VA Aid and Attendance for a Nursing Home in Vermont

VA Aid and Attendance can help pay for a nursing home in Vermont, but not in the way most families assume. The VA does not run or directly pay a nursing facility's bill. Instead, qualifying for Aid and Attendance raises the ceiling on the veteran's whole pension, and that larger monthly payment can go toward the cost of care. For a veteran already in a nursing home, the more powerful rule is often a quieter one: the cost of that care can be deducted from the income the VA counts, which is what makes many families eligible in the first place.

This guide explains how that works in Vermont, what a nursing home costs here, how Aid and Attendance interacts with Vermont Medicaid, and the one federal rule that caps the pension at $90 a month once Medicaid is paying the bill.

In This Guide

• Key Takeaways
• How Much a Nursing Home Costs in Vermont
• How VA Aid and Attendance Helps Pay for a Vermont Nursing Home
• How Nursing Home Costs Lower Your Countable Income
• Who Qualifies
• The Nursing-Home Pension Cap When Medicaid Pays
• How VA Aid and Attendance Works with Vermont Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much a Nursing Home Costs in Vermont

A nursing home is the most expensive level of long-term care, and Vermont's rates sit among the steepest in the nation.

In Vermont, a private nursing home room runs about $186,333 a year in 2026, according to the CareScout 2025 Cost of Care Survey (released March 2026), which places Vermont in the top ten states for nursing-home costs. That is well above the national private-room median of about $129,575 a year ($355 a day). Semi-private (shared-room) care in Vermont runs about $169,360 a year, the eighth-highest in the country and up 3 percent from 2024, against a national semi-private median of about $114,975 a year ($315 a day).1 These are industry-survey medians, not government figures, and costs vary within the state and rise as care needs grow.

That steep cost is why Vermont families look hard at every benefit that can offset the bill, including VA Aid and Attendance.

How VA Aid and Attendance Helps Pay for a Vermont Nursing Home

Aid and Attendance is not a separate program. It is a higher pension rate the VA applies to a veteran's or surviving spouse's pension when that person already gets a VA pension and meets at least one of four requirements: needing another person to help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large portion of the day in bed, because of illness; being a patient in a nursing home due to the loss of mental or physical abilities related to a disability; or limited eyesight, meaning "5/200 or less in both eyes; or concentric contraction of the visual field to 5 degrees or less" even with glasses or contact lenses.2,4

For 2026, the most a person can receive is set by the Maximum Annual Pension Rate, and the monthly figure is that yearly rate divided by 12:

Two points families miss. First, these are maximums, not flat checks: the VA pays the difference between your countable income and the cap, so the amount you receive depends on your other income. Second, the VA does not pay this money to the nursing home. It pays the veteran, who then applies it toward care. Against a Vermont private room of about $186,333 a year, even the full $2,424 a month covers only a fraction of the bill, so Aid and Attendance is best understood as one funding source among several, not a complete answer on its own.2,1

How Nursing Home Costs Lower Your Countable Income

This is the part that changes outcomes. VA pension is needs-based: the VA pays the gap between your countable income and the pension cap. The higher your countable income, the smaller the benefit, and above the cap you get nothing.

But you can subtract unreimbursed medical expenses (UMEs) from that income, and nursing home fees you pay yourself count as unreimbursed medical expenses.2 Only the portion of those expenses that exceeds 5% of the applicable Maximum Annual Pension Rate is deductible. For 2026 that floor is $872 a year for a veteran with no spouse or child, and it rises for a veteran with dependents, though it never includes the aid-and-attendance or housebound increase.2

Consider what that means against a Vermont nursing home. A single veteran paying for a private room at about $186,333 a year is spending far above the $872 annual floor.1,2 Once that expense is deducted, countable income often drops to zero, which can unlock the full pension at the Aid and Attendance rate. A veteran whose income looked too high to qualify can become eligible precisely because the nursing home bill is so large.

A note on wording: that floor, $872, is an annual figure, not a monthly one. The deduction is calculated against your yearly medical spending.2

Who Qualifies

To receive Aid and Attendance, a veteran must not have received a dishonorable discharge, and generally must also meet all of the following:5

• Wartime service: the length required depends on when the veteran started active duty, not on which war they served in. VA lists three paths, and at least one has to be true. Started before September 8, 1980: at least 90 days of active duty with at least one day during a wartime period. Started as an enlisted person after September 7, 1980: at least 24 months, or the full period called or ordered to active duty (with some exceptions), with at least one day during wartime. Started on active duty as an officer after October 16, 1981, without having previously served on active duty for at least 24 months. Wartime periods include WWII, Korea, Vietnam, and the Gulf War, which began August 2, 1990 and has no end date set, so it covers post-9/11 service.
• Age, disability, or benefit status: at least one of these has to be true: 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. A permanent and total rating is not the only disability route, and a wartime veteran under 65 who receives SSI qualifies on that branch alone.
• Need for aid: any one of four alternatives is enough. Help with daily activities such as bathing, dressing, or feeding; having to stay in bed, or spend a large portion of the day in bed, because of illness; being a patient in a nursing home due to the loss of mental or physical abilities related to a disability; or limited eyesight, meaning "5/200 or less in both eyes; or concentric contraction of the visual field to 5 degrees or less" even with glasses or contact lenses. A Vermont veteran on a pension who is legally blind but independent at home qualifies on the eyesight route alone.4
• Net worth under $163,699 for 2026, counting assets and annual income but excluding the primary home, the veteran's car, and basic home items.2

The VA also enforces a 3-year look-back on assets transferred for less than fair market value, with a penalty period that can reach five years.5 A veteran living in a nursing home because of disability satisfies the "need for aid" test, so for nursing-home residents the eligibility question usually turns on wartime service, net worth, and income.

