VA Aid and Attendance can help pay for a nursing home in Ohio, where a semi-private room runs about $110,230 a year. The benefit can bring a veteran's pension up to a maximum of $29,093 a year, and because nursing home fees count as a deductible medical expense, the cost of care can also lower the income the VA uses to set your payment. For Ohio families pricing out long-term care, that pairing is worth knowing.

This guide explains what Aid and Attendance pays, how nursing home costs lower your countable income, who qualifies, the federal rule that caps the pension at $90 a month once Medicaid covers the bed, and how to apply with free help.

In This Guide

How Much a Nursing Home Costs in Ohio

Nursing home care in Ohio is a major expense, though it sits below the national median. The median semi-private room costs $110,230 a year, or about $9,186 a month. A private room runs higher, at a median of $124,666 a year (roughly $10,389 a month).

Both figures run below the national medians of $114,975 a year for a semi-private room and $129,575 for a private room; the CareScout 2025 Cost of Care Survey ranked Ohio 34th among states for a semi-private nursing home room. Even so, that bill drains a typical retirement income quickly, which is why families look hard at every benefit a veteran has earned.

How VA Aid and Attendance Helps Pay for an Ohio Nursing Home

Aid and Attendance is the VA's needs-based pension paid at a higher maximum rate for veterans (or surviving spouses) who need help with daily activities or live in a nursing home because of physical or mental incapacity, so the maximums in the table below cover the whole pension, not an Aid and Attendance amount stacked on the basic rate., It is paid as monthly cash, so the money can go straight toward the nursing home bill.

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

The VA publishes these as annual rates, but it pays the pension monthly: under 38 CFR 3.273, the monthly payment is the annual rate minus your countable income, divided by 12. These are ceilings, not payments: the maximum annual pension rate is the most pension the VA can pay, and because the pension is needs-based, the VA pays the difference between your income for VA purposes and that limit, so your actual payment depends on your income after allowed deductions. The next section explains why a nursing home bill usually pushes that payment toward the top of the range.

How Nursing Home Costs Lower Your Countable Income

The VA pension, including its Aid and Attendance increase, is needs-based: to be eligible, your yearly family income and net worth have to fall inside limits set by Congress. Because the benefit is keyed to the income the VA counts, you can shrink that income by deducting unreimbursed medical expenses (UMEs), and a nursing home bill is exactly that kind of expense.

There is a floor: only the portion of your UMEs that exceeds 5% of your applicable maximum annual pension rate (MAPR) is deductible, under 38 CFR 3.272. As the VA puts it, "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)." The floor rises if you have dependents, but it never includes the Aid and Attendance or housebound increase. The floor is annual, not monthly.

Here is why this matters in Ohio. A nursing home bill of roughly $110,230 a year dwarfs the $872 floor, so nearly the entire cost is deductible. For most residents, that wipes out countable income entirely and pushes the Aid and Attendance payment to the maximum. A veteran whose income looked too high to qualify on paper can still qualify once the nursing home cost is subtracted.

Who Qualifies

To receive Aid and Attendance, the veteran must meet all of these:

  • Wartime service: at least one day of active duty during a recognized wartime period, plus at least 90 days of active duty if service began before September 8, 1980; an enlisted person who started after September 7, 1980 generally needs 24 months or the full period called or ordered to active duty.
  • No dishonorable discharge, plus at least one of four: 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. Any one of the four satisfies this test, so a wartime veteran under 65 who receives SSI qualifies on it without a permanent-and-total rating.
  • Net worth under $163,699 for 2026, a limit the VA calculates from the claimant's and their dependents' assets and income for VA purposes, excluding the primary home, a vehicle, and basic household goods; comparing assets alone against the limit gives the wrong answer.
  • A care need: help with daily activities such as bathing, dressing, or feeding; being bedridden; or being a nursing home patient because of mental or physical incapacity.

