room paid out of pocket, the first $872 comes off and roughly $137,463 is deductible, which can bring a veteran who first looked too "high income" back within the limits. A service officer can confirm which of your care costs the VA will count.

Who Qualifies

To qualify for Aid and Attendance, a veteran must meet these tests:

  • Wartime service, with the required length keyed to when active duty began. Someone who started active duty before September 8, 1980 needs at least 90 days of active duty with at least one day during a wartime period. Someone who started active duty as an enlisted person after September 7, 1980 generally needs at least 24 months, or the full period for which they were called or ordered to active duty (with some exceptions), again with at least one day during wartime. A third branch covers an officer who started active duty after October 16, 1981 and had not previously served on active duty for at least 24 months.
  • No dishonorable discharge, plus at least one of four conditions. The veteran must be at least 65 years old, 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 satisfies this test on its own, so a wartime veteran under 65 who receives SSDI or SSI qualifies here without a permanent-and-total rating.
  • Net worth under $163,699 for 2026. The calculation includes the claimant's and dependents' assets and income for VA purposes, and assets exclude the primary residence, the car, and basic home items.
  • A need for aid and attendance, established by the criteria at 38 CFR 3.352(a): being unable to dress or undress, to keep yourself ordinarily clean and presentable, to feed yourself, or to attend to the wants of nature; needing frequent adjustment of a special prosthetic or orthopedic appliance; or needing care or assistance on a regular basis to protect you from hazards or dangers in your daily environment. Being bedridden qualifies on its own, as does being a patient in a nursing home due to the loss of mental or physical abilities related to a disability, as does limited eyesight (5/200 or less in both eyes, or concentric contraction of the visual field to 5 degrees or less).

The VA also looks back at the 36 months before it receives the pension claim: if you transferred an asset for less than fair market value in that window, and keeping it would have pushed your net worth over the limit, the VA will assess a penalty period of up to five years.

The $90/Month Nursing-Home Pension Cap

Here is the rule families miss most often. 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 pension in excess of $90 per month may be paid to or for that veteran for any period after the month of admission to the facility. The same rule reaches a surviving spouse who has no child, under 38 U.S.C. 5503(d)(5)(A). The cap applies to the pension as a whole, Aid and Attendance increase included, and the VA carries it out at 38 CFR 3.551(i). That regulation dates the cap from a different month than the statute does: "for any period after the month in which the Medicaid payments begin." Where Medicaid starts in the month of admission the two match, but for someone admitted as a private payer months before Medicaid began, the gap can be worth several months of pension, so confirm with the VA which date it applied to your award.,

The facility cannot take that $90. Under 38 U.S.C. 5503(d)(3), the payment a nursing facility receives under a Medicaid plan may not be reduced by any amount of pension the veteran is permitted to keep, and the VA says that if it awards the $90 rate, the facility cannot count that monthly payment as income toward the cost of care, so the beneficiary keeps the full $90 for personal expenses.

What the federal cap does not settle is how the $90 lines up with the personal needs allowance a state's Medicaid program deducts in its own post-eligibility calculation. Those are two different rules from two different programs. Whether the retained $90 comes in addition to a state's personal needs allowance or instead of it is governed by that state's own post-eligibility rules and varies from state to state: Rhode Island, for instance, treats the $90 pension as the veteran's personal needs allowance and provides it instead of the allowance non-veteran residents get. North Dakota's own post-eligibility rule, N.D. Admin. Code § 75-02-02.1-38.1, addresses the $90 directly. Among the income that "may be disregarded," it lists, for as long as 38 U.S.C. 5503 remains in effect, $90 of VA improved pension 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. How that disregard combines with the deductions the same rule allows is set by the rule itself. Do not assume the amounts add. Ask North Dakota Health and Human Services or a County or Tribal Veterans Service Officer how it applies to your situation before you plan around a number.

The cap has limits of its own. It applies to Medicaid-covered nursing-facility care for a veteran with neither a spouse nor a child, or a surviving spouse with no child; a beneficiary who has a spouse or dependents, or who is receiving home- and community-based waiver services rather than nursing-facility care, is outside it. It also does not reach a State veterans home for which the VA makes per diem payments for nursing home care, because the statute leaves that kind of home out of the term "nursing facility." A separate federal Medicaid rule, 42 U.S.C. 1396a(r)(1)(B), covers that setting: for a veteran with no spouse or child (or a surviving spouse with no child) who is found eligible for Medicaid, any pension above $90 a month, Aid and Attendance included, is counted as income only for the purpose of applying that excess to the State home's cost of nursing care. Whether a particular North Dakota State veterans home receives that per diem is something to confirm with a Veterans Service Officer, and how the federal rule and North Dakota's own rule work together for a stay there is a question for North Dakota Health and Human Services.

In plain terms: once Medicaid is footing the nursing-home bill, a veteran in this situation does not also keep the full Aid and Attendance payment. The benefit matters most while you are private-paying, or before Medicaid starts.

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, 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. As a general federal rule, however, when an unmarried veteran or surviving spouse with no dependents is receiving Medicaid-covered nursing-home care, the VA pension, Aid and Attendance included, is reduced to no more than $90 a month. Whether that $90 sits alongside North Dakota's Medicaid personal needs allowance or takes its place is a question of state post-eligibility rules, and it is not settled by the federal statute.

