VA Home Health Aide Care: Who Qualifies and Costs

Your dad served. Now he needs help getting showered and dressed, and your mom can't do it alone anymore. Someone at the VA clinic mentions a home health aide. Someone else says Medicare pays for home health. Both can be true, and they are not the same program.

I'm an occupational therapist, and I've worked in home health. Bathing, dressing and getting around the house are my part of the job.

Below, a rule means a federal regulation, and I'll cite the paragraph. When I quote a VA or Medicare.gov web page, that's the program's own description, not the regulation. Anything else is my own suggestion, and I'll say so.

What the VA Home Health Aide Program Is

VA's name for it is Homemaker and Home Health Aide Care. VA describes the aide this way: "A Homemaker and Home Health Aide is a trained person who can come to a Veterans home and help the Veteran take care of themselves and their daily activities."

It is not nursing. VA's page says: "Homemakers and Home Health Aides are not nurses, but they are supervised by a registered nurse who will help assess the Veterans daily living needs."

VA says who it's for: "This program is for Veterans who need personal care services and help with activities of daily living. This program is also for Veterans who are isolated, or their caregiver is experiencing burden." The aide works for a contractor, not VA directly: "Homemaker Home Health Aides work for an organization that has a contract with VA."

The examples VA gives of help with daily activities are eating, getting dressed, personal grooming, bathing, using the bathroom, moving from one place to another, and grocery shopping.

VA says "Services are based on your assessed needs," and "an aide may be able to come to your house several times a week or just once in a while." On how long: "You can continue to receive an aide's services for as long as you need extra help with your daily activities."

Who Qualifies

VA's page for the program puts it in one sentence: "All enrolled Veterans are eligible for Homemaker Home Health Aide Care If they are eligible for community care and meet the clinical criteria for the service and it is available. Services may vary by location."

That's four things:

Enrolled in VA health care. VA's Geriatrics page says "Veterans must be enrolled in VA health care before applying for VA long term care services". The same page warns: "Receiving financial compensation for a VA disability does NOT automatically enroll you in VA health care."
Eligible for community care. VA's aide page doesn't explain what that means for this program. Ask the VA social worker how it applies to your parent.
Clinical criteria. The VA team decides whether your parent needs the service.
Available where you live. VA says more than once that services vary by location.

VA's long-term care page adds: "We may also consider other factors, like your service-connected disability status or insurance coverage."

Two differences from Medicare: VA's aide page does not list being homebound as a condition, and it doesn't list skilled care as one either. Medicare home health requires both.

How to Ask for It

Start with the VA social worker. The aide page says "Talk with a VA social worker to find out what specific help you may be able to receive," and "If Homemaker or Home Health Aide services are right for you, your VA social worker can help you make arrangements for those."

VA's long-term care page gives a second route. It says to contact your VA social worker, or to call VA's toll-free hotline at 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.

VA also points families to two worksheets, a "Veteran Decision Aid for Care at Home or in the Community" and a "Caregiver Self-Assessment." Ask the social worker for both.

What It Costs

VA's page for the program says: "A copay for Homemaker and Home Health Aide services may be charged based on your VA service-connected disability status."

VA's Geriatrics page lists Homemaker and Home Health Aide Care among its long-term care services and says: "Long term care copays are not charged until the 22nd day of care." VA's copay page describes long-term care copays in general: "You won’t need to pay a copay for geriatric care (also called elder care) or extended care (also called long-term care) for the first 21 days of care in a 12-month period." After that, VA says it bases the copay on the level of care and the financial information on the Application for Extended Care Services (VA Form 10-10EC).

Here's where I have to be careful. The regulation that sets extended care copays is 38 CFR §17.111. It defines "extended care services" as "adult day health care, domiciliary care, institutional geriatric evaluation, noninstitutional geriatric evaluation, nursing home care, institutional respite care, and noninstitutional respite care" (38 CFR §17.111(c)(3)). The aide program is not named in that list, and VA's copay table doesn't list a separate aide rate. So I won't give you a dollar figure for aide care. The VA social worker can tell you your actual amount.

On other insurance, VA's insurance page says: "We don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services." It also says: "You won’t have to pay any unpaid balance not covered by your health insurance provider. But, depending on your assigned priority group, you may have a copay for non-service-connected care." And when a private insurer does pay VA, VA says it may be able to use that money to offset part or all of your copay.

The Other VA Programs Around It

The aide program is one of several. VA says aide services "can be used in combination with other Home and Community Based Services." Here is how VA describes the ones families ask about most.

