VA Aid and Attendance for a Nursing Home in Washington

VA Aid and Attendance can help with the cost of a nursing home in Washington. It is not a separate program or a second check: it is an increased rate of the Veterans Pension or Survivors Pension, paid only to someone already eligible for that pension.1 For a veteran already paying a nursing home, a second rule matters as much: payments to a nursing home are medical expenses, and the part above 5% of the pension cap can be deducted from the income the VA counts, which can make a veteran eligible who otherwise would not be.1

This guide explains how that works in Washington, what a nursing home costs here, how Aid and Attendance interacts with Washington Apple Health (the state's Medicaid program), and the federal rule that caps the pension of a veteran with no spouse or child at $90 a month once Medicaid is paying the nursing-facility bill.2

In This Guide

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

How Much a Nursing Home Costs in Washington

Of the care settings CareScout surveyed in Washington, a nursing home costs the most, and this guide plans around the semi-private (shared) room rate, the lower of its two nursing-home figures.3

In Washington, a semi-private nursing home room ran a median of about $13,155 a month, roughly $432 a day, in 2025, according to the CareScout 2025 Cost of Care Survey, published in March 2026 from rates gathered July through November 2025. A private room runs about $191,625 a year, or roughly $15,969 a month.3 Washington's semi-private nursing-home cost runs well above the 2025 national median of about $9,581 a month. These are industry-survey medians, not government figures, so a specific facility's rate can differ.3

With shared-room care at roughly $13,155 a month, it helps to know exactly how VA Aid and Attendance fits against a bill that size.3

How VA Aid and Attendance Helps Pay for a Nursing Home in Washington

Aid and Attendance is not a separate program, and it is not a second check. It is a higher ceiling on the pension itself, applied when a veteran or surviving spouse needs another person's help with daily activities, has to stay in bed or spend a large part of the day in bed because of illness, is a patient in a nursing home because of a loss of mental or physical abilities related to a disability, or has severely limited eyesight.4 Each figure below already contains that category's basic pension rate rather than stacking on top of it.1

VA publishes these rates as annual maximums (the Maximum Annual Pension Rate). Pension is paid monthly, and under VA's regulations the monthly rate is the annual maximum minus your countable income, divided by 12 and rounded down to the whole dollar. For December 1, 2025 through November 30, 2026 the annual ceilings are:1

Two points matter here. 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, Aid and Attendance is an increased rate of that same pension, which VA describes as monthly payments to wartime veterans. Against a Washington semi-private room of about $13,155 a month, even the full ceiling of $29,093 a year 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.1,3

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.1

But you can subtract unreimbursed medical expenses (UMEs) from that income, and nursing home fees you pay yourself count as unreimbursed medical expenses.1 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.1

Consider what that means against a Washington nursing home. A single veteran paying roughly $13,155 a month for care passes the $872 annual floor within the first month.3,1 Deducting that expense can bring countable income down sharply, and a veteran whose countable income falls to zero can receive the full pension at the Aid and Attendance rate.1 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.1

Who Qualifies

To receive Aid and Attendance, a veteran must have no dishonorable discharge (VA says an other than honorable or bad conduct discharge may also bar eligibility) and meet all of the following:4

• Wartime service: how long the veteran had to serve turns on when they started active duty, not on which war they served in. VA lists three paths, and meeting any one of them satisfies the test. 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 (the periods VA recognizes include World War II, the Korean conflict, the Vietnam War era, and the Gulf War, which began August 2, 1990 and has no end date set yet). Someone who started active duty 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. And an officer who started on active duty after October 16, 1981, and had not previously served on active duty for at least 24 months, also meets the service test, again with at least one day during wartime.4,1
• Age, disability, or care status: 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. These branches are independent, so a wartime veteran under 65 who receives SSI qualifies on that branch alone, with no permanent-and-total rating.4
• Need for aid: at least one of four: needing another person's help with daily activities such as bathing, dressing, or feeding; having to stay in bed, or spend a large part of the day in bed, because of illness; being a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or eyesight of 5/200 or less in both eyes even with glasses or contacts, or a visual field narrowed to 5 degrees or less. In rating that need, VA also weighs whether someone needs care or assistance on a regular basis to stay safe from everyday hazards, and the need has to be regular, not constant.4
• Income and net worth within limits: yearly family income and net worth must meet limits Congress sets. For 2026 the net worth limit is $163,699, counting assets and annual income but excluding the primary home, the car, and basic home items like appliances.4,1

The VA also enforces a 3-year look-back on assets transferred for less than fair market value: a transfer of an asset that, if kept, would have pushed net worth over the limit can trigger a penalty period of up to five years.4 A veteran who is a nursing-home patient because of a disability-related loss of mental or physical abilities can meet both the "need for aid" test and the nursing-home branch of the age-or-disability test, so for such a resident the remaining questions are the service, discharge, income, and net worth tests.4

The $90/Month Nursing-Home Pension Cap

Here is the rule to know before Medicaid starts paying. Once Washington Apple Health is paying for a veteran's nursing-home care, federal law can sharply limit the VA pension.

