VA Aid & Attendance for In-Home Care in South Dakota

VA Aid and Attendance can help pay for in-home care in South Dakota, where in-home help is among the more expensive forms of senior care in the state. It's an increased monthly pension for wartime veterans and their surviving spouses who need help with everyday activities, and it reaches the household as a pension payment rather than a payment to a care agency, so the family decides how to put it toward care at home.

This guide explains what in-home care costs in South Dakota, how much Aid and Attendance pays in 2026, how your care costs can lower the income the VA counts against you, and where to get help applying.

In This Guide

• Key Takeaways
• How Much In-Home Care Costs in South Dakota
• How Aid and Attendance Helps Pay for In-Home Care in South Dakota
• How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in South Dakota
• Who Qualifies
• Using Aid and Attendance to Pay a Family Caregiver
• How Aid and Attendance Works with South Dakota Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much In-Home Care Costs in South Dakota

South Dakota is a split picture: facility care is among the most affordable in the country, but in-home care runs high. A non-medical caregiver runs about $101,244 a year on a 44-hour-per-week basis, according to the CareScout 2025 Cost of Care Survey, which in 2025 merged the former homemaker and home health aide lines into that single category. That's roughly $44 an hour, well above the national figure of about $80,080.2

These are industry-survey medians, not government figures, and the real number depends on how many hours of help you need each week. A few hours a day to help with bathing and meals costs far less than around-the-clock care, but South Dakota's high hourly rates mean even part-time help adds up. That makes a benefit like Aid and Attendance especially worth pursuing here.

How Aid and Attendance Helps Pay for In-Home Care in South Dakota

Aid and Attendance is an increased monthly pension for wartime veterans, and their surviving spouses, who need another person's help with daily activities.3 It reaches the household as a monthly pension payment rather than a payment to a provider, so the family decides how to apply it to a home health aide, a homemaker, or other in-home help.

For 2026 (rates effective December 1, 2025 through November 30, 2026), the Maximum Annual Pension Rate, or MAPR, sets the ceiling. VA publishes these rates as annual amounts. Pension is paid monthly, and under 38 CFR 3.273 the monthly rate is your MAPR minus your countable income, divided by 12, so there is no fixed monthly figure that applies to every household.1

MAPR is the maximum amount of pension payable, not a check anyone is guaranteed. VA bases the award on the difference between your income for VA purposes and that limit, so a claimant with countable income receives less than the figure above.1

Because South Dakota in-home care is costly, around $101,244 a year, the benefit won't cover the whole bill on its own, but it can offset part of it. That $101,244 is the survey's median for a non-medical caregiver at 44 hours a week, roughly $44 an hour, so fewer hours means a smaller bill and a larger share covered.2 Run both halves of that against your own household: the hours you actually buy, and the award you are actually granted rather than the ceiling.1 What you need to show the VA is the medical need, documented on VA Form 21-2680, and the financial picture, including any unreimbursed care costs you report on VA Form 21P-8416.5

How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in South Dakota

This is the part most families miss. Aid and Attendance is a needs-based benefit: to be eligible, your yearly family income and net worth have to fall within limits set by Congress.1 Your in-home care costs can lower the income the VA counts against those limits, and that is what brings many families under them.

Payments to an in-home attendant who helps with daily activities count as medical expenses as long as the attendant provides health care or custodial care and the pay matches the hours the attendant actually works, and the payments must be unreimbursed to be deducted. The attendant has to be a health care provider unless the person needing care needs aid and attendance or is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that a physical, mental, developmental, or cognitive disorder means the person requires the care the attendant provides. But only the portion of your medical expenses above 5% of your annual Maximum Annual Pension Rate (MAPR) counts. For 2026 that floor is $872 a year for a veteran with no spouse or child, and it rises with dependents, though never with the Aid and Attendance increase itself.1 Everything you pay above that floor reduces your countable income dollar for dollar.

South Dakota's high in-home care costs cut both ways here, and the second cut works in your favor. Say a veteran with no dependents pays $50,000 a year for an in-home aide. The first $872 doesn't count, but the remaining $49,128 comes off countable income. A veteran whose income looked too high to qualify can drop to near zero countable income once that care cost is deducted, and qualify after all.1 These numbers are illustrative; your own deduction depends on what you actually pay and what the VA allows.

Who Qualifies

To receive Aid and Attendance, a veteran generally must meet all of the following:3

• Wartime service. A veteran who started active duty before September 8, 1980 needs at least 90 days of active duty with at least one day during a recognized wartime period (such as World War II, Korea, Vietnam, or the Gulf War). An enlisted veteran who started after September 7, 1980 generally needs at least 24 months of service, or the full period called to active duty, with at least one day during wartime, and an officer who started after October 16, 1981 and hadn't previously served at least 24 months on active duty also needs at least one day during wartime.
• No dishonorable discharge, plus any one of four status tests. VA lists four alternatives, and meeting a single one is enough: 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. The nursing-home and SSDI/SSI branches stand on their own, so a wartime veteran under 65 who receives SSI meets this test with no adjudicated disability rating at all.
• A care need. Meet at least one of four: need another person's help with daily activities like bathing, feeding, and dressing; have to stay in bed, or spend a large part of the day in bed, because of illness; be a nursing-home patient because of lost mental or physical abilities related to a disability; or have severely limited eyesight (5/200 or less in both eyes even with glasses or contacts, or a visual field narrowed to 5 degrees or less).
• Net worth under $163,699. The VA's calculation for this limit (for 2026) combines your and your dependents' assets with your annual income, and the assets it counts exclude your primary home, your car, and basic household items. Comparing savings alone against $163,699 gives you the wrong answer.1

