VA Aid and Attendance can help a wartime veteran or surviving spouse pay for a nursing home in Pennsylvania, where care costs run well above the national line. 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 Pennsylvania

Per the CareScout 2025 Cost of Care Survey (released March 2026, the most recent state-level data), a semi-private nursing home room in Pennsylvania runs about $143,445 per year (roughly $11,954 per month), priced on 365 days of care and well above the national median of about $114,975.

That figure is why so many Pennsylvania 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. Some of those benefits are state-run rather than federal, including an exemption from real estate tax for qualifying disabled veterans that our guide to Pennsylvania's disabled veteran property tax exemption explains in full.

How Aid and Attendance Helps Pay for It

Aid and Attendance is part of the federal VA pension, for someone who needs help with daily activities or is a patient in a nursing home because of a loss of mental or physical abilities related to a disability., The money is paid to the veteran, who can use it toward nursing-home charges.

Category Monthly Amount
Veteran, no dependents Up to $2,424
Veteran with one dependent Up to $2,874
Surviving spouse, no dependents Up to $1,558

These are 2026 rates, effective December 1, 2025 through November 30, 2026. The VA publishes them as maximum annual amounts ($29,093 for a veteran with no dependents, $34,488 with one dependent, and $18,697 for a surviving spouse), and the monthly figure is that yearly rate divided by 12. They are ceilings on the whole pension at the Aid and Attendance rate, not amounts paid on top of it, and the VA bases the actual amount on the difference between your income for VA purposes and that limit, so a claimant with countable income receives less. Against a Pennsylvania nursing-home bill of roughly $11,954 a month, $2,424 at the top of the range 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 fall within limits Congress sets. Because the benefit is keyed to the income the VA counts, 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 that exceeds 5% of your applicable maximum annual pension rate is deductible. For 2026 that threshold is $872 per year for a veteran with no spouse or child, and it rises for a veteran with dependents, though it never reflects the Aid and Attendance increase itself.

A nursing-home bill dwarfs that floor. For example, a veteran paying $143,445 a year for a semi-private room subtracts the first $872, leaving roughly $142,573 in deductible medical expense, which can reduce the income the VA counts to nothing and qualify a veteran who first looked too "high income" to apply.

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, and no dishonorable discharge. 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, again with at least one day during wartime. An officer who started active duty after October 16, 1981 and had not previously served on active duty for at least 24 months qualifies on that basis.
  • Any one of four age-or-disability tests. The veteran must be at least 65 years old, or have a permanent and total disability, or 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. These are independent routes: a wartime veteran under 65 who receives SSI meets this test with no disability rating at all.
  • 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 applies a 3-year look-back on assets transferred for less than fair market value before filing.

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).

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 that federal cap does not settle is how the $90 lines up with the personal needs allowance Pennsylvania Medical Assistance 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. Do not assume the two stack. Ask the Pennsylvania Department of Human Services, or a county director of veterans affairs, how Pennsylvania handles it before you plan around a number.

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 Pennsylvania Medicaid

VA Aid and Attendance is part of the federal VA pension, administered by the U.S. Department of Veterans Affairs separately from Pennsylvania Medical Assistance (Medicaid), which is administered by the Pennsylvania Department of Human Services (DHS). The two programs run under different applications and rules, and a veteran or surviving spouse can receive both at the same time.

