VA Aid and Attendance for In-Home Care in Virginia

VA Aid and Attendance is one of the most useful and most overlooked ways to help pay for in-home care in Virginia. It raises the ceiling on the monthly VA pension a qualifying veteran or surviving spouse receives, and because that pension is paid to them, the family can put the money toward an aide who comes to the house. For a family trying to keep a parent at home rather than move them to a facility, that monthly check can be the deciding factor.

This guide explains exactly how Aid and Attendance works for in-home care, how much it pays in 2026, who qualifies, and how to get free help filing the claim.

In This Guide

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

How Much In-Home Care Costs in Virginia

In-home care in Virginia costs about what it does nationally. According to the CareScout (Genworth) 2025 Cost of Care Survey, released March 2026 and the most recent state-level data, non-medical in-home care in Virginia runs about $80,080 per year. In its 2025 survey, CareScout merged the former homemaker and home health aide categories into a single "non-medical caregiver" category.2 That matches the national median: CareScout puts non-medical caregiver care at $35 an hour nationally, which it annualizes to the same $80,080 assuming 44 hours of care a week.2

A homemaker helps with errands, meals, and housekeeping, while a home health aide adds hands-on help with bathing, dressing, and similar daily tasks. These are industry-survey medians, not government figures.2 Either way, paying for in-home care out of pocket adds up fast, which is why an extra monthly benefit matters. Cutting a fixed cost helps as much as adding income does. A veteran staying at home whom the VA rates 100 percent service-connected, permanently and totally disabled (including at 100 percent through individual unemployability) may owe no local real estate tax on that home, if it is their principal residence, under Virginia's exemption for disabled veterans.4 Our guide to Virginia's disabled veteran property tax exemption covers the rating it takes and how to claim it.

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

Aid and Attendance is an increased monthly pension the VA pays a qualifying veteran or surviving spouse who needs help with daily activities, at a higher maximum rate than the basic VA pension.1 Because it comes as part of the monthly pension paid to the veteran or surviving spouse, the family can put it toward an in-home aide, a homemaker, or other care costs at home.

Here is the most the benefit can pay in 2026 (rates effective December 1, 2025 through November 30, 2026):1

The VA publishes these as annual rates. By regulation, your monthly payment is the annual rate minus your countable income, divided by 12 and rounded down to the whole dollar (38 CFR 3.273 and 3.29(b)). These are ceilings, not payments. The Maximum Annual Pension Rate is the maximum amount of pension payable, and the VA pays the difference between your income for VA purposes and that limit, so a claimant with countable income receives less than the figures above.1

Against Virginia's roughly $80,080-a-year cost for in-home care, the maximum veteran rate covers a meaningful share of part-time care.2 It rarely covers full-time care on its own, but combined with other income it can keep a loved one safely at home.

How Virginia In-Home Care Costs Lower Your Countable Income for Aid and Attendance

VA Pension, including the Aid and Attendance increase, is a needs-based benefit: to be eligible, your yearly family income and net worth have to meet limits set by Congress.1 Because the benefit is keyed to the income the VA counts, unreimbursed medical expenses can be subtracted from that income, which can make a family that looked "over income" eligible after all.

The rule has a floor. Only the portion of your unreimbursed medical expenses that exceeds 5% of the applicable Maximum Annual Pension Rate (MAPR) counts. For 2026, the VA puts that floor at $872 for a veteran with no spouse or child; it rises with dependents, but never includes the aid-and-attendance or housebound increase.1

In-home attendant care carries a condition of its own. The attendant has to be a health care provider unless the person needs aid and attendance or is housebound, or unless a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that a physical, mental, developmental, or cognitive disorder is why the person requires the health care or custodial care the attendant provides.1 The yearly cost of an aide clears the floor easily, so a documented care need is what turns those costs into a deduction that can lower the income the VA counts.1

Who Qualifies

To qualify for Aid and Attendance, a veteran generally must meet all of the following:5

• Wartime service: at least one day of active duty during a wartime period (such as World War II, Korea, Vietnam, or the Gulf War). If you started active duty before September 8, 1980, you need at least 90 days of active duty; an enlisted person who started after September 7, 1980 generally needs 24 months or the full period they were called to serve, with some exceptions.5
• Discharge, plus one of four qualifying circumstances: no dishonorable discharge, and at least one of these must be true: at least 65 years old; 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. 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 rating.5
• A need for aid and attendance: need another person's help with daily activities such as bathing, dressing, or eating; have to stay in bed, or spend much of the day there, 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
• Net worth under $163,699 for 2026, which counts assets and annual income but excludes the primary home, a vehicle, and basic household goods.1

The VA reviews asset transfers made for less than fair market value during the three years before it receives your claim, and a covered transfer can bring a penalty period of up to 5 years, so it is worth planning ahead.5 A surviving spouse can qualify under the Survivors Pension version of the benefit.

Using Aid and Attendance to Pay a Family Caregiver

A relative can be the one providing the care: VA rules say that having a relative or another member of the household perform the aid and attendance will not prevent the VA from granting the benefit.5 And because the pension is paid to the veteran or surviving spouse, a family can use it to help compensate that relative.