Program	What VA says it is	Who VA says can get it	Service or money?
Skilled Home Health Care	Nursing, therapy, wound care or IV antibiotics at home, from a home health agency with a VA contract	Enrolled veterans who are eligible for community care and meet the clinical criteria	Service
Home Based Primary Care	A VA team that provides primary care at home. Veterans are often homebound, "but that is not required"	Enrolled veterans with a clinical need, where it's available	Service
Veteran-Directed Care	A budget the veteran or a representative manages to hire their own workers, who can include a family member or neighbor	Enrolled veterans who are eligible for community care, meet the clinical criteria, where it's available	Service you direct
Respite Care	Short-term care so the family caregiver can take a break, at home, at adult day health care, or in a nursing home	Enrolled veterans who meet the clinical criteria, where it's available	Service
Program of Comprehensive Assistance for Family Caregivers (PCAFC)	Training, a monthly stipend for the primary caregiver, at least 30 days of respite a year, and more	The veteran has a VA disability rating of 70% or higher, has been discharged (or has a medical discharge date), needs at least 6 months of continuous in-person personal care, and is enrolled in VA health care	Support for the caregiver, including money
Program of General Caregiver Support Services (PGCSS)	Skills training, coaching, peer support and referrals for caregivers	Caregivers of veterans enrolled in VA health care who served in any era	Support for the caregiver
Aid and Attendance or Housebound	Monthly payments added to a VA pension	Veterans and survivors who get a VA pension and meet the need rules	Money

Don't confuse the last row with the aide program. VA says these benefits "provide monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors." It's money, not a person who comes to the house.

How It Fits With Medicare Home Health

Medicare home health is skilled and part-time. Medicare.gov says you must need "part-time or intermittent skilled services" and be homebound. Medicare covers aide care only alongside skilled care: "only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time." Medicare does not pay for personal care like bathing and dressing "when this is the only care you need." Our guide to who qualifies for home health care walks through those rules.

When the nurse and therapist finish and Medicare home health ends, the need for help with a shower often doesn't. In my experience, that's the gap families feel most. Our article on what home health does not cover goes through it.

Using both

Medicare.gov says: "If you have (or can get) both Medicare and Veterans’ benefits, you can get treatment under either program." It goes on: "Generally, Medicare and the U.S. Department of Veterans Affairs (VA) can’t pay for the same items or services. Each time you get health care or visit a provider, you’ll have to choose which benefit to use."

VA's insurance page adds: "It’s always a good idea to let your VA doctor know if you’re receiving care outside VA."

Here's what I won't tell you: a rule for running VA aide hours in the same weeks as Medicare home health visits. Neither page I read spells one out. Ask the VA social worker and the home health agency before you plan around it.

What I'd Do

This section is my own advice, not a VA or Medicare rule.

What I'd ask the VA team:

Is my parent enrolled in VA health care, not just getting disability payments?
Does my parent meet the community care eligibility for the aide program?
Who is my parent's VA social worker, and how do we reach them?
Can we fill out the 10-10EC now, so we know the copay before care starts?
Is Veteran-Directed Care available here? What about respite?
If my parent also gets Medicare home health, how do you want us to tell you?

What I'd have ready:

A list of the daily tasks your parent needs help with, and how often. Be specific. Needing help stepping into the tub tells the team more than needing help with bathing.
Who helps now, and for how many hours a week.
Insurance cards, and income and asset paperwork for the 10-10EC.

How a home health clinician can flag the need. If your parent is on Medicare home health right now, tell the agency your parent is a veteran. Medicare.gov lists "Medical social services" among covered home health services, so ask whether the agency's social worker can help connect you to the VA. In my experience, the therapist and the aide see daily needs up close. Ask the OT or PT to write down what your parent can and can't do safely in the bathroom and getting dressed, and ask the agency how to get those notes to the VA team. Do this before home health ends, not after.

Find an Agency lists the Medicare-certified agencies that serve your ZIP code. For the bigger picture, see home health vs home care vs hospice.

Frequently Asked Questions

Who qualifies for the VA home health aide program?

VA says all enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and the service is available where they live. The first step is being enrolled in VA health care. Getting VA disability payments does not enroll you on its own.

Does the VA home health aide program cost anything?

It can. VA's page for the program says a copay may be charged based on the veteran's service-connected disability status. VA's long-term care page, which lists the aide program among its services, says long-term care copays are not charged until the 22nd day of care. Ask the VA social worker for your actual amount.

Can a veteran use both Medicare home health and VA care?

A veteran with both can get treatment under either program. Medicare.gov says Medicare and the VA generally can't pay for the same items or services, so you choose which benefit to use each time. VA asks you to tell your VA doctor about care you get outside VA.

Is Aid and Attendance the same as the VA home health aide program?

No. Aid and Attendance and Housebound are monthly payments added to a VA pension. They are money, not a service, and you have to get a VA pension to qualify. The aide program is a service VA arranges through your VA health care.

Sources

Does your parent qualify for Medicare home health?

Answer a few questions about your parent's situation. The checker tells you whether Medicare home health is likely, probably not, or something to ask the doctor about.

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VA Home Health Aide Care: Who Qualifies, What It Covers, and How It Fits With Medicare