For VA pension, unreimbursed medical and care expenses can be deducted from countable income, which can raise the benefit. Pennsylvania Medical Assistance handles VA pension income in two separate steps. At the eligibility decision, a state applies SSI income methodologies to aged, blind, and disabled applicants (42 CFR 435.601), and under SSI methodology VA aid and attendance and housebound allowances are not income (SSA POMS SI 00830.308), so it is the basic VA pension amount, not the Aid and Attendance increase, that counts toward the income limit. The eight states that use eligibility criteria more restrictive than SSI, the 209(b) states, may count it differently, and Pennsylvania is not one of them. At the patient-liability step, which applies once someone is eligible and receiving nursing-facility care under the Medicaid nursing-facility benefit, income that was disregarded at eligibility becomes part of the income the required deductions are taken from, and that can raise the amount the resident owes the facility. Someone receiving Community HealthChoices (CHC) services at home has a post-eligibility calculation too, and Pennsylvania's own rules set that one. The federal rule here, 42 CFR 435.725, is post-eligibility treatment of income of institutionalized individuals in SSI states, and it reaches only individuals in medical institutions and intermediate care facilities. It does not settle the calculation in a 209(b) state or for HCBS waiver services such as CHC, so for a waiver setting ask DHS what Pennsylvania's own rule is rather than assuming the federal result. Where 435.725 does govern, the deductions are not open-ended, and incurred medical expenses are not the first of them. The agency must deduct a personal needs allowance "that is reasonable in amount for clothing and other personal needs of the individual while in the institution," and that protected allowance "must be at least" $30 a month for an aged, blind, or disabled individual. The $30 is a federal floor rather than the amount Pennsylvania sets, so ask DHS what Pennsylvania actually protects and, where the $90 pension cap above applies, how the two relate rather than adding them together. The agency must also deduct "Amounts for incurred expenses for medical or remedial care that are not subject to payment by a third party," and the category covering care recognized under State law but not covered by the state plan is "subject to reasonable limits the agency may establish." Ask DHS what else comes off in your own case, including anything protected for a spouse still living at home, before you budget on the gross figure. Because that treatment differs by step and can differ by state, confirm with DHS how a VA pension will be counted in your own case. Because the order and timing of applying can matter, consult a VA-accredited representative or an elder law attorney before applying.

How to Apply and Get Free Help

The steps here are the pension route, which is what applies to most families paying for a nursing home: the VA's condition for this benefit is that you may be eligible if you get a VA pension. Apply using VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner completes to document the need for care. 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 without filing a pension application. 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), which is the means-tested wartime pension application. A nursing-home claim will also need VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance) filled out; ask the facility how it handles that form, because the VA's own instructions do not settle whether the claimant or a nursing home official completes it. You can file online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office, and an accredited representative can help you file. The VA's answer on how long a decision takes is "It depends," and it processes claims in the order it receives them unless a claim requires priority processing.

Do not do this alone. Pennsylvania veterans can get free help applying for county, state, and federal veterans benefits, including the non-service-connected disability pension, through the Pennsylvania Department of Military and Veterans Affairs (DMVA) and the County Directors of Veterans Affairs, accredited service officers who never charge for their assistance. County directors are often located at the county courthouse, and DMVA's toll-free line is 1-800-547-2838. As of January 2026 the DMVA counted more than 200 accredited veterans service officers across Pennsylvania, all free to use, reachable through the department, county offices, and several veteran service organizations.

If Your Claim Is Denied

A denial is not the end of the road. If the VA denies the claim or grants less than you expected, the menu after that initial decision is three decision-review options: a Supplemental Claim to file new and relevant evidence the VA did not have when it reviewed the case before, a Higher-Level Review to have a higher-level reviewer look at the case with no new evidence submitted, or a Board Appeal to the Board of Veterans' Appeals for review by a Veterans Law Judge. 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; certain types of VA benefits have time limits shorter than one year, and your decision letter states which deadline applies. 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. 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)). In practice, filing after the one-year mark can cost back pay all the way to the original claim date, so file inside the year even though the door stays open. An accredited attorney, claims agent, or Veterans Service Organization representative can help you request the review, and a Pennsylvania county director of veterans affairs never charges for their assistance.

Frequently Asked Questions

Does the VA pay for a nursing home in Pennsylvania?

Not through Aid and Attendance. Aid and Attendance is part of the federal VA pension, 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 Pennsylvania nursing home?

Up to about $2,424 a month for a veteran with no dependents, about $2,874 with one dependent, and about $1,558 for a surviving spouse. 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 $11,954 a month in Pennsylvania, 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 for any period after the month of admission. 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 Pennsylvania's Medicaid personal needs allowance or in place of it turns on state post-eligibility rules, which vary, so confirm it with the Pennsylvania Department of 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, above a small floor ($872 a year for a veteran with no spouse or child). A large care bill can reduce countable income enough to qualify someone who first appeared over the limit.

Compare Care Settings in Pennsylvania

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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