VA extended care services cover long-term help with daily living for veterans with chronic illness or disability, ranging from nursing home placement to a medical team that visits your home. Whether the Department of Veterans Affairs must provide that care or simply may provide it depends on your disability rating, whether the condition is connected to your military service, and your income. Those same factors determine what, if anything, you pay.
Who the VA Must Cover and Who It May Cover
Federal law requires the VA to provide nursing home care to two groups: veterans who need nursing home care for a service-connected disability, and veterans with a service-connected disability rating of 70% or higher who need nursing home care for any reason.1Office of the Law Revision Counsel. 38 USC 1710A – Required Nursing Home Care If you fall into either group, the VA cannot turn you away because of budget constraints or bed shortages. It has to provide or pay for the care.
Every other veteran falls into the discretionary category. You can still qualify for extended care under the VA’s medical benefits package, but approval depends on clinical need, available resources, and your finances.2eCFR. 38 CFR 17.38 – Medical Benefits Package A VA physician evaluates whether you have limitations in activities of daily living such as bathing, dressing, or eating. When the condition is not service-connected, income and assets carry more weight in the decision.
Catastrophic Disability
Veterans below the 70% threshold can still get high-priority access through a catastrophic disability determination. The designation applies to a permanent, severely disabling condition that either requires personal or mechanical help to leave home or bed, or requires constant supervision to avoid physical harm.3Department of Veterans Affairs. Catastrophically Disabled Veteran Evaluation, Enrollment, and Certain Copayment Exemptions – VHA Directive 1630(1) You, your representative, or VA clinical staff can request the evaluation, and the facility must complete it within 30 days. Approved veterans are placed in Priority Group 4 unless they already qualify for a higher group.
How Priority Groups Affect Access
Every enrolled veteran is assigned to one of eight priority groups based on disability rating, service history, income, and other factors.4U.S. Department of Veterans Affairs. VA Priority Groups Priority Group 1 covers veterans with a 50% or higher service-connected rating, those deemed unemployable due to a service-connected disability, and Medal of Honor recipients. Priority Group 4 covers veterans receiving Aid and Attendance or housebound benefits and those determined catastrophically disabled. The groups descend from there through combinations of lower ratings, income limits, and copay agreements.
For extended care, priority groups do one specific thing: they set your place in line. If a Community Living Center is full, a Priority Group 1 veteran will be placed ahead of a Priority Group 5 veteran waiting for the same bed. If you qualify for more than one group, the VA assigns you to the highest.
The Care Options
The VA offers both institutional and home-based programs. A clinical team helps decide which setting matches your needs, with the aim of not overshooting or undershooting the level of care.
Institutional Settings
Community Living Centers are VA-run nursing homes that provide 24-hour skilled nursing and rehabilitation, including complex care like wound treatment and IV therapy.5U.S. Department of Veterans Affairs. Community Living Centers (VA Nursing Homes) Veterans in the mandatory nursing home category are placed in CLCs or in contracted community nursing homes.
State Veterans Homes are run by state governments with VA financial support. The VA pays a per diem for each eligible veteran — either half the daily cost or a basic rate set each fiscal year, whichever is lower.6eCFR. 38 CFR Part 51 – Per Diem for Nursing Home, Domiciliary, or Adult Day Health Care of Veterans in State Homes Out-of-pocket costs at State Homes vary widely; some states charge a percentage of the veteran’s income rather than a flat rate.
Medical foster homes suit veterans who need supervised living but not full nursing home intensity. Veterans who qualify for mandatory nursing home care can be placed in VA-approved medical foster homes at no cost to the veteran.7Office of the Law Revision Counsel. 38 USC 1720 – Transfers for Nursing Home Care; Adult Day Health Care
Home and Community-Based Programs
Home Based Primary Care sends an interdisciplinary medical team to your home to manage chronic conditions and coordinate treatment. It’s designed for veterans whose health needs make clinic visits ineffective, often because illness makes travel difficult. You don’t have to be fully homebound; isolation and caregiver strain are also factors.8Department of Veterans Affairs. Home Based Primary Care
Adult Day Health Care provides daytime supervision, social activities, and medical monitoring at a VA facility or in your home. It fits situations where family caregivers can handle evenings and weekends but need coverage during working hours.
Veteran-Directed Care gives you a budget to hire your own workers, which can include a family member or neighbor, for help with bathing, dressing, shopping, and meal preparation.9U.S. Department of Veterans Affairs. Veteran-Directed Care A counselor helps build the spending plan, and you or a representative manage the budget.
Respite care gives family caregivers a temporary break by placing the veteran in inpatient or outpatient care. Nursing home respite is capped at 30 days per calendar year.10U.S. Department of Veterans Affairs. Respite Care Hospice and palliative care focus on comfort for veterans with terminal illness or advanced chronic conditions, and can be delivered in a facility or at home.
Support for a Family Caregiver
If a family member provides daily care for you, the Program of Comprehensive Assistance for Family Caregivers may cover them. Eligibility requires a combined VA disability rating of 70% or higher, enrollment in VA health care, and a need for at least six continuous months of in-person personal care services.11U.S. Department of Veterans Affairs. VA Family Caregiver Assistance Program The caregiver must be a family member or someone living with the veteran full-time.