The VA reviews asset transfers made for less than fair market value during the three years before you file, so giving money away to qualify can trigger a penalty.3 A surviving spouse can qualify under the same framework, with the survivor net-worth limit also set at $163,699.1

Using Aid and Attendance to Pay a Family Caregiver

Many families want to pay an adult child or other relative who's already providing care. A relative's help doesn't stand in the way of the benefit: under VA's rule, care given by a relative or another member of the household won't prevent the VA from granting Aid and Attendance.3 If you pay an in-home attendant, the payments count as a medical expense only if they're in line with the hours of care actually provided and meet the attendant conditions described above, so keep a clear written arrangement and records of hours and payments.1

There's also a separate VA program built for this. Veteran-Directed Care (VDC) gives enrolled veterans of all ages a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers, and enrolled veterans may hire family, friends, or neighbors.6 VA medical centers deliver it through aging and disability network agencies, such as Area Agencies on Aging, whose options counselor helps plan the care and arranges fiscal management services.6 An enrolled veteran is eligible if they're eligible for community care, meet the clinical criteria, and VDC is available, so ask your local VA medical center whether it's offered in your area.6

How Aid and Attendance Works with South Dakota Medicaid

Aid and Attendance and South Dakota Medicaid, administered by the South Dakota Department of Social Services, are separate programs that can interact for veterans needing long-term care.7 The programs coordinate once Medicaid pays for nursing-facility care. For a veteran with no spouse or child, or a surviving spouse with no child, whose nursing-facility care Medicaid covers, the VA pension can be no more than $90 a month for any month after the month of admission, and federal law bars that $90 from reducing what Medicaid pays the facility. The cap does not reach a State home for which VA makes nursing-home per diem payments, so check a State Veterans Home stay with an accredited Veterans Service Officer rather than assume it applies.7

At the eligibility step, South Dakota applies SSI income rules, under which the Aid and Attendance allowance is not counted as income, though the basic pension is not covered by that exclusion. The calculation after eligibility is different. For a nursing-facility resident without a spouse at home, South Dakota's regulations exclude the Aid and Attendance allowance when deciding eligibility but do not carry that exclusion into working out how much long-term care assistance the Department of Social Services pays, so an Aid and Attendance amount VA is still paying at the full rate is counted as income toward what the resident pays the facility. Not all of the resident's income goes to the facility: the agency must first deduct a personal needs allowance, which South Dakota sets at $100 a month, any amount for family members at home, and incurred expenses for medical or remedial care that no third party pays. A resident with a spouse at home is budgeted under different rules that don't say how Aid and Attendance is treated, so that household should confirm it with the Department.7 The facility calculation also doesn't set the arithmetic for someone getting home- and community-based waiver services at home, so ask the South Dakota Department of Social Services or an accredited Veterans Service Officer which rule applies to a waiver participant.7

Because the exact treatment of Aid and Attendance income and assets in a Medicaid determination depends on program rules and individual circumstances, confirm the interaction with the South Dakota Department of Social Services and an accredited Veterans Service Officer before relying on it.7

How to Apply and Get Free Help

VA Form 21-2680 is the form that establishes the Aid and Attendance need, and the VA describes it as applying for Aid and Attendance "that will be added to your monthly compensation or pension benefits," so it serves two routes. The steps below are the pension route, the one this guide covers, where the VA's condition is that you may be eligible for this benefit if you get a VA pension. A veteran who receives VA disability compensation rather than pension takes the compensation route instead and should ask a service officer which claim to file.5

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), on which a medical examiner fills out the examination information section to document the need for care.
• VA Form 21P-527EZ (Application for Veterans Pension). This is the wartime, means-tested pension application. On the pension route, a wartime veteran who is not already receiving a VA pension files it alongside Form 21-2680.
• VA Form 21-0966 (Intent to File), optional and filed first if you are still gathering information. The VA says submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive.
• VA Form 21P-8416 (Medical Expense Report), for the in-home care and other medical costs you paid yourself and weren't, and don't expect to be, reimbursed for.

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 attorney, accredited claims agent, or accredited Veterans Service Organization representative can file the claim for you.5 Asked how long a decision takes, the VA answers "It depends," and adds that it works through claims in the order it receives them unless a claim requires priority processing, which is one more reason to submit an intent to file early if you need time to gather records.5

Don't do this alone. The South Dakota Department of Veterans Affairs was created to help veterans and their dependents prepare claims for federal VA benefits, including pension benefits for certain wartime veterans, and every South Dakota county has a County Veterans Service Officer, with Tribal Veterans Service Officers on some reservations.4 Most of those offices sit in the county courthouse or the tribal office, so start there to find local help, or call the state agency in Sioux Falls at (605) 333-6869 or in Pierre at (605) 773-3269.4 The VA says an accredited VSO representative's help on your claim is always free, while an accredited attorney or claims agent can charge fees.4

Compare Care Settings in South 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 South Dakota
• How Aid and Attendance Pays for a Nursing Home in South Dakota
• How Aid and Attendance Pays for Memory Care in South 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.