How does a home care agency get paid through the VA Homemaker and Home Health Aide program?

Through a VA referral. A VA clinical team decides a veteran needs Homemaker and Home Health Aide (H/HHA) care, and VA authorizes a number of hours a week for a set period. Your agency delivers those hours under a Community Care Network contract with Optum or TriWest, or under a Veterans Care Agreement with VA. You bill the payer named on the referral, at your contract rate or, where none applies, VA’s fee schedule.

What is the VA Homemaker and Home Health Aide program?

It is VA’s program for in-home personal care. You will see it written as Homemaker and Home Health Aide, Homemaker/Home Health Aide, or H/HHA. Federal law names it the “Homemaker and Home Health Aide program” in 38 U.S.C. 1720L(c), added by Public Law 118-210, the Elizabeth Dole Act, on January 2, 2025. The same law requires VA to run it through every VA medical center by January 2, 2027.

VA says a homemaker or home health aide is “a trained person who can come to a Veterans home” to help with daily activities, such as eating, getting dressed, grooming, bathing, using the bathroom, moving around and grocery shopping (VA, updated March 6, 2026). Aides are not nurses. A registered nurse supervises them and helps assess the veteran’s needs. The program serves veterans of any age, and services vary by location.

VA doesn’t employ the aides. They “work for an organization that has a contract with VA.” The law behind VA’s home care alternatives to nursing homes says VA furnishes these services “solely through contracts” with public and private agencies, while VA staff handle case management (38 U.S.C. 1720C(b)).

Who qualifies?

VHA Notice 2024-01, Purchased Home and Community-Based Services Programs, is interim policy. It carried a February 28, 2025 expiry date, and VA’s publications list still showed it as active in October 2026.

A copay may apply based on the veteran’s service-connected disability status. That is between the veteran and VA. See Do you collect a copay?

Who authorizes the care?

VA does. A family or an agency can’t start H/HHA on its own. VA’s community care claims page says all non-urgent care “requires authorization from VA in advance,” and the referral is VA Form 10-7080 (VA, updated October 20, 2026).

The usual path:

1. The veteran’s VA team assesses needs. VA tells veterans to talk with a VA social worker about H/HHA. Case management under 38 U.S.C. 1720C(b)(2) covers assessment of needs, planning, referral, monitoring and reassessment.
2. A VA clinician orders the care. The approved referral goes to the VA medical center’s community care staff (TriWest unskilled home health guide, revised September 26, 2025).
3. VA picks the agency. A veteran may name a provider. If the veteran doesn’t, VA refers them to one (38 CFR 17.4020(b)).
4. Your agency receives the referral. It defines the services you may provide and says where to send the claim. Under a VCA, referrals usually come through VA’s HealthShare Referral Manager (HSRM) system (VA).

How does VA set the hours?

Each H/HHA referral carries a Standardized Episode of Care (SEOC). TriWest, the network administrator for Regions 4 and 5, describes it this way (TriWest CCN home health guide, revised September 18, 2026):

• VA selects the SEOC “based upon the Veteran’s needs.”
• Each SEOC sets “the number of hours authorized each week, and duration in which care may be rendered.”
• The VA physician’s order controls. If the SEOC allows up to 20 hours a week and the order says 10, you deliver 10.
• Don’t go over the hours in the VA order.

TriWest’s September 2025 unskilled home health guide adds that H/HHA is authorized for 30, 90, 180 or 365 days, that SEOC weeks run Sunday through Saturday, and that you can’t be paid for more units than the SEOC authorizes. To get more, you request a new SEOC from VA.

TriWest’s guides cover its regions. Optum runs Regions 1 to 3, so check your Optum contract and provider manual for its rules.

There is also a cost ceiling. The total cost of a veteran’s home and community services in a fiscal year can’t exceed 100% of what VA would have paid for nursing home care, with room to go higher for veterans with ALS, a spinal cord injury or a similar condition (38 U.S.C. 1720C(d)). The ceiling was 65% before January 2, 2025.

How does an agency become a VA H/HHA provider?

There are 2 routes. Most agencies join the Community Care Network (CCN). A Veterans Care Agreement (VCA) is the fallback when the network can’t cover the need.

Joining the Community Care Network

Contact the administrator for your state to start enrollment. VA lists the regions on its CCN page, updated July 6, 2026:

TriWest says it can’t issue a home health referral to an agency that isn’t credentialed, so finish credentialing before you expect VA cases.

Getting a Veterans Care Agreement

1. Contact the nearest VA medical facility. It decides whether a VCA is needed.
2. Get certified. You apply with your licenses and details such as your NPI, tax ID and taxonomy code. VA aims to decide within 120 days and denies applicants on the OIG or SAM exclusion lists (38 CFR 17.4110).
3. Sign VA Form 10-10171, the VHA Veterans Care Agreement (VA).
4. Receive referrals and bill VA directly.

