Texas VA Aid and Attendance

Quick answer: VA Aid and Attendance adds to a VA pension for wartime veterans and survivors who need help with daily activities. Maximum pensions with A&A are $29,093 a year for a veteran with no dependents, and Texas Medicaid exempts A&A from both eligibility and co-payment.

How Aid and Attendance works with Texas Medicaid

Aid and Attendance (A&A) is an extra monthly amount added to a VA pension. It's for wartime veterans and surviving spouses who need another person's help with daily activities, are largely bedbound, live in a nursing home because of a disability, or have severely limited eyesight. To get it, the person must first qualify for VA pension:

• wartime service
• a discharge other than dishonorable
• age 65 or older, or a permanent disability
• income and net worth under the limits Congress sets

VA pays the difference between countable income and the Maximum Annual Pension Rate (MAPR). Unreimbursed medical expenses, such as home-care or assisted-living costs, can reduce countable income.

How Texas Medicaid treats it: under the Texas HHSC Medicaid for the Elderly and People with Disabilities (MEPD) Handbook, VA Aid and Attendance, housebound allowances and reimbursements for unusual medical expenses are exempt from both eligibility and co-payment. Regular VA pension and compensation generally do count as income. Two details matter:

• Qualified Income Trust (QIT) deposits: if A&A money is deposited into a QIT, the deposited amount becomes countable for co-payment. HHSC lets the A&A portion be separated from the pension before the rest goes into the QIT, and doing so doesn't invalidate the trust.
• The $90 VA pension: when a single veteran or surviving spouse on Medicaid enters a nursing home, VA reduces the pension to $90 a month. Texas treats that $90 as an A&A allowance, not income.

Two different look-backs: VA reviews asset transfers made in the 36 months before a pension claim. Texas Medicaid reviews 60 months before a long-term care application. A gift that's fine for one program can cause a penalty in the other, so plan for both.

Example

Carlos, 84, is a Vietnam-era veteran in San Antonio. He pays $4,800 a month for assisted living and has $70,000 in savings. His assisted-living costs count as unreimbursed medical expenses that reduce his countable income, so he may qualify for the maximum A&A pension. If he later needs Texas Medicaid nursing-home care and sets up a QIT, his family should make sure the A&A portion of his VA payment isn't deposited into the trust.

Illustrative example; names and figures are hypothetical.

Common mistakes

• Assuming A&A is a separate program. It's an add-on to VA pension, and the pension rules come first.
• Moving assets to qualify for VA without checking the Texas Medicaid five-year look-back.
• Depositing the whole VA check into a QIT, which makes the exempt A&A portion countable for co-payment.
• Not documenting care needs: VA relies on a physician's statement (often VA Form 21-2680).

Questions and answers

Does VA Aid and Attendance count as income for Texas Medicaid?

No. Texas HHSC exempts A&A, housebound allowances and reimbursements for unusual medical expenses from both eligibility and co-payment, unless they're deposited into a Qualified Income Trust.

What is the 2026 VA net worth limit?

$163,699 (assets plus annual income) for December 1, 2025 through November 30, 2026. The primary residence and personal belongings aren't counted.

Can a surviving spouse get Aid and Attendance?

Yes, through Survivors Pension. The 2026 maximum with A&A for a surviving spouse with no dependents is $18,697 a year.

Can A&A help pay for assisted living or home care?

Yes. The pension can be used for any care. The cost of that care can also count as an unreimbursed medical expense that raises the pension amount.