Aid and Attendance for In-Home Care in Montana

01Who qualifies, including edge cases

The federal rules are the same in every state. The veteran needs 90 days of active duty with at least one day during a wartime period (24 months or the full call-up for most who entered after Sept. 7, 1980), a discharge other than dishonorable, and a net worth under $163,699. Net worth means assets plus yearly income, and VA looks back 36 months for assets given away¹²³⁴. For home care, the medical test is a need for help with daily activities or protective supervision, shown on VA Form 21-2680⁵⁶.

• Surviving spouses. A wartime veteran's surviving spouse can qualify based on their own care needs, using Form 21P-534EZ⁷.
• Under 65. Applicants younger than 65 also have to be permanently and totally disabled to get the pension.
• The home. A main home on a lot of up to two acres isn't counted in net worth⁸.

02How Aid and Attendance pays for home care

Payments to an agency or to an individual for help with bathing, dressing, eating, toileting or supervision count as medical expenses when the person needs that help⁹. The 2026 ceiling is $29,093 a year for a single veteran⁴. A son or daughter can be the paid caregiver. Keep a written agreement, a log of hours and proof of each payment. See our national home care guide.

03What home care aides earn in Montana

Montana’s median wage for home health and personal care aides was $17.61 an hour in May 2025, compared with $17.21 nationally¹⁰¹¹. That’s a wage, not an agency price. Agencies charge more to cover payroll taxes, insurance, travel and supervision, and long rural drives can add to the bill. As a rough budget, 20 hours a week at the aide wage alone is about $18,300 a year (20 × 52 × $17.61); an agency bill will be higher. Use your own quote for the VA claim. Browse home care in Montana.

04A Montana worked example

VA only subtracts care and medical costs above 5% of the basic pension rate, which is $584 a year for a surviving spouse in 2026¹²¹³. Here’s the math for the surviving spouse of a Vietnam veteran in Missoula, who has $17,000 a year of income and $16,000 a year of care and medical costs. Countable income is $17,000 − ($16,000 − $584) = $1,584. The pension is the $18,697 ceiling minus that: $18,697 − $1,584 = $17,113 a year, or about $1,426 a month¹³. If costs climb to $17,584 or more, countable income reaches zero and the full ceiling is paid.

Because the surviving spouse ceiling is lower, a smaller care bill reaches the break-even point. Even $16,000 a year of paid help, well under the cost of a nursing home, brings most of the ceiling back to her¹³.

05Montana's Big Sky Waiver at home

The Big Sky Waiver lets people who’d otherwise need a nursing home get services at home. To qualify, a person must be financially eligible for Medicaid, meet the minimum nursing home level of care and have a need that only waiver services can meet¹⁴. Services listed by DPHHS include personal assistance, homemaker services, respite care, adult day health, nutrition, personal emergency response systems (PERS), private duty nursing, a specially trained attendant and transportation¹⁴.

To start, call Mountain Pacific at (800) 219-7035 or (406) 443-4020 for a referral. Your county Office of Public Assistance decides Medicaid eligibility¹⁴. For a married applicant, Montana lets income flow to the spouse at home, up to $4,067 a month in 2026¹⁵.

06VA's own home care programs in Montana

Veterans enrolled in VA health care through VA Montana, based at Fort Harrison, can ask about homemaker and home health aide care, home-based primary care, respite and Veteran-Directed Care, which gives a budget to hire your own helpers where it’s offered^16171819. These are health care benefits, separate from the pension. See VA senior care programs in Montana.

07How home care benefits fit together

• Pension and the waiver. The VA pension counts as income for Medicaid eligibility. Ask how your total income will be treated before you apply for both.
• Housebound. A veteran mostly confined to home who doesn't need daily help may get the lower Housebound rate; see Housebound vs. A&A.
• If home stops working. Montana's three veterans homes take veterans and, when there's room, spouses²⁰; see Montana state veterans homes.
• Medicare. Medicare home health covers short-term skilled care, not ongoing personal care.

08Mistakes to avoid

• Paying a relative in cash with no records. VA needs proof of payment.
• Skipping the doctor's form. Form 21-2680 is the key evidence⁶.
• Assuming rural means no help. Big Sky Waiver case management teams of a nurse and a social worker plan services¹⁴.

09How to apply in Montana

1. Get the medical evidence. A doctor fills out VA Form 21-2680. For a nursing home resident, the facility fills out Form 21-0779⁶²¹.
2. File the pension claim. Veterans file VA Form 21P-527EZ and surviving spouses file 21P-534EZ, along with income, asset and care-cost records²²⁷.
3. Use MVAD's free service officers. Call MVAD at 406-324-3742. A veteran benefit technician sets up your file and books you with an accredited service officer; MVAD has nine offices around the state²³²⁴.
4. Add caregiver records. Agency invoices, or a signed caregiver agreement with timesheets and pay records.