Certification lasts 3 years. Apply for recertification at least 60 days before it ends. VA says it pays nothing for care given before the VCA is signed. Either side can end a VCA with 45 days’ written notice, and VA can end it sooner to protect veterans’ health (38 CFR 17.4130).

How does VA pay, and how much?

Mostly fee for service, per authorized unit of care (TriWest, September 2025). VA’s fee schedule page (updated September 18, 2026) gives the order VA uses for authorized community care:

1. A contract-negotiated rate, if one exists.
2. The Medicare rate, if there is no contract rate.
3. The VA fee schedule rate, if neither of those exists.
4. A percentage of billed charges, if nothing else applies.

TriWest notes that Medicare doesn’t currently cover H/HHA services, but “many codes have VA fee schedule rates associated with them” (September 2026 guide). In practice your rate is your CCN contract rate, your VCA price terms, or the VA fee schedule. The regulations cap CCN contract and VCA rates at the Medicare rate where one exists, allow higher rates in highly rural counties, and let VA go above them when it finds the cap impractical (38 CFR 17.4035, 17.4120).

The 2026 VA fee schedule covers services from January 1 to December 31, 2026. It lists a rate for each Medicare locality, including home care codes such as G0156, S5125, S5130, S9122 and T1019. We don’t print those rates because they vary by locality and your contract rate can differ. To look yours up, open the spreadsheet on VA’s page, find the code and modifier, then find the Medicare locality where the care was given.

Some rules apply whatever your rate:

• VA pays only for services “explicitly authorized in the VA-approved referral.”
• Depending on the contract, VA may pay the lower of your agreed rate and your billed amount.
• VA pays VCA providers electronically. Enroll in electronic funds transfer with VA Form 10091 (VA provider payments).

How do you submit claims?

To the payer named on the referral, within 180 days of the date of service. That deadline is in federal law, which also requires VA to pay clean electronic claims within 30 days and clean paper claims within 45 (38 U.S.C. 1703D).

Sources: TriWest CCN home health guide and VA provider claims page.

TriWest’s coding rules for H/HHA:

• Bill in 15-minute or 1-hour units. G0156, home health aide services and one of the codes TriWest lists as most common, is billed per 15 minutes, so 1 hour is 4 units. See the units calculator.
• Put every charge for the same date on one claim.
• Add time-of-day modifiers (UF morning, UG afternoon, UH evening, UJ night) or modifier 76 to tell same-day services apart.

TriWest recommends filing within 30 days of the service. Claims without the referral number or with a wrong Veteran ID are denied.

Do you collect a copay?

No. When a community provider gives care through the Veterans Community Care Program, the copay at the time of care is $0. VA works out any copay at the end of billing and assesses it to the veteran (38 CFR 17.111(b)(3)). Under a VCA, VA says you “may not collect, or attempt to collect, payment from a Veteran or a Veteran’s other health insurance” for authorized care.

How is this different from Aid and Attendance?

H/HHA is care that VA buys. Aid and Attendance is money VA pays the veteran.

Sources: VA Aid and Attendance page, updated May 8, 2026, and VA H/HHA page.

A veteran can have both. VA policy says receipt of Aid and Attendance “is not to be considered when ordering or authorizing” these home care services (VHA Notice 2024-01, section 7a). To estimate what Aid and Attendance could pay toward private care, use the Aid and Attendance calculator.

What should an agency plan for?

• The order, not the ceiling. Staff the hours in the VA order, even when the SEOC allows more.
• A weekly limit. Under TriWest’s rules the week runs Sunday through Saturday. A long visit early in the week leaves fewer hours for Friday.
• End dates. Authorizations run 30 to 365 days. Ask the VA facility about renewal before the end date, because care after it isn’t covered.
• The right payer. A TriWest claim sent to VA, or a VCA claim sent to TriWest, loses time against the 180 days.

How Caregiver Scheduling handles this

On Growth and up, Caregiver Scheduling warns you when a client’s week goes over their authorized hours, and blocks a calendar move that would push a client over. GPS check-in and check-out record when each visit started and ended.

FAQ

Does VA pay for non-medical home care? Yes. H/HHA covers help with daily activities such as bathing, dressing, eating and toileting, for enrolled veterans who meet the clinical criteria. A community agency delivers it under contract.

Can a veteran choose my agency? Yes. Under 38 CFR 17.4020(b), a veteran may name a particular provider. Your agency has to be in the network or have a VCA.

Can I bill VA for hours over the authorization? No. VA pays only for services in the approved referral. If the veteran needs more hours, the VA team has to authorize them first.

Does VA publish H/HHA rates? VA publishes its fee schedule, with rates by Medicare locality. Your CCN contract or VCA price terms may set a different rate.

Does Aid and Attendance reduce a veteran’s H/HHA hours? VA policy says Aid and Attendance is not to be considered when VA authorizes these services.

General information, not legal or billing advice. Check current rules with your VA medical center, your network administrator and your contract.