The VA also applies a 3-year look-back on assets transferred for less than fair market value before filing, with a penalty period that can run as long as five years. Aid and Attendance does not require a service-connected disability.

The $90/Month Nursing-Home Pension Cap

This is the rule that surprises most families, and you need to understand it before you apply. When a veteran with no spouse or child is covered by Medicaid for nursing facility care, federal law limits the VA pension to no more than $90 a month; the same limit applies to a surviving spouse with no child. That cap comes from 38 U.S.C. 5503(d)(2), with the surviving-spouse extension at 5503(d)(5)(A), carried out in 38 CFR 3.551(i). The two texts date the cap differently: the statute applies it after the month of admission to the nursing facility, while the regulation applies it after the month Medicaid payments begin, so a veteran who entered as a private payer should check which date VA used on their own award.

Which facilities the cap reaches turns on a definition inside the statute rather than on the everyday sense of a nursing home. For purposes of that subsection, 38 U.S.C. 5503(d)(1)(B) defines a nursing facility as one described in section 1919 of the Social Security Act, "other than a facility that is a State home with respect to which the Secretary makes per diem payments for nursing home care pursuant to section 1741(a) of this title", and 38 CFR 3.551(i) states the rule without repeating that definition. So if the veteran lives in a state veterans home, have an accredited service officer check the stay against the statutory definition rather than assume the cap applies., Where VA does pay that per diem, a separate federal Medicaid rule, 42 U.S.C. 1396a(r)(1)(B), applies to a veteran with no spouse or child (or a surviving spouse with no child) whose pension runs above $90 a month: any pension in excess of $90, including Aid and Attendance, is counted as income only to apply that excess to the State home's cost of nursing home care.

VA says that where it pays the $90 rate, the facility can't count that payment as income toward the cost of care, and the veteran keeps the full $90 for personal expenses; federal law also bars the Medicaid payment to the facility from being reduced by it. In Ohio, that $90 is also left out of the resident's patient liability, as the next section explains. The practical takeaway: Aid and Attendance is most valuable while the veteran is paying privately or through other means. Once Medicaid is footing the nursing home bill for a veteran with no spouse or child, the pension drops to $90. A veteran with a spouse or child, or a surviving spouse with a child, is outside this specific cap, which is one reason the timing of each application deserves professional review.

How VA Aid and Attendance for a Nursing Home Works with Ohio Medicaid

Aid and Attendance is a federal VA benefit. Ohio Medicaid is administered separately, with different agencies, different applications, and different rules, and an Ohio veteran can receive both at the same time.

The two count money differently. For VA pension purposes, unreimbursed medical and care expenses like nursing home fees reduce countable income, which can raise the Aid and Attendance amount. Ohio Medicaid applies its own income and asset tests for long-term-care eligibility, but at the eligibility step it uses SSI income rules, under which the Aid and Attendance allowance is not counted as income at all; only the basic pension counts toward Ohio's income limit. The A&A amount can return at the post-eligibility step, where the state sets the resident's patient liability.

Eligibility is only the first step. The federal post-eligibility rule at 42 CFR 435.725 covers institutionalized individuals in SSI states, which is how Ohio determines Medicaid eligibility, and it provides that income disregarded in determining eligibility must still be considered when the state calculates what a resident owes. So an Aid and Attendance amount left out at eligibility does not automatically stay out of the patient-liability calculation, and it can raise what the resident owes, though a state's own post-eligibility rule can exempt it. Ohio's rule, OAC 5160:1-6-07(I)(2)(j), excludes VA pension, including Aid and Attendance, up to $90 a month for a nursing facility resident who is a veteran with no spouse or dependent minor or disabled child, or a surviving spouse with no such child. For a veteran with a spouse or child, whose pension VA still pays at the full rate, confirm how Ohio treats the Aid and Attendance amount with your county Job and Family Services office or the Ohio Department of Medicaid. The deductions the state takes from the resident's income before that bill is set are not open-ended: the agency deducts "Amounts for incurred expenses for medical or remedial care that are not subject to payment by a third party," and the category covering care that is recognized under State law but not covered under the state plan is "subject to reasonable limits the agency may establish." For home and community-based waiver services, 42 CFR 435.725 does not settle the question, so ask Ohio Medicaid how patient liability is figured for the specific waiver.

