VA benefits for senior care in North Dakota cover more than most families realize. If your loved one is a veteran, the VA offers home-based medical care, nursing homes, monthly cash payments, and more. The challenge usually isn't eligibility. It's knowing what to ask for.

This guide covers every VA program that helps pay for or provide senior care, how to access them in North Dakota, and what happens when VA care isn't enough on its own.

In This Guide

VA Senior Care Benefits in North Dakota: Long-Term Care Options

The VA offers multiple long-term care programs. Access isn't automatic once a veteran is enrolled: VA also has to conclude the veteran needs that specific service for their ongoing treatment and personal care, and the service, or a space in the care setting, has to be available near them. That test isn't closed: VA says it may also consider other factors, like the veteran's service-connected disability status or insurance coverage.

Home Based Primary Care (HBPC)

A VA doctor-led health care team provides services such as nursing care, physical therapy, and help with daily tasks in the veteran's home.

This isn't the same as home health care through Medicare. Ask the veteran's VA care team whether HBPC is available where they live.

Adult Day Health Care

Veterans attend a structured daytime program that provides social activities, companionship, recreation, care, and support. Attending an adult day health care program is also one of the ways VA delivers home respite, so it gives a family caregiver a daytime break. Like VA's other long-term care, it may be run by VA or by a state or community organization.

Community Living Centers (VA Nursing Homes)

Community Living Centers are VA nursing centers designed to feel like home, providing nursing-home-level care. Stays can be short-term or long-term, and a CLC is also one of the places VA provides overnight respite care.

For North Dakota veterans, the nearest CLC may be at a VA medical center in the region. Your VA social worker can help you find the closest option and confirm eligibility.

Community Nursing Home Program

The VA contracts with community (non-VA) nursing homes so veterans can get nursing home care near home. Whether VA benefits help pay for nursing home care depends on the veteran's income and the level of their service-connected disability. Some veterans are exempt from the extended-care copay; for one who isn't, there's no copay for the first 21 days of care in a 12-month period, and starting on the 22nd day the VA bases the copay on the level of care being received and the financial information provided on the Application for Extended Care Services (VA Form 10-10EC). In a largely rural state like North Dakota, this program matters: it lets a veteran receive nursing home care closer to home rather than traveling far to a VA facility.

Respite Care

All enrolled veterans are eligible for VA respite care if they meet the clinical criteria for the service and it is available. If the respite comes from a community agency, an adult day health care center, or a nursing home, the veteran also has to meet community care eligibility, and VA may charge a respite copay based on service-connected disability status and financial information. Through the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC), eligible Primary Family Caregivers receive at least 30 days of respite care per year. Respite can be in-home (a substitute caregiver comes to the house, or the veteran attends an adult day health care program) or a short stay in a CLC or community nursing home, and VA's 2026 copay page describes both overnight and daily respite care as available up to 30 days each calendar year. To learn more or apply, contact the veteran's VA social worker or case manager. Family caregivers can also call the VA Caregiver Support Line at 1-855-260-3274, Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.

Not sure which VA program fits your family's situation? Chat with Brevy to get a personalized recommendation.

North Dakota Veterans Home

North Dakota operates one State Veterans Home, the North Dakota Veterans Home, located at 1600 Veterans Drive in Lisbon, on a 90-acre wooded campus bordering the Sheyenne River. It has served honorably discharged veterans and their spouses since 1893, and provides two levels of long-term care across 142 private rooms and 4 semi-private rooms, each with its own bathroom.

Care Level Details
Basic Care For residents who independently care for their own needs; requires total independence with personal care such as bathing, dressing, eating, walking, toileting, and transferring, with medical and nursing supervision available; 98 beds
Skilled Care Nursing home care for residents who need ongoing nursing supervision or help with activities of daily living; a licensed Medicare/Medicaid provider; 52 beds

The bed counts above are the ones the Home publishes on its own site; the North Dakota Department of Veterans Affairs lists a different split (111 basic care and 38 skilled nursing beds). Admission rules come from state law and the Home's admissions rules: an applicant generally must be a bona fide North Dakota resident, must apply formally, and needs approval from the Home's board of admissions. Contact the North Dakota Veterans Home directly for current availability, rates, and admission policies.

