VA Aid and Attendance for a Nursing Home in Virginia

VA Aid and Attendance can help pay for a nursing home in Virginia, but not in the way most families assume. The VA does not run or directly pay a nursing facility's bill. Instead, Aid and Attendance raises the ceiling on a veteran's monthly pension, and that cash 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 Virginia, what a nursing home costs here, how Aid and Attendance interacts with Virginia 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 Virginia
• How VA Aid and Attendance Helps Pay for a Nursing Home in Virginia
• How Nursing Home Costs Lower Your Countable Income
• Who Qualifies
• The Nursing-Home Pension Cap Under Medicaid
• How Aid and Attendance Works with Virginia Medicaid
• How to Apply and Get Free Help
• Frequently Asked Questions
• Learn More

How Much a Nursing Home Costs in Virginia

A nursing home is the most expensive level of long-term care, and the figure families plan around is the semi-private (shared) room rate, because that is what most long-term residents pay.

In Virginia, a semi-private nursing home room runs about $123,005 a year, or roughly $10,250 a month, in 2026, according to the CareScout 2025 Cost of Care Survey (released March 2026). A private room runs about $140,160 a year, or roughly $11,680 a month.1 After sharp year-over-year increases, Virginia's semi-private nursing-home costs now run above the national median of about $114,975 a year, and Northern Virginia runs higher than rural parts of the state. These are industry-survey medians, not government figures, and costs rise as care needs grow.

A year of shared-room care in Virginia now runs about $123,005, above the national median.1 That is why 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 Nursing Home in Virginia

Aid and Attendance is not a separate program. It is a higher pension rate that applies when a veteran or surviving spouse needs help with daily activities, is bedridden, or is a patient in a nursing home because of disability: for a veteran with no dependents, the maximum annual pension rises from $17,441 to $29,093.2

For 2026, the Maximum Annual Pension Rate with Aid and Attendance, and what it works out to per month, is:

The VA publishes these rates as annual maximums, so a monthly amount is the yearly award divided by 12.2

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 Virginia semi-private room of about $10,250 a month, even the full ceiling of $29,093 a year, about $2,424 a month, covers only part of the bill, so Aid and Attendance is best understood as one funding source among several, not a complete answer on its own.1,2

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, including meals and lodging the facility charges, count as a deductible medical expense.2 Only the portion of those expenses above 5% of the applicable Maximum Annual Pension Rate is deductible, and that 5% floor is figured on the MAPR including any increase for family members but excluding the aid-and-attendance or housebound increase. For 2026 the VA puts that floor at $872 a year for a veteran with no spouse or child; it rises if you have dependents.2

Consider what that means against a Virginia nursing home. A single veteran paying roughly $10,250 a month is spending about $123,005 a year on care, 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 monthly.2 The deduction is calculated against your yearly medical spending.

Who Qualifies

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

• No dishonorable discharge. This is the VA's baseline condition, before any of the tests below.
• Wartime service. The VA lists three service paths, and which one applies depends on when the veteran started active duty. Someone who started before September 8, 1980 needs at least 90 days of active duty with at least one day during a wartime period (WWII, Korea, Vietnam, or the Gulf War, which began August 2, 1990). Someone who started as an enlisted person after September 7, 1980 generally needs at least 24 months, or the full period they were called or ordered to active duty (with some exceptions), again with at least one day during wartime. A third path covers a veteran who started on active duty as an officer after October 16, 1981 and had not previously served on active duty for at least 24 months.2
• Age, disability, or care status. At least one of these must 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 receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). The nursing-home and SSDI/SSI branches stand on their own, so a wartime veteran under 65 who receives SSI can qualify without a permanent-and-total rating.5
• Need for aid: help with daily activities such as bathing, dressing, or feeding; or being bedridden; or being a patient in a nursing home due to physical or mental incapacity.
• Net worth under $163,699 for 2026, counting the claimant's and dependents' assets and income but excluding the primary residence, the 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 Virginia 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), when a single veteran with neither a spouse nor a child is covered by Medicaid for nursing-facility care, no VA pension above $90 a month may be paid for any period after the month of admission to the facility, and that limit applies to the pension including any Aid and Attendance amount.6 Under 38 U.S.C. 5503(d)(3), a Medicaid-participating facility cannot count that $90 toward the cost of care, so the veteran keeps the full $90 for personal expenses rather than seeing it flow to the nursing home.6

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 that $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 Aid and Attendance Works with Virginia Medicaid

VA Aid and Attendance and Virginia Medicaid are separate programs run under different rules, and a Virginia veteran or surviving spouse can often qualify for both. In Virginia, Medicaid is called Cardinal Care and is administered by the Department of Medical Assistance Services (DMAS); it provides long-term services and supports, including nursing-facility care and home- and community-based waiver services.4

The two programs count income differently, and Medicaid handles the Aid and Attendance amount in two separate steps. Virginia matters here, because most states apply SSI income methodologies at the eligibility step, and under those methodologies the aid-and-attendance and housebound allowances are not income. Virginia is one of the eight states SSA identifies as having elected the more restrictive 209(b) option, so Virginia's own rule governs whether the Aid and Attendance amount counts at that step, and you should not assume it is set aside. Once a person is eligible, a second step, the post-eligibility share-of-cost calculation, decides how much of their income goes to the facility. The federal rule that requires income disregarded at eligibility to be counted again at this step, 42 CFR 435.725, is written for institutionalized individuals in SSI states, so it does not settle the answer in Virginia, a 209(b) state, and it does not cover home- and community-based waiver services. Where 435.725 does govern, the previously disregarded income becomes part of the income from which the required deductions are made, and that can raise the amount the resident owes. Those deductions 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." For a Virginia nursing-home or waiver case, check the Commonwealth's own post-eligibility rule with DMAS rather than assuming the federal result.3 The precise treatment depends on the Medicaid pathway and is determined case by case, so a veteran receiving Aid and Attendance who also needs Medicaid should have the income and expense treatment reviewed with a DVS benefits representative or DMAS before applying.4

How to Apply and Get Free Help

The steps below are the pension route, the one that applies to a wartime veteran seeking Aid and Attendance as part of a VA pension. The VA's own condition for it reads, "You may be eligible for this benefit if you get a VA pension." A veteran who receives VA disability compensation rather than a pension uses the same medical form, because VA Form 21-2680 covers Aid and Attendance "that will be added to your monthly compensation or pension benefits," but should not file the pension application below.7

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), with the examination information section filled out by a medical examiner, documenting the need for help. This is the form for Aid and Attendance added to either a pension or monthly compensation.
• VA Form 21P-527EZ (Application for Veterans Pension), the wartime, means-tested pension application. A wartime veteran pursuing the pension route who is not already receiving a VA pension files this one. It is not the route for a veteran whose benefit is disability compensation.
• VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance). A nursing-home claim will also need this form filled out to confirm the veteran's status as a resident.7

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. If you are still gathering information, you can submit VA Form 21-0966 (Intent to File) first, because, in the VA's words, "Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive." On how long a decision takes, the VA's answer is "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.7

Do not do this alone. The Virginia Department of Veterans Services (DVS) provides benefits claims assistance through a statewide network of 38 benefit service offices across the Commonwealth, and DVS states that all of its services are provided free of charge.4 DVS handles disability claims and pensions, its team members receive comprehensive training, and many of them are veterans or military spouses who have been through the claims process themselves. Veterans in Virginia 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.4

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 In-Home Care 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.