Because the two programs interact, and because the pension cap above can take effect, the order and timing of applications can matter. A benefits counselor or accredited representative who understands both should review the case before applying.

How to Apply and Get Free Help

The steps below describe the pension route, the one this guide covers: as the VA puts it, "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 same examination form and should not file the wartime, means-tested pension application.

On the pension route, an Ohio nursing home claim runs on these forms:

  1. VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), with the examination section filled out by a medical examiner documenting the need for care.
  2. VA Form 21P-527EZ (Application for Veterans Pension), for a wartime veteran pursuing the pension route who is not already receiving a VA pension.
  3. VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance), which a nursing-home claim will also need.
  4. VA Form 21-0966 (Intent to File), if you are still gathering information: submitting an intent to file "can secure the earliest possible effective date for any retroactive payments you may be eligible to receive."

You can file online at va.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office; an accredited representative can also help you file. Asked how long a decision takes, the VA answers "It depends," and it processes claims in the order it receives them unless a claim requires priority processing.

Do not do this alone, and you don't need to pay for help. Ohio's County Veterans Service Offices do the hands-on claim work: staffed by accredited service officers, they help veterans, dependents, and surviving spouses file and manage federal VA claims, free of charge, and ODVS's own pension page sends anyone asking about VA pension to their county office. The Ohio Department of Veterans Services (ODVS) trains those officers and their commissioners, but it is a state agency that is not directly affiliated with the federal VA and does not have autonomy over the 88 county offices. Find yours in the county-by-county listing of the ODVS Benefits Resource Guide or at ohiovets.gov/cvsos; ODVS itself can be reached at (614) 644-0898. A good representative will also help you document the nursing home cost so it is counted as a medical expense.

Frequently Asked Questions

Will Aid and Attendance cover the full cost of an Ohio nursing home?

No. At a maximum of $29,093 a year for a veteran alone, the benefit covers a meaningful share of a semi-private room that runs about $110,230 a year, but not the whole bill. Its bigger role is often indirect: counting the nursing home cost as a medical expense can lower your countable income enough to lift the payment to the maximum. Most families combine Aid and Attendance with other income and, eventually, Medicaid.

Does the VA run or pay for nursing homes directly through Aid and Attendance?

No. On the pension route described here, Aid and Attendance is paid in monthly cash as part of your VA pension, and VA Form 21-2680 also covers an Aid and Attendance amount added to monthly compensation; either way the VA does not operate or directly pay a nursing home. The money goes to the veteran (or their representative), who applies it to the cost of care. The VA does run separate long-term care programs, but those are distinct from the pension benefit described here.

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

For a veteran with no spouse or child, or a surviving spouse with no child, federal law caps the VA pension at $90 a month once Medicaid covers nursing facility care; the statute starts the cap after the month of admission, and VA's regulation after the month Medicaid payments begin. VA says the veteran keeps the full $90 for personal expenses and the facility can't count it toward the cost of care. A veteran with a spouse or child is not subject to this specific cap.

Can I qualify if my income seems too high?

Possibly. The VA looks at your income after deducting unreimbursed medical expenses, and nursing home fees are deductible above the annual floor, which is $872 for a veteran with no spouse or child and rises with dependents. Because an Ohio nursing home costs far more than that floor, a large bill can reduce the income the VA counts enough to qualify a veteran who looked ineligible on paper.

Compare Care Settings in Ohio

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

Learn More

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Your next step Find personalized help using VA benefits to pay for a nursing home in Ohio 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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