VA Aid and Attendance

The Aid and Attendance pension is a monthly cash benefit for veterans (or surviving spouses) who need help with daily activities.

2026 Rates

The VA publishes these as maximum annual pension rates, ceilings rather than payments. Its regulations turn them into a monthly payment: your ceiling minus your countable income, divided by 12, then rounded down to the whole dollar (38 CFR 3.273 and 3.29(b)).

Category Maximum Annual Rate
Veteran alone $29,093
Veteran with spouse $34,488
Surviving spouse $18,697

Who Qualifies

To be eligible, the veteran must:

  • Have served during a wartime period
  • Have no dishonorable discharge
  • Meet at least one of four conditions: 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
  • Meet at least one aid-and-attendance need: needing another person's help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend much of the day in bed, because of illness; being in a nursing home because of a disability-related loss of mental or physical abilities; or having severely limited eyesight
  • Have a net worth below $163,699. VA's net worth calculation includes the claimant's and their dependents' assets and their income for VA purposes, so comparing assets alone against the limit gives the wrong answer; the primary home isn't counted,

The VA enforces a 3-year look-back period on asset transfers.

How to Apply

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, and, if the veteran isn't already receiving a VA pension, Form 21P-527EZ (Application for Veterans Pension). The VA does not publish an expected processing time for these claims; it works through them in the order it receives them, unless a claim qualifies for priority processing.

Don't do this alone. The North Dakota Department of Veterans Affairs and the County and Tribal Veterans Service Officers it trains and supports provide free help with VA claims, including pensions and long-term care benefits, at no cost to veterans and their dependents.

For the full application walkthrough, see our VA Aid and Attendance guide.

Veteran-Directed Care

The Veteran-Directed Care (VDC) program gives enrolled veterans of all ages a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers to help them live at home or in their community.

Veterans may hire family, friends, and/or neighbors to provide services. VA medical centers deliver VDC through aging and disability network agencies, such as area agencies on aging; through an options counselor, the agency helps with assessment and care planning, arranges fiscal management services, and provides ongoing counseling and support. Enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria, and the service is available. This is a good option for veterans who want control over their care and prefer family members as caregivers.

Contact your local VA medical center's social work department to ask about VDC availability in your area and to confirm who may be hired.

Community Care Through the MISSION Act

The VA MISSION Act of 2018 has, since 2019, let an enrolled veteran get care from a community (non-VA) provider at the VA's expense. Two requirements always apply: you must be enrolled in or eligible for VA health care, and you must have approval from your VA health care team before you get care from a community provider, except in certain cases like urgent or emergency care. At least one of six additional conditions must also be true, including:

  • You've asked the VA for the care and it can't schedule it within its wait-time standard: 20 days (primary care, mental health, and extended outpatient care) or 28 days (specialty care), unless you agreed to a later date
  • You've asked the VA for the care and it can't schedule it within its drive-time standard: a 30-minute average drive (primary care, mental health, and extended outpatient care) or 60 minutes (specialty care), an average driving time the VA calculates from your home with mapping software, not your own measured trip
  • The service you need isn't provided at any VA health facility
  • You and your VA provider agree that care from an in-network community provider is in your best medical interest
  • You qualified under the 40-mile distance requirement as of June 6, 2018, and you live in North Dakota (the same condition covers Alaska, Montana, South Dakota, Wyoming, or another location that would still make you eligible under those requirements)

On May 19, 2025, the VA streamlined the "best medical interest" pathway by implementing language in the Dole Act (Public Law 118-210, enacted January 2, 2025) that removes the extra step of review by a second VA doctor, giving eligible veterans faster access to community care.

For North Dakota veterans in rural areas far from a VA medical center, the MISSION Act can be the difference between getting timely care and waiting months.

How VA Senior Care Benefits in North Dakota Work with Medicare and Medicaid

VA benefits don't replace Medicare or Medicaid, a veteran isn't required to enroll in Medicare to keep VA health care, and a veteran or surviving spouse can qualify for and receive a VA pension and Medicaid at the same time., VA doesn't bill Medicare or Medicaid, and Medicare and the VA generally can't pay for the same items or services, so each time you get care you choose which benefit to use. VA health care is also no shield against Medicare's Part B late-enrollment penalty. The VA warns that if you delay Part B and then have to sign up later, because you lose your VA health care or need more choice in care options, you'll pay a penalty that gets bigger every year you delayed and that you pay for the rest of your life.