Approved primary caregivers can receive a monthly stipend, CHAMPVA health coverage if they lack other insurance, at least 30 days of respite care per year, free legal and financial planning help, and virtual psychotherapy. Secondary caregivers receive education, training, mental health counseling, and certain travel benefits. This program is designed to run alongside other extended care services, not in place of them.
What You’ll Pay
The first 21 days of extended care in any 12-month period are copay-free. Starting on day 22, the VA sets your copayment based on the level of care and the financial information you report on VA Form 10-10EC.12U.S. Department of Veterans Affairs. Current VA Health Care Copay Rates The 2026 maximum daily rates:
- Inpatient care (Community Living Center stays, overnight respite, overnight geriatric evaluations): up to $97 per day.13eCFR. 38 CFR 17.111 – Copayments for Extended Care Services
- Outpatient care (adult day health care, daily respite, non-overnight geriatric evaluations): up to $15 per day.
- Domiciliary care for homeless veterans: up to $5 per day.
Those ceilings apply to veterans with the highest incomes. Lower incomes and higher disability ratings mean lower copays or none at all. The calculation uses your gross household income, liquid assets, and deductible expenses such as medical bills. If you don’t submit Form 10-10EC, the VA charges the maximum by default, so filing the form almost always works in your favor.
Protections for a Spouse at Home
When a veteran enters institutional care for 181 days or more, the VA shields the community-dwelling spouse from being wiped out financially. The 2026 community spouse resource allowance is $162,660, meaning that much in liquid assets is excluded from the copayment calculation. The spouse’s primary residence and vehicle are also excluded, and a $20-per-day spousal allowance is subtracted from the veteran’s available resources.13eCFR. 38 CFR 17.111 – Copayments for Extended Care Services
Ongoing household expenses the spouse continues to pay, including rent or mortgage, utilities, food, insurance, vehicle payments, out-of-pocket medical costs, and taxes, are also deducted from the veteran’s available resources. These protections apply only after 181 days of institutional care, and only if the spouse or dependents live in the community.
Pension, Aid and Attendance, and the Look-Back Trap
Veterans planning to use VA pension benefits to help pay for nursing home care need to know about the three-year look-back period. When the VA receives a pension claim, it reviews any assets transferred in the three years before filing. Assets given away or sold below fair market value that would have pushed your net worth above the pension limit can trigger a penalty period of up to five years without pension benefits.14U.S. Department of Veterans Affairs. Veterans Pension FAQ
The 2026 net worth limit for VA pension is $163,699, adjusted each year. The look-back rule took effect on October 18, 2018, and never applies to transfers made before that date. Transferring a home or savings to a child shortly before applying is where families most commonly get caught.
Aid and Attendance is an enhanced pension for veterans who need daily personal assistance or are in a nursing home due to loss of mental or physical abilities related to a disability.15Veterans Affairs. VA Aid and Attendance Benefits and Housebound Allowance For 2026, the maximum annual pension rate with Aid and Attendance is $29,093 for a veteran with no dependents and $34,488 for a veteran with at least one dependent.16U.S. Department of Veterans Affairs. Current Pension Rates for Veterans Veterans already in a nursing home also complete VA Form 21-0779 as part of the application. Aid and Attendance can offset out-of-pocket costs at a State Veterans Home or other setting the VA doesn’t fully cover.
How to Apply
Enrollment in VA health care is a prerequisite. If you’re not enrolled, contact your nearest VA medical center or apply through the VA website first. The extended care application itself centers on VA Form 10-10EC.
The form asks for your marital status, dependents, and detailed financial information for you and your spouse, covering employment wages, business income, Social Security, retirement pay, interest, and dividends. It also collects deductible expenses such as medical bills, education costs, and funeral expenses.17Department of Veterans Affairs. VA Form 10-10EC – Application for Extended Care Services The VA uses prior-year gross income to set your copayment level. Alongside the form, gather documentation of current health status, any existing disability ratings, proof of insurance including Medicare or private plans, and records of liquid assets.
You can get Form 10-10EC from the VA website or from the business office at any VA medical center. A VA social worker or case manager can help you complete it and often starts the process during a care planning conversation.8Department of Veterans Affairs. Home Based Primary Care
Once submitted, your primary care team runs a clinical assessment, usually coordinated by a social worker, to evaluate what tasks you can perform and which level of care fits. The VA then notifies you which program was approved, whether there’s a copayment, and when services begin. If the program or facility is full, you go on a waitlist ordered by priority group. Final approval produces a coordinated care plan covering the frequency of home visits, terms of a residential move, or caregiver support arrangements.
If You Disagree With the Decision
Two very different appeal tracks exist, and picking the wrong one costs months. If you disagree with a clinical treatment decision, such as being offered adult day care when you believe you need nursing home placement, that’s a clinical appeal. Contact the patient advocate at the VA facility that made the decision and submit a written appeal identifying the decision, your reasons, and any supporting medical evidence.18U.S. Department of Veterans Affairs. Appeal a VA Clinical Decision The facility’s chief medical officer reviews the file. If you still disagree, escalate in writing to the Veterans Integrated Service Network office for your region, where the VISN patient advocate and chief medical officer take a second look.
If the dispute is about eligibility itself, such as the VA denying enrollment or saying you don’t qualify for extended care at all, it goes through the separate decision review process instead. That system has three lanes: a supplemental claim with new evidence, a higher-level review by a senior reviewer, or an appeal to the Board of Veterans’ Appeals.