When a family prices in-home care for a veteran, the usual arithmetic is the monthly care bill minus the VA pension. Medicaid changes that arithmetic because it is a separate program with its own rules. It is not a VA benefit, and whether it helps, and by how much, depends on the state where Dad lives and on how his income and assets are counted under Medicaid rules. This article covers only what moves the price up or down. It is general information, not legal advice, and the state Medicaid office is the authority on eligibility.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
What pulls the price down
The first lever is whether the state covers home-based help at all. Many states run home and community-based waiver programs that can pay for personal care at home instead of a facility bed. Where such a program exists and Dad qualifies, the family may pay less out of pocket for the hours it covers. Ask whether the state offers an in-home waiver, which services it includes, and whether it pays individual aides, agencies, or both.
What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).
The second lever is the service mix. A program may cover hands-on personal care but not companionship, overnight supervision, or certain errands. Each hour the program covers is an hour the family does not pay privately, so compare your planned weekly hours against the covered list and mark which fall inside it and which fall outside.
The third lever is timing. Some programs keep waiting lists for slots. Private pay covers the wait, so a short wait may cost little and a long one may change the whole plan.
What pushes the price up
Medicaid looks back at asset transfers made before an application. A gift to a child may create a penalty period during which Medicaid will not pay for certain care. Before moving money or property to family, ask the state office how the look-back applies.
State-set provider rates may be lower than a private agency's rate. Some agencies do not accept Medicaid. A family that switches to a participating provider to get the covered rate may face a gap in service and a new contract to review.
Medicaid also counts income. The VA pension, including any aid and attendance add-on, may be counted as income for Medicaid purposes. Ask the state office directly how the VA payment is treated. Do not assume the VA's figures carry over to the Medicaid calculation.
What to ask the state office
- Does the state run a waiver for in-home personal care, and who qualifies for it?
- Is there a waiting list, and how is the place in line set?
- Which services are covered, and which are excluded?
- How is the VA pension and any aid and attendance add-on counted?
- How does the transfer look-back work, and what is the penalty rule?
- Which local agencies accept the program's rate?
Local contacts for St. Louis are listed on Local Help: St. Louis Offices. The desk's sourcing method is on the Sources page. This desk is not affiliated with the U.S. Department of Veterans Affairs.
Footnotes
- VA.gov, Veterans Pension and Aid and Attendance pages, for the VA-side income and net worth rules that apply to the pension and its add-on.
- The Medicaid points in this article are not VA claims. The sources are the federal Medicaid program and your state Medicaid agency. No VA.gov page sets those rules.