  • VA + Medicare: Many veterans have both. Medicare pays for Medicare-covered services, and the VA pays for VA-authorized care in a VA or non-VA facility. If the VA authorizes a non-VA hospital stay but not every service you get during it, Medicare may pay for the Medicare-covered services the VA didn't authorize.
  • VA + North Dakota Medicaid: Aid and Attendance and North Dakota Medicaid long-term care are separate programs run by different agencies, and a veteran or surviving spouse can be eligible for both. North Dakota Medicaid does cover long-term care: North Dakota Health and Human Services provides nursing facility services to Medicaid-eligible residents who require regular or daily services of a licensed nurse, and whether a particular person is eligible is decided under the state's own rules (N.D. Admin. Code ch. 75-02-02.1). One important federal rule: when a veteran with no spouse or child, or a surviving spouse with no child, is receiving Medicaid-covered nursing home care, no VA pension (including Aid and Attendance) in excess of $90 per month will be paid to or for the beneficiary for any period after the month in which the Medicaid payments begin (38 CFR 3.551). The statute behind that cap excludes a State home for which the VA makes per diem payments for nursing home care, so check a North Dakota Veterans Home stay against that definition with an accredited Veterans Service Officer rather than assume the $90 cap applies. A separate federal Medicaid rule covers a State veterans home that does receive that VA per diem: for a veteran with no spouse or child (or a surviving spouse with no child) on Medicaid there, any pension above $90 a month, Aid and Attendance included, is counted as income only to apply that excess to the home's cost of nursing home care (42 U.S.C. 1396a(r)(1)(B)). Confirm with North Dakota Health and Human Services how that rule and North Dakota's own rule apply together to a stay., The $90 cap limits the pension; it does not itself set North Dakota's Medicaid personal needs allowance, which is fixed by the state's own post-eligibility rule. North Dakota's rule, N.D. Admin. Code § 75-02-02.1-38.1 ("Post-eligibility treatment of income"), lists among the income that may be disregarded, 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. 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. North Dakota is one of the eight states that use Medicaid eligibility rules more restrictive than SSI, so the federal post-eligibility section that reaches it is 42 CFR 435.733, not 42 CFR 435.725, and it carries the same instruction: income disregarded in deciding eligibility must be considered in the share-of-cost calculation. So where the pension keeps being paid (to a beneficiary with a spouse or dependents, say), the Aid and Attendance amount is considered again at the share-of-cost step, not only at eligibility, and whether it raises what the resident owes turns on North Dakota's own post-eligibility rule. North Dakota's own rule sets what a nursing-facility resident applies toward the cost of care: what remains after six deductions, taken in this order: 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 their spouse, documented medical or remedial care expenses that no third party (Medicaid and Medicare included) will pay, and the cost of a guardian or conservator, up to 5% of countable gross monthly income. That rule covers nursing facilities and other institutional settings, not home and community-based waiver services, so it doesn't settle how Aid and Attendance is treated for someone receiving waiver services at home. Confirm both with North Dakota Health and Human Services before planning around a figure.,

Because these 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 benefits.

How to Get Started

1
Step 1

Confirm VA health care enrollment

If the veteran isn't already enrolled in VA health care, apply at va.gov/health-care/how-to-apply. Once you're enrolled, the VA assigns you to one of eight priority groups based on military service history, disability rating, income level, whether you qualify for Medicaid, and other benefits you may be receiving, with veterans who have service-connected disabilities assigned the highest priority. Some veterans are exempt from copays because of their disability rating, income level, or special eligibility factors.

2
Step 2

Get free help before you file

Don't file claims or applications alone. The North Dakota Department of Veterans Affairs provides personalized assistance with claims (find your local service officer at veterans.nd.gov), as do the County and Tribal Veterans Service Officers it trains and supports, who provide free, professional assistance with health care, compensation, pensions, long-term care, and burial benefits at no cost to veterans and their dependents.

3
Step 3

Gather records

You'll need the veteran's DD-214 (discharge papers), medical records documenting the need for care, and financial information. If you can't find the DD-214, the National Personnel Records Center can provide copies (request through va.gov).