If you want a more structured way to pay a family caregiver, ask your VA medical center about Veteran-Directed Care (VDC). VDC gives an enrolled veteran a flexible budget, managed by the veteran or a representative, to hire and supervise their own workers, including family, friends, or neighbors. VA medical centers run it through local aging and disability agencies, whose options counselor helps plan the care and arranges fiscal management services.6 Any enrolled veteran is eligible if they are eligible for community care, meet the clinical criteria, and the program is available where they live.6 VDC is a VA Geriatrics and Extended Care program, not part of the Aid and Attendance pension, but both can help keep a veteran at home.

How Aid and Attendance Works with Virginia Medicaid

VA Pension, including Aid and Attendance, and Virginia Medicaid long-term care use different income rules, so a veteran who needs both has to plan for each.3 On the VA side, unreimbursed medical expenses can lower your income for VA purposes, but only the amount above 5% of your Maximum Annual Pension Rate counts.3 On the Medicaid side, Virginia is on the Social Security Administration's list of 209(b) states, which use at least one eligibility rule stricter than the federal SSI program's and must let an applicant whose income is over the limit spend down to it by incurring medical and remedial care expenses that insurance does not cover.3 How that applies to a given applicant depends on the Medicaid pathway and is decided case by case.3 Virginia's own eligibility manual settles one piece of it: when DMAS decides eligibility for someone as an institutionalized individual, payments for Aid and Attendance are not counted as income, in every covered group except the F&C medically needy groups.3

In Virginia, Medicaid is part of Cardinal Care, administered by the Department of Medical Assistance Services (DMAS). Cardinal Care provides long-term services and supports to eligible people, and DMAS warns that eligibility is complicated, with special rules for people seeking long-term services and supports.3 For care at home, Virginia's Commonwealth Coordinated Care Plus waiver covers personal assistance services, respite and adult day health care for people 65 and older, among others, who meet a hospital or nursing facility level of care.7 Eligibility is only the first step, though. Once someone is eligible and receiving long-term care, Virginia calculates a monthly patient pay: the part of their income that must go toward the cost of that care. The federal post-eligibility rule for a 209(b) state like Virginia (42 CFR 435.733) counts again any income that was disregarded at eligibility, then deducts a personal needs allowance, an allowance for a spouse or family at home, and incurred medical expenses no third party pays. That section covers people in medical institutions and intermediate care facilities, not home- and community-based waiver services, so ask DMAS which deductions Virginia allows, in a facility or on a waiver at home, before you budget on any figure.3 For VA money specifically, Virginia's manual has its own patient-pay rule, and it applies to all long-term-care recipients. It counts Aid and Attendance and VA pension payments above $90 a month when the patient is a veteran with no community spouse or dependent child, a surviving spouse with no dependent child, or a veteran's dependent child. It counts none of those payments for a veteran who has a community spouse or dependent child, or for a surviving spouse who has a dependent child.3 One federal limit matters if care at home gives way to a nursing home: a veteran with no spouse and no child, or a surviving spouse with no child, whose nursing-facility care is covered by Medicaid can be paid no more than $90 a month in VA pension after the month of admission, and the facility's Medicaid payment cannot be reduced by that $90.3 Whether the cap reaches a stay in a Virginia State Veterans Home depends on whether the VA pays that home a per diem for its nursing home care, so check it with an accredited Veterans Service Officer.3 A veteran receiving Aid and Attendance who also needs Medicaid long-term care should have the income and unreimbursed-medical-expense treatment reviewed for their situation, ideally with a DVS benefits representative or DMAS.3

How to Apply and Get Free Help

The steps below are the pension route, the one this guide covers: the VA says you may be eligible for this benefit if you get a VA pension. You apply using two VA forms: Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner fills out to document the need for help, and, for a wartime veteran on the pension route who is not already receiving a VA pension, Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application.8 Form 21-2680 is not limited to pension claims: the VA describes it as applying for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits, so a veteran who receives VA disability compensation rather than a pension uses the same form to seek Aid and Attendance added to that compensation.8 You can apply 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 also help you file. Asked how long a decision takes, the VA answers, "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.8

Do not do this alone. The Virginia Department of Veterans Services (DVS) provides claims assistance through a statewide network of 38 benefit service offices across the Commonwealth, and states that all of its services are provided free of charge.3 DVS handles disability claims and pensions; many of its team members are veterans or military spouses who have been through the claims process themselves, and they receive comprehensive training.3 Virginia veterans are highly encouraged to seek assistance from a DVS Veterans Services Representative before filing a claim, which DVS says affords a number of advantages over self-filing. You can find your nearest office through the office locator at dvs.virginia.gov.3

If your claim is denied, you have options. You can file a Supplemental Claim with new and relevant evidence the VA did not have when it reviewed the case before, request a Higher-Level Review in which a higher-level reviewer looks at the case again to decide whether an error or a difference of opinion changes the decision (no new evidence may be submitted), or appeal to the Board of Veterans' Appeals for review by a Veterans Law Judge. For most VA benefits, a Higher-Level Review or Board Appeal must be requested within one year of the date on your decision letter, and certain benefits carry shorter deadlines, so check the deadline your letter states. A Supplemental Claim can be filed at any time, though the VA recommends filing within one year to keep your effective date. The VA's online claim-status tool covers pension claims, decision reviews, and appeals, and for questions the VA benefits hotline is 800-827-1000 (TTY: 711), Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.9

Compare Care Settings in Virginia

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 Virginia
• How Aid and Attendance Pays for a Nursing Home in Virginia
• How Aid and Attendance Pays for Memory Care in Virginia

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.