Under 38 U.S.C. 5503(d)(2), implemented at 38 CFR 3.551(i), when a veteran with no spouse or child is receiving Medicaid-covered nursing-facility care, the VA limits the pension, including any Aid and Attendance amount, to no more than $90 a month. The same cap applies to a surviving spouse with no child (5503(d)(5)(A)).2 The statute and the regulation date the cap differently: the statute applies it to any period after the month of admission to the nursing facility, while 38 CFR 3.551(i) applies it after the month Medicaid payments begin. If the veteran was admitted as a private payer months before Medicaid started, check which date VA used on the award rather than assume either one.2 The VA says that where it awards the $90 rate, the facility can't count that payment as income toward the cost of care, and the veteran keeps the full $90 for personal expenses. That is a federal rule about the facility's cost-of-care math. Whether the $90 comes on top of Washington's own Medicaid personal needs allowance or in place of it is set by Washington's post-eligibility rules, so confirm that with the Health Care Authority rather than assuming the two amounts add together.2

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(i) 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.2

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 veteran with no spouse or child, or a surviving spouse with no child, and only the $90 remains. The cap is written for beneficiaries without a spouse or child, so a married veteran's circumstances differ, which is exactly the kind of timing question a VA-accredited representative should review before you file.2

How Aid and Attendance Works with Washington Medicaid

VA Aid and Attendance and Washington Apple Health, the state's Medicaid program administered by the Health Care Authority, are separate programs run under different rules, and a Washington veteran or surviving spouse can qualify for and receive both at the same time.2 Apple Health counts most income when determining long-term-care eligibility and a client's share of cost, but it treats parts of a VA pension differently at each of those two steps.1

Under Washington's eligibility rule, WAC 182-512-0840, the Aid and Attendance allowance, the housebound allowance, and the unreimbursed medical expense amounts the VA pays are excluded from income for Supplemental Security Income (SSI)-related Apple Health, while the basic pension amount is treated as income.1 That exclusion governs eligibility only. For institutionalized individuals in SSI states, 42 CFR 435.725 provides that income disregarded in determining eligibility must be considered in the post-eligibility calculation, and Washington's own long-term-care rule points the same way: under WAC 182-513-1340, Aid and Attendance, housebound, unreimbursed medical expense amounts and special monthly compensation are excluded when determining eligibility but are available as a third-party resource when the agency determines what an institutionalized client contributes to the cost of care, and WAC 182-513-1380 adds that a client may have to pay third-party resources in addition to the participation amount. So for a Washington nursing-home resident whose VA pension has not been reduced to the $90 cap (for example, a veteran who has a spouse or a child), the Aid and Attendance amount can raise what the resident pays toward care.1 Once the pension has been capped at $90, though, federal law provides that the Medicaid payment to the facility may not be reduced by that permitted pension.2 Not all of a resident's income goes to the facility, either. Under 42 CFR 435.725(c) the agency first deducts amounts that include a personal needs allowance (at least $30 a month under federal rules, a floor rather than necessarily the amount Washington protects), amounts for the needs of a spouse or family at home, and "Amounts for incurred expenses for medical or remedial care that are not subject to payment by a third party." Those deductions are not open-ended: the category covering care recognized under State law but not covered by the state plan is "subject to reasonable limits the agency may establish." By its own terms that rule reaches individuals in medical institutions and intermediate care facilities, so it does not settle the calculation for home and community-based waiver services; for waiver services, check the rule Washington applies to your own case rather than assuming the institutional result.1,2 Because the exact countable-income mechanics and any client-participation calculation depend on your situation, confirm them with the Health Care Authority or the Department of Social and Health Services (DSHS) for your specific case.1

How to Apply and Get Free Help

The steps below are the pension route, which is the one that applies here: the VA's condition for it is "You may be eligible for this benefit if you get a VA pension." Aid and Attendance is not only paid that way. VA Form 21-2680 also covers an aid-and-attendance amount "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 examination form without the pension application below.5

• VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), with the examination section filled out by a medical examiner, documenting the need for help.
• VA Form 21P-527EZ (Application for Veterans Pension), if you are a wartime veteran pursuing the pension route and are not already receiving a VA pension. This is the wartime, means-tested pension application, so it is not the form for someone whose aid-and-attendance amount would be added to disability compensation.
• VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance), which a nursing-home claim will also need.
• VA Form 21-0966 (Intent to File), 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."

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 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.5

The Washington State Department of Veterans Affairs (WDVA) strongly recommends working with an accredited Veteran Service Officer, says that help is free, and says its Service Officers guide you through claims and appeals. WDVA also runs a Service Center in Olympia, with in-person and virtual appointments, whose Benefit Specialists help with filing for VA Disability Compensation, VA Pension or Survivors Pension, VA Health Care, and other federal, state, or county benefits. For a pension application, WDVA's list of documents to bring includes proof of medical expenses, such as facility care expenses.6 Aid and Attendance is itself an increased rate of Veterans Pension or Survivors Pension.1 To start, find a Service Officer near you on WDVA's county map; the Service Officers listed there are contracted with WDVA to provide accredited VA claims assistance. WDVA warns that unaccredited people who prepare, present, or prosecute VA benefit claims are violating federal law. Its Claims Assistance page lists 1-800-562-2308 and benefits@dva.wa.gov.6

Compare Care Settings in Washington

See how Aid and Attendance works with the other care settings in Washington:

• How Aid and Attendance Pays for Assisted Living in Washington
• How Aid and Attendance Pays for In-Home Care in Washington
• How Aid and Attendance Pays for Memory Care in Washington

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.