Robert Gordon

Home Care Policy Analyst, AHVA

May 12, 2026  ·  8 min read

The Dole Act Raised VA’s Home Care Spending Cap to 100%: What It Means for Orange County Veterans

For years, the Department of Veterans Affairs could spend no more than 65 percent of what nursing home care would have cost on a veteran’s care at home. A veteran who hit that cap had to pay for the rest of the year’s care or move into a nursing home. The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118-210, signed January 2, 2025) raised the cap to 100 percent, and VA put the change into effect on September 11, 2025. It is a spending cap, not a promise that VA pays every home care bill in full: VA copays and program rules still apply.

Orange County is home to about 85,000 veterans (84,235 in the 2023 Census estimate cited by the County of Orange), and more than a third served during the Vietnam era. A significant share are aging, many live alone or with family members who are already stretched thin, and a meaningful portion have needs that could qualify them for substantially more home-based support than they are currently receiving. This guide explains what changed, who qualifies, and how OC families can ask for these services.

What Is the Elizabeth Dole Act and What Actually Changed?

The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act is named after former U.S. Senator Elizabeth Dole, who has long championed the cause of military caregivers. Signed into law on January 2, 2025, this legislation made sweeping changes to how the VA funds home-based care, expands caregiver support, and streamlines access to benefits for veterans and their families.

The most important change for Orange County families is Section 120: the cap on what VA may spend on a veteran’s non-institutional care rose from 65% to 100% of the nursing home rate. Beginning September 11, 2025, VA will pay up to 100% of the nursing home rate in a fiscal year for eligible veterans who need care at home. The covered services are Homemaker/Home Health Aide, Home Respite, Community Adult Day Health Care, Veteran Directed Care, Skilled Home Health Care and PACE. For veterans whose needs cost more than that, such as veterans with ALS or a spinal cord injury, VA may approve more on a case-by-case basis. VA says only a small number of veterans ever hit the old 65% cap, so for most families the change matters most when care needs are heavy (source: VA notice, Federal Register, Jan. 12, 2026).

Before and After: How the Dole Act Changed VA In-Home Care Coverage

The 4 VA Programs That Now Cover In-Home Care for OC Veterans

The Dole Act doesn’t create one single new program — it expands and improves several existing VA pathways that Orange County veterans may already be enrolled in or eligible to join. Here’s what each one offers and who it serves.

Who Qualifies for VA In-Home Care Benefits in Orange County?

Not every veteran automatically qualifies for every program, but eligibility is broader than many OC families realize. The baseline requirement is VA healthcare enrollment. Beyond that, each program has its own criteria:

For HBPC and H&HHA: Veterans must be enrolled in VA healthcare and have a clinical need for home-based services. Priority is given to veterans who have difficulty traveling to VA facilities, those with serious chronic illnesses, and veterans who would otherwise require nursing home placement. There is no requirement that the condition be service-connected for these programs.

For Veteran Directed Care: Veterans must be enrolled in VA healthcare and assessed by a VA social worker as needing hands-on assistance at home. VDC is not available in every region, but Orange County veterans are within the Long Beach VAMC service area, which does offer VDC.

For PCAFC: The veteran must have a serious injury or illness incurred or aggravated in the line of duty, need personal care services for at least six continuous months, and have a designated family caregiver. PCAFC has been open to veterans of all service eras since October 1, 2022. If your family was turned down years ago because of when the veteran served, it is worth applying again.

Orange County Veterans: Where to Start

The primary VA resource for Orange County veterans is the VA Long Beach Healthcare System (5901 E. 7th St., Long Beach, CA 90822). The Long Beach VAMC serves OC veterans and coordinates home-based primary care, social work referrals, and Veteran Directed Care enrollment for this region.

There are also VA outpatient clinics closer to many OC communities:

• Placentia VA Clinic — 770 South Placentia Avenue, Placentia (North OC)
• Laguna Hills VA Clinic — 23719 Moulton Parkway, Laguna Hills (South OC)
• Santa Ana VA Clinic — 1506 Brookhollow Drive, Suite 100, Santa Ana (central OC)

To ask for a home care assessment, call VA Long Beach at (562) 826-8000 and ask for social work or the veteran’s primary care team. For pension and other benefits questions, the national VA benefits line is 1-800-827-1000.

How Non-Medical In-Home Care Fits In

VA-funded programs primarily cover skilled nursing, therapy, and medically necessary aide services. What they don’t typically cover is ongoing non-medical support: daily companionship, errand running, medication reminders, meal preparation that isn’t a clinical service, and the kind of steady presence that prevents isolation and family caregiver burnout.

This is where a licensed non-medical home care agency like At Home VA Staffing becomes a meaningful complement to VA benefits. AHVA caregivers work alongside the VA system — filling the hours when VA-funded aides are not present, providing consistent daily companionship and support, and giving family members the peace of mind that someone trustworthy is with their veteran throughout the week.

With VA benefits now covering a larger share of clinical care, many OC families find they have more budget flexibility to invest in non-medical support that significantly improves quality of life for their veteran — and their own wellbeing as caregivers.

VA Aid & Attendance: The Pension Benefit That Stacks with In-Home Care

The Dole Act’s in-home care expansion is separate from the VA Aid & Attendance pension benefit — but the two can work together. Aid & Attendance provides monthly pension