VA Expands Day Care Options for Veterans in State Homes
Published Date: 2/20/2026
Proposed Rule
Summary
The VA is updating rules to officially recognize and pay for a special kind of adult day health care called medical model adult day health care (MMADHC) at State Veterans Homes. This helps veterans with complex medical needs get care outside of nursing homes. States running these homes can now enter agreements with the VA for payment, with comments on the proposal due by April 21, 2026.
Analyzed Economic Effects
5 provisions identified: 5 benefits, 0 costs, 0 mixed.
VA will pay for MMADHC at 65% rate
VA proposes to pay State homes for medical model adult day health care (MMADHC) at the lesser of (1) 65 percent of the prevailing rate VA pays for nursing home care, or (2) the actual daily cost on the invoice. This payment method would be established in a State Home Care Agreement (SHCA).
Who qualifies for MMADHC per diem
VA proposes that per diem for MMADHC is payable only for eligible veterans who either (1) need nursing home care or MMADHC for a VA adjudicated service-connected disability, or (2) have a 70 percent or greater combined service-connected disability rating (or total disability based on individual unemployability) and need nursing home care or MMADHC. VA also notes MMADHC per diem is only payable for veterans who would need nursing home care if MMADHC did not exist or was not available.
Retroactive MMADHC payment allowed back to 2013
VA proposes that if a veteran receives a retroactive service-connected disability rating and becomes eligible, a State home may request payment under the SHCA for nursing home care or MMADHC back to the retroactive effective date of the rating or February 2, 2013, whichever is later. For care after the effective date but before February 2, 2013, payment may be requested at the special per diem rate in effect when care was rendered.
MMADHC defined to include medical services
VA proposes a formal definition of medical model adult day health care (MMADHC) to mean adult day health care that includes coordination of physician services, dental services, nursing services, administration of drugs, and other requirements the Secretary determines appropriate. The term is declared interchangeable with "medical supervision model adult day health care."
VA and State homes must enter SHCAs or contracts
VA proposes to change regulatory language so that VA and a State home will (shall) enter into a contract or State Home Care Agreement to pay per diem for each eligible veteran's nursing home care, rather than "may" enter. This makes entering agreements mandatory as described in 38 U.S.C. 1745(a)(1).
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