One North Dakota specific point matters at the Medicaid eligibility step. In most states, a Medicaid agency deciding whether an aged, blind, or disabled applicant is financially eligible applies SSI income methodologies (42 CFR 435.601), and under those methodologies VA aid and attendance and housebound allowances are not income (SSA POMS SI 00830.308). North Dakota is one of the eight states the Social Security Administration identifies as using eligibility criteria more restrictive than SSI, the so-called 209(b) states, so North Dakota's own rule governs whether it counts a VA Aid and Attendance allowance at that step. Ask North Dakota Health and Human Services how yours will be treated rather than assuming the general rule.

North Dakota Medicaid does cover long-term care, including nursing-facility services, for eligible low-income residents who meet the state's income and asset limits. 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. Because North Dakota is a 209(b) state, the federal rule for the share-of-cost step is 42 CFR 435.733, which says that "Income that was disregarded in determining eligibility must be considered in this process," so that income is reached when Medicaid works out what the resident owes the facility, not only at eligibility. Exactly how North Dakota treats a full-rate Aid and Attendance amount at that step is not spelled out in the rules above, so confirm it with North Dakota Health and Human Services. North Dakota's own rule sets the deductions, in this order, before income goes toward the cost of care: the nursing care income level; amounts provided to a spouse or family member for maintenance needs; health insurance premiums; long-term care insurance premiums for the resident or spouse; documented medical or remedial care expenses not payable by any third party, including Medicaid and Medicare; and the cost of a guardian or conservator, capped at five percent of countable gross monthly income. What the resident applies toward the bill is what remains after all six. Those are deductions the state makes, not benefits a family applies for. That rule covers nursing facilities and other institutional settings, not home- and community-based waiver services, so for someone receiving waiver services at home, ask North Dakota HHS how Aid and Attendance is treated. 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 Health and Human Services before relying on both.

How to Apply and Get Free Help

The steps here describe the pension route, the one this guide is about: the VA says you may be eligible for this benefit if you get a VA pension. VA 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 a pension pursues it on the compensation side and does not use the pension application below.

Apply using VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner completes to document the need for care. A wartime veteran on the pension route who is not already receiving VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application. A nursing-home claim also requires VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance). Forms can be submitted online at VA.gov, by mail to the VA Pension Intake Center, in person at a VA regional office, or through an accredited representative. Asked how long a decision takes, the VA answers, "It depends," and adds that it processes claims in the order it receives them unless a claim requires priority processing.

Do not do this alone. North Dakota veterans and their dependents can get free help with VA benefits from County and Tribal Veterans Service Officers, who are trained and supported by the North Dakota Department of Veterans Affairs (NDDVA). NDDVA says County service officers provide free, professional assistance with health care, compensation, pensions, long-term care, and burial benefits, at no cost to veterans and their dependents, and every North Dakota county is legally required to appoint and fund a service officer. State law also lets one officer serve more than one county, so do not assume there is a staffed office in your own county; call ahead. NDDVA itself also provides personalized assistance with claims. Find your local County or Tribal service officer through the NDDVA website at veterans.nd.gov. You can also reach the VA benefits hotline at 800-827-1000 (TTY: 711), Monday through Friday.

If Your Claim Is Denied

A denial is not the end. If you disagree with a VA pension decision, you have three decision review options: file a Supplemental Claim with new and relevant evidence, request a Higher-Level Review by a higher-level reviewer, or appeal to the Board of Veterans' Appeals. For most VA benefits, a Higher-Level Review or Board Appeal must be requested within one year of the date on your decision letter, and the letter itself states your deadline. A Supplemental Claim can be filed at any time, but the year still matters: under 38 CFR 3.2500, a Supplemental Claim received more than one year after the decision notice takes an effective date no earlier than the date the VA receives it, so filing inside the year is what keeps your earlier effective date., The same County or Tribal service officer who helped with your claim can help here too, at no cost.

Frequently Asked Questions

Does the VA pay for a nursing home in North Dakota?

Not through Aid and Attendance. Aid and Attendance is an enhanced VA pension benefit paid to the veteran, who applies it toward the nursing-home bill. It is money you direct, not a facility.

How much will Aid and Attendance pay toward a North Dakota nursing home?

Up to $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, paid in monthly installments. Those are ceilings on the whole pension at the Aid and Attendance rate, not amounts paid on top of it. Against a semi-private nursing-home cost of about $138,335 a year in North Dakota, it covers part of the bill, not all of it.

What happens to Aid and Attendance once Medicaid pays for the nursing home?

For a veteran with neither a spouse nor a child on Medicaid-covered nursing-facility care, federal law caps the VA pension at $90 a month (the statute starts the cap after the month of admission; the VA's regulation, after the month Medicaid payments begin). The facility cannot count that $90 toward the cost of care, so the beneficiary keeps it for personal expenses. Whether it arrives on top of North Dakota's Medicaid personal needs allowance or in place of it turns on state post-eligibility rules, which vary, so confirm it with North Dakota Health and Human Services.

Can a nursing-home bill help a "high income" veteran qualify?

Yes. The VA lets you deduct unreimbursed medical expenses, including a nursing home's charges for meals and lodging, but only the amount above 5% of your MAPR, which the VA states as $872 for a veteran with no spouse or child. A large care bill can reduce your income for VA purposes enough to qualify someone who first appeared over the limits.

Compare Care Settings in North Dakota

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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