Frequently Asked Questions

Do you have to be service-connected disabled to get VA long-term care?

Not for all programs. The VA assigns veterans with service-connected disabilities the highest priority, and the lowest priority to veterans who earn a higher income and have no service-connected disability. Priority Group 1, the highest, covers a service-connected disability the VA has rated 50% or more disabling, a service-connected disability the VA has concluded makes the veteran unable to work, or receipt of the Medal of Honor. Some veterans are exempt from copays because of their disability rating, income level, or special eligibility factors. But other enrolled veterans can access many programs too, depending on their priority group and available resources. Aid and Attendance doesn't require a service-connected disability at all. It requires wartime service, no dishonorable discharge, a qualifying need for aid and attendance (such as needing another person's help with daily activities), and at least one of these: 65 or older, permanently and totally disabled, a patient in a nursing home for long-term care because of a disability, or receiving Social Security Disability Insurance or Supplemental Security Income.

Can a veteran's spouse live in the North Dakota Veterans Home?

Yes, if they meet the admission rules. The North Dakota Veterans Home has cared for honorably discharged veterans and their spouses since 1893, and under state law the spouse or surviving spouse of an eligible veteran may be admitted on the same footing as the veteran. Every applicant still has to apply formally and be approved by the Home's board of admissions. Contact the Home directly for current admission policies.

How long does it take to get Aid and Attendance approved?

The VA does not publish an expected processing time for these claims; it works through them in the order it receives them, unless a claim qualifies for priority processing. A North Dakota County or Tribal Veterans Service Officer can help you prepare and file the claim at no cost. You can apply while your loved one is already receiving care.

Does the VA pay for assisted living?

The VA doesn't directly operate assisted living facilities, but Aid and Attendance is paid to the veteran as an increase to the monthly VA pension, and the household can put that money toward assisted living. Assisted living fees can also count as deductible medical expenses when VA calculates the award. Care from a health care provider counts, and help with daily activities from other staff counts if the veteran is receiving health care or custodial care in the facility and either needs aid and attendance, is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist has stated in writing that they need to be in a protected environment. Meals and lodging have a separate test, and only medical expenses above 5% of the veteran's basic pension rate are deducted ($872 for a veteran with no spouse or child). Veteran-Directed Care is a different tool: its flexible budget is for hiring and supervising workers who help a veteran live at home or in their community, so ask the VA social worker making the referral whether it fits an assisted living plan. The North Dakota Veterans Home's Basic Care unit is a different thing: it is designed for residents who care for their own needs independently, requiring total independence with bathing, dressing, eating, walking, toileting, and transferring, so it isn't a substitute for assisted living once hands-on help is needed.

Next Steps

If you're caring for a veteran who needs help, start by finding your local County or Tribal Veterans Service Officer through the North Dakota Department of Veterans Affairs at veterans.nd.gov. They can assess which benefits apply and help you file, free of charge.

Learn More

VA BenefitsVA benefits for senior care nationwideA 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. VA BenefitsVA Aid and Attendance in North DakotaVA Aid and Attendance in North Dakota for 2026: who qualifies, pension ceilings up to $34,488 a year, how to apply, and free help from local service officers. VA BenefitsNorth Dakota Disabled Veteran Property Tax CreditNorth Dakota's disabled veteran property tax exemption is a credit: a 50%+ VA rating cuts up to $9,000 of taxable value. Who qualifies, survivors, SFN 24770. Care TypesHome Care vs Home Health in North DakotaHome care vs. home health in North Dakota: home health is skilled care Medicare covers; home care is non-medical help it won't. It decides who pays. Care TypesNursing Homes in North DakotaNursing homes in North Dakota in 2026: a semi-private room runs about $138,335/year, above the national median. What it costs, who pays, and how to choose. Care TypesCost of Senior Care in North DakotaWhat senior care costs in North Dakota in 2026: assisted living about $56,745 a year, a nursing home about $138,335. See every setting and how to pay. Care TypesAssisted Living vs Nursing Home in North DakotaAssisted living vs. nursing home in North Dakota: about $4,729/mo private-pay assisted living vs. $138,335/year skilled nursing, and who pays differs sharply.
Your next step Find personalized help navigating VA senior care benefits in North Dakota 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.

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