The $90/Month Nursing-Home Pension Cap

Here is the rule that surprises families most. Once Vermont Medicaid is paying for a veteran's nursing-home care, federal law sharply limits the VA pension.

Under 38 U.S.C. 5503(d)(2), implemented at 38 CFR 3.551, when a single veteran with no spouse or dependent children is covered by Medicaid in a nursing facility, the VA reduces the pension, including any Aid and Attendance amount, to no more than $90 a month for any period after the month of admission. The facility can't count that $90 as income toward the cost of care, so the veteran keeps the full $90 for personal expenses.3 How that $90 relates to Vermont's own Medicaid personal needs allowance is set by Vermont's post-eligibility rules, not by the federal cap, so ask DVHA how it will be applied in your case rather than assuming the two amounts add together.4

The cap also turns on a defined term rather than the everyday sense of a nursing home. For purposes of that subsection, 38 U.S.C. 5503(d)(1)(B) defines "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 states the rule without repeating that definition. So if the facility is a State veterans home, have that checked against the statutory definition rather than assume the $90 cap applies.3

The takeaway: Aid and Attendance is most valuable while the veteran is paying privately or through other means. Once Medicaid takes over the nursing-home bill, the large monthly pension effectively goes away for a single veteran, and only the $90 remains. This cap applies to the single, no-dependents situation; a married veteran's circumstances differ, which is exactly the kind of timing question a VA-accredited representative should review before you file.3

How VA Aid and Attendance Works with Vermont Medicaid

VA Aid and Attendance and Vermont Medicaid are separate programs run under different rules, and a Vermont veteran or surviving spouse can often qualify for both. In Vermont, Medicaid long-term care is delivered mainly through the Choices for Care program, administered by the Department of Vermont Health Access (DVHA).4

The two programs interact on income, and Medicaid handles the Aid and Attendance amount in two separate steps. When a state first decides whether an aged, blind, or disabled applicant is financially eligible, it applies SSI income methodologies, and under those methodologies the aid-and-attendance and housebound allowances are not income, so only the basic pension counts toward the income limit; states that use eligibility criteria more restrictive than SSI may count it there as well, so the state's own rule governs. Once a person is eligible, a second step figures the share of cost, and the federal rule usually quoted for it is narrower than it sounds. 42 CFR 435.725 covers the post-eligibility treatment of income of institutionalized individuals in SSI states, and its applicability paragraph reaches only individuals in medical institutions and intermediate care facilities, so it does not settle the calculation for home and community-based waiver services. Where it does govern, income that was disregarded at eligibility must be considered in that calculation, and the deductions from that income 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 recognized under State law but not covered by the state plan is "subject to reasonable limits the agency may establish."3 Vermont is more generous than that federal rule for nursing-facility residents: its Health Benefits Eligibility and Enrollment rule § 24.04 lists VA aid-and-attendance payments made to a veteran or surviving spouse residing in a nursing facility among the deductions from gross income when the actual patient share is figured, so in Vermont that payment comes off the patient share rather than counting toward what is owed the facility. That deduction as written names nursing-facility residents, so ask DVHA how Aid and Attendance is treated in a home and community-based setting such as Choices for Care.4 And under the federal rule above, a veteran or surviving spouse without a dependent spouse or child whose nursing-facility care is covered by Medicaid may be paid no more than $90 a month in VA pension for any month after the month of admission. Because the precise treatment of VA income and the order in which to apply vary by situation, confirm how DVHA will treat the benefit before applying, ideally with an accredited Vermont Veterans Service Officer or DVHA.4

How to Apply and Get Free Help

The steps below are the pension route, the one this guide is about: VA's condition for it is "You may be eligible for this benefit if you get a VA pension," and on that route the increase takes the form of a higher pension ceiling rather than a second payment on top. VA Form 21-2680 covers a second route as well, 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 files that form without the pension application below.6

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), with a medical examiner filling out the examination information section to document the need for help.
• VA Form 21P-527EZ (Application for Veterans Pension), for a wartime veteran pursuing the pension route who is not already receiving a VA pension.
• VA Form 21-0966 (Intent to File), filed first if you are still gathering information. VA says 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, and an accredited attorney, claims agent, or Veterans Service Organization representative can file it for you. Asked how long a decision takes, the VA answers "It depends," adding that it processes claims in the order it receives them unless a claim requires priority processing.6

Do not do this alone, and do not pay anyone to file an initial claim. The Vermont Office of Veterans Affairs runs a Veterans Service Officer program that provides free, accredited help finding and filing claims for pension and Aid and Attendance.7 To speak with a Veteran Service Officer, the office directs veterans to call (802) 828-1082; its main line is (802) 828-3379, and its toll-free number within Vermont is (888) 666-9844.7

Compare Care Settings in Vermont

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 Vermont
• How Aid and Attendance Pays for In-Home Care in Vermont
• How Aid and Attendance Pays for Memory Care in Vermont

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.