VA Nursing Home Benefits: Eligibility, Costs, and Appeals

Eligibility for VA nursing home benefits falls into two tracks: the VA is required by law to provide care to veterans who need it for a service-connected disability or who carry a service-connected rating of 70% or higher, and it may provide care to other veterans based on clinical need, priority group placement, and financial eligibility. Which track you fall into determines whether placement is guaranteed, whether you owe a copay, and how much of the daily cost the VA covers.

Who the VA Must Cover

Under 38 U.S.C. § 1710A, the VA is legally obligated to furnish nursing home care to two groups. The first is any veteran who needs nursing home care specifically for a service-connected disability, at any rating level. The second is any veteran rated at 70% or higher for a service-connected disability who needs nursing home care for any reason, including conditions unrelated to military service.¹ If you fall in either group, the VA must furnish your care rather than offer it when a bed happens to be free.

One caveat: the mandate is tied to annual appropriations. The broader eligibility statute makes the nursing home requirement effective “only to the extent and in the amount provided in advance in appropriations Acts.”² Congress has consistently funded the program, but the statutory language is not an unconditional guarantee.

Who Else Can Qualify

Veterans who don’t meet either mandatory category are not shut out. Under 38 U.S.C. § 1710(a)(2), the VA may furnish nursing home care to veterans with a compensable service-connected disability rated below 70%, veterans discharged for a disability incurred in service, former prisoners of war, Medal of Honor and Purple Heart recipients, and veterans who cannot afford the cost of care.² The operative word is “may.” Placement in this track depends on available resources and clinical need.

Two other filters apply to everyone. You must be enrolled in VA health care, which itself requires meeting eligibility criteria based on service history, disability, or financial need.³ And you need a clinical determination that nursing home-level care is appropriate. A VA physician assesses whether you can manage bathing, dressing, eating, and medications on your own; if you require around-the-clock skilled nursing, you meet the clinical threshold. Veterans who need less intensive support may be directed to home-based primary care or adult day health care instead.

Priority group placement decides who gets a bed first when resources are tight. Priority Group 1 includes veterans rated at 50% or more, veterans the VA has determined are unemployable due to service-connected disabilities, and Medal of Honor recipients.⁴ Higher priority means earlier access when demand exceeds capacity.

Where the Care Happens

VA nursing home benefits are delivered in three settings, and the rules for cost-sharing and paperwork differ across them.

Community Living Centers

Community Living Centers are nursing homes operated directly by the VA, usually on or near VA medical center campuses. They provide skilled nursing, rehabilitation, and end-of-life care. Eligibility rests on clinical need and setting availability, and a copay may apply depending on your service-connected status and financial information.³ Bed availability is tightest here, which is why priority group matters.

Community Nursing Homes

When a VA facility has no available bed or isn’t geographically practical, the VA may contract with a private nursing home in your community. Eligibility for VA-paid placement depends on clinical need, service-connected status, disability level, and income. Veterans who don’t meet the criteria for VA-paid community nursing home care may need to cover costs through Medicare, Medicaid, or their own resources.⁵

State Veterans Homes

Each state operates its own veterans home program, and these facilities receive per diem payments from the VA. For veterans who qualify under the same mandatory categories that trigger § 1710A — service-connected need or a 70% or higher rating — the VA pays the state home directly, and that payment counts as full payment for the veteran’s care.⁶ For everyone else, the VA per diem covers only part of the daily cost, and the veteran pays the balance. State homes set their own room-and-board fees, and those vary widely. A VA social worker can pin down what you would actually owe at a specific facility.

What It Costs

Veterans in the mandatory categories generally pay nothing for care tied to a service-connected condition. Everyone else goes through a financial assessment. The VA uses income thresholds that vary by number of dependents and local cost of living.⁷ You report Social Security, pensions, and investment income. Medical expenses you’ve already paid can reduce countable income and shift you to a lower cost-sharing tier.

Extended Care Copays

Veterans admitted to a Community Living Center or other extended care setting complete VA Form 10-10EC, which collects the income and insurance information the VA needs to set your copay. For 2026, there is no copay for the first 21 days of care in any 12-month period. Starting on day 22, copays are capped based on the level of care:⁸

Inpatient care, including community living center stays, overnight respite, and overnight geriatric evaluations: up to $97 per day
Outpatient care, including adult day health care, daily respite, and non-overnight evaluations: up to $15 per day
Domiciliary care for homeless veterans: up to $5 per day

Those are ceilings. Your actual copay depends on the financial assessment and your service-connected status. Higher ratings and lower income pay less, and some pay nothing.

What Counts as an Asset

For pension-related benefits, some assets are excluded from net worth. Your primary residence is excluded as long as it sits on two acres or less, even if you have moved into a nursing home.⁹ Your car and personal belongings such as appliances and household items are also excluded. Sale proceeds from a home become a countable asset unless you buy another residence within the same calendar year.

Aid and Attendance

Veterans already receiving a VA pension who need help with daily activities, are largely bedridden, are in a nursing home due to disability-related functional loss, or have severely limited eyesight may qualify for an Aid and Attendance allowance on top of the pension.¹⁰ For the period running December 1, 2025 through November 30, 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. The net worth limit for pension eligibility during this period is $163,699, counting both assets and annual income (and a spouse’s, if married).¹¹ Because this is a pension enhancement rather than a health care enrollment benefit, it follows different financial rules than the means test for VA nursing home placement. Many families use these payments to offset state veterans home fees or other out-of-pocket costs.

How to Apply

VA Form 10-10EZ, the Application for Health Benefits, is the starting point if you are not already enrolled. It collects household income, spouse’s earnings, and deductible expenses.¹² For placement in a state veterans home, you also need VA Form 10-10SH, the State Home Program Application for Veteran Care Medical Certification.¹³ When the VA calculates your extended care copay, it will ask for Form 10-10EC.

Your DD214 verifies service history and discharge status, but the VA will request it on your behalf when it receives your application; you don’t need to pull it from the National Archives yourself.¹⁴ Having a copy speeds things up. Also gather recent non-VA medical records, bank statements, and the most recent tax return. Every figure on your forms should match the supporting documents. Discrepancies slow processing and can trigger denials that take weeks to unwind.

Submit the package to a Geriatric and Extended Care coordinator at your nearest VA Medical Center in person, by mail, or through the VA’s online portal. A clinical team then evaluates whether nursing home-level care is appropriate. If you are approved but no bed is available, you go on a waiting list managed by priority group and medical urgency, and the GEC coordinator keeps the family updated on placement timelines.

Keeping Your Benefits

Approval is not permanent. The VA reviews both financial and clinical status periodically, and either can shift your copay, your eligibility, or the type of care you receive.

VA Form 10-10EZR is used to report changes in income, assets, insurance, or dependents after enrollment.¹⁵ Submitting updates is technically voluntary, but skipping them cuts both ways. The VA may continue charging copays based on outdated income data, or it may flag your file when IRS and Social Security Administration data show changes you haven’t reported. Veterans in certain priority groups can opt into automatic financial retrieval from the IRS and SSA, which eliminates the need to file the 10-10EZR each year.¹⁶ Major financial events like a home sale or an inheritance should be reported promptly, because they can push you over the net worth threshold.

On the clinical side, VA physicians periodically reassess whether you still need nursing home-level care. If your condition improves, the VA may transition you to home-based services or adult day health care. If your service-connected rating climbs to 70% or higher during your stay, your eligibility shifts to mandatory coverage under § 1710A, which can eliminate or reduce your copay.¹ Stay in contact with the VA social worker assigned to the case; they typically know a reassessment is coming and can flag it before it creates a coverage gap.

If You Are Denied

Denials come in two forms, and the appeal route depends on which you received. Filing the wrong type means starting over.

If a VA care team decided you don’t clinically need nursing home-level care, that’s a medical determination. Contact the Patient Advocate at the VA facility and ask to initiate a written clinical appeal. The Patient Advocate routes it to the facility’s Chief of Staff, who reviews your medical records and may consult specialists. The facility must resolve the appeal within 45 business days.¹⁷ If you disagree with the result, you can escalate to a second-level appeal through the regional network’s Patient Advocate Coordinator.

If the VA denied eligibility as a benefits decision rather than a clinical judgment, you have three options. A Higher-Level Review (VA Form 20-0996) asks a senior reviewer to re-examine the same evidence within one year of the decision. A Supplemental Claim (VA Form 20-0995) lets you submit new evidence. An appeal to the Board of Veterans’ Appeals (VA Form 10182) puts your case before a Veterans Law Judge, with the option to submit additional evidence or request a hearing.¹⁸ You don’t have to exhaust lower-level reviews before going to the Board.

1
Office of the Law Revision Counsel. 38 U.S.C. 1710A – Required Nursing Home Care
2
Office of the Law Revision Counsel. 38 U.S.C. 1710 – Eligibility for Hospital, Nursing Home, and Domiciliary Care
3
U.S. Department of Veterans Affairs. Community Living Centers
4
U.S. Department of Veterans Affairs. VA Priority Groups
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U.S. Department of Veterans Affairs. Community Nursing Homes
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Office of the Law Revision Counsel. 38 U.S.C. 1745 – Nursing Home Care, Adult Day Health Care, and Medications for Veterans With Service-Connected Disabilities
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U.S. Department of Veterans Affairs. Income Limits and Your VA Health Care
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U.S. Department of Veterans Affairs. Current VA Health Care Copay Rates
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eCFR. 38 CFR 3.275 – How VA Determines the Asset Amount for Pension Net Worth Determinations
10
U.S. Department of Veterans Affairs. Aid and Attendance Benefits and Housebound Allowance
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U.S. Department of Veterans Affairs. Current Pension Rates for Veterans
12
Department of Veterans Affairs. VA Form 10-10EZ – Application for Health Benefits
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U.S. Department of Veterans Affairs. VA Form 10-10SH – State Home Program Application for Veteran Care Medical Certification
14
U.S. Department of Veterans Affairs. Request Your Military Service Records
15
Department of Veterans Affairs. VA Form 10-10EZR – Health Benefits Update Form
16
Office of Information and Regulatory Affairs. Supporting Statement for VA Forms 10-10EZ, 10-10EZR, and 10-10HS
17
Department of Veterans Affairs. VHA Directive 1041 – Appeal of Veterans Health Administration Clinical Decisions
18
VA News. Appealing Your Health Care Decisions