South Dakota Veteran Home Care Benefits: VA Aid and Attendance and Caregiver Support

VA Aid and Attendance: The Monthly Pension Add-On

If your aging parent is a wartime veteran — or the surviving spouse of one — the VA's Aid and Attendance (A&A) benefit can add significant monthly income specifically to help pay for home care.

Aid and Attendance is not a standalone program. It's an enhanced pension benefit for veterans (or surviving spouses) who meet three criteria:

1. Wartime service — at least 90 days of active military service, with at least one day during a defined wartime period (WWII, Korea, Vietnam, Gulf War era)
2. Financial need — income minus unreimbursed medical expenses falls below the VA's pension threshold
3. Care need — the veteran requires the regular assistance of another person for daily activities, is bedridden, is a patient in a nursing home, or has severely limited eyesight

2026 maximum annual A&A pension rates (MAPR):

These are annual MAPR limits for the current rate period, not guaranteed payments or monthly rates. The actual amount depends on the applicable rate, countable income, and unreimbursed medical expenses. The VA subtracts countable income (minus allowable unreimbursed medical expenses, including the cost of home care) from the applicable rate. Rates can be higher when there are qualifying dependents; check the current VA table when applying.

There is no requirement to use the money for any specific purpose. Once approved, the A&A benefit is added to the monthly pension payment. It can fund home care aides, adult day programs, home modifications, or any other care-related expense.

How to Apply for A&A in South Dakota

1. Gather military service records. You'll need the DD-214 (Certificate of Release or Discharge from Active Duty). If your parent can't locate it, request a copy from the National Personnel Records Center using VA Form SF-180.

2. Document the care need. Your parent's physician must complete VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), describing the specific daily activities where your parent needs help.

3. Document financial status. Complete VA Form 21P-534EZ (for surviving spouses) or VA Form 21P-527EZ (for veterans) with detailed income, asset, and medical expense information.

4. Submit through your local VA Regional Office or a Veterans Service Organization (VSO). In South Dakota, county Veterans Service Officers (VSOs) provide free assistance with VA claims — every county has one. The South Dakota Division of Veterans Affairs coordinates these services.

Processing times vary with the VA and the claim. A county Veterans Service Officer can help submit the claim at no charge.

The VA Caregiver Support Program

If your parent is a veteran enrolled in VA healthcare and needs a family caregiver, the VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides:

• A monthly stipend paid directly to the family caregiver, based on the veteran's care needs (calculated as a percentage of what the VA would pay a professional caregiver)
• Health insurance for the caregiver through CHAMPVA if they're not otherwise insured
• Caregiver training — structured education on care techniques, safety, and managing the veteran's specific conditions
• Respite care — at least 30 days per year of temporary relief
• Mental health counseling for the caregiver
• Travel expenses for the caregiver when accompanying the veteran to VA appointments

To qualify for PCAFC, the veteran must meet the VA's current eligibility criteria for a qualifying serious injury or illness and caregiver need. The VA determines eligibility based on the individual claim.

Contact the VA Caregiver Support Line at 1-855-260-3274 to begin the application.

Using VA Benefits Alongside Medicaid

VA benefits and Medicaid are not mutually exclusive. A common strategy in South Dakota:

• VA A&A pays for private home care while the Medicaid HOPE Waiver application processes (which can take months)
• Once the HOPE Waiver is approved, Medicaid covers in-home care at no cost, and the VA A&A pension continues as supplemental income
• The VA benefit can fund services that Medicaid doesn't cover, or can be saved for future needs

However, coordination matters. VA pension income counts toward Medicaid's gross monthly income limit ($2,982 for the HOPE Waiver). If A&A pushes your parent's total monthly income above that cap, a Miller Trust can shelter the excess.

VA benefits do not count as a countable asset for Medicaid purposes in the month they're received. But any VA pension money that remains unspent at the end of the month becomes a countable asset the following month. Families managing both programs need to spend down VA income monthly to maintain Medicaid asset eligibility.

South Dakota-Specific VA Resources

• South Dakota Division of Veterans Affairs: 605-773-3269
• VA Sioux Falls Health Care System: 605-336-3230
• VA Black Hills Health Care System (Hot Springs and Fort Meade): 605-745-2000
• County Veterans Service Officers: every county has one; contact information available through the Division of Veterans Affairs

The South Dakota Home Care Navigator includes a section on combining VA benefits with state Medicaid programs, including a worksheet for calculating whether A&A income requires a Miller Trust adjustment.

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