VA Aid and Attendance for Long-Term Care

Most families have never heard of the VA Aid and Attendance (A&A) pension. It can pay over $2,000 per month toward assisted living, home health aides, or nursing home care. Unlike Medicaid, A&A has no 5-year lookback (though the VA added a 36-month lookback for asset transfers in October 2018). For veterans and surviving spouses who need care but do not qualify for Medicaid, or who need to bridge the gap until Medicaid kicks in, A&A can make the difference between affording care and not.

Who Qualifies?

The Aid and Attendance pension is available to wartime veterans (or their surviving spouses) who meet the following criteria:

• Military service: At least 90 days of active duty, with at least one day during a qualifying wartime period (WWII, Korea, Vietnam, Gulf War/post-9/11). Veterans who entered service after September 7, 1980 (officers after October 16, 1981) must have served at least 24 months of continuous active duty, or the full period for which they were called up, in addition to that one wartime day. The veteran does not need to have served in a combat zone, just during a wartime period.
• Discharge: Other than dishonorable.
• Medical need: The claimant requires the regular aid and attendance of another person to perform activities of daily living (bathing, dressing, eating, toileting), or is bedridden, or is in a nursing home, or has corrected visual acuity of 5/200 or less in both eyes.
• Income: Unreimbursed medical expenses (including assisted living or home care costs) must reduce countable income below the Maximum Annual Pension Rate (MAPR). For a single veteran with A&A in 2026, the MAPR is $29,093. For a surviving spouse with A&A, $18,697.
• Assets: Net worth (excluding the primary residence and personal property) must not exceed $163,699 (adjusted annually for inflation; effective Dec. 1, 2025 through Nov. 30, 2026).

2026 Maximum Monthly Rates (Approximate)

Rates effective December 1, 2025 through November 30, 2026. These are tax-free benefits. Rates adjust annually with the Social Security COLA.

The 36-Month Lookback (Since October 2018)

Before 2018, the VA pension had no asset transfer restrictions. That changed with a 36-month lookback period for asset transfers. If the claimant (or their spouse) transferred assets for less than fair market value within the 36 months preceding the application, the VA will impose a penalty period during which the pension benefit is reduced or denied.

This is shorter than Medicaid's 5-year lookback but still requires advance planning. The penalty period equals the covered (transferred) assets divided by the monthly penalty rate, which is the MAPR for a veteran with Aid and Attendance plus one dependent, divided by 12 and rounded down. The penalty period is capped at 5 years (38 CFR 3.276).

How A&A Fits with Medicaid Planning

A&A and Medicaid are not mutually exclusive. They serve different populations and can work together:

• Before Medicaid: Many families use A&A to help pay for assisted living or home care during the years before Medicaid eligibility. Medicaid does not cover most assisted living. A&A can fill that gap.
• During the lookback: If the family made asset transfers and is within the 5-year Medicaid lookback, A&A can help pay for care during the penalty period.
• Instead of Medicaid: For veterans whose income or assets are slightly too high for Medicaid but who cannot afford care privately, A&A may be the only available benefit.

Legal and factual content on this page was last verified: Aug. 2026. If you are reading this significantly after that date, confirm key provisions with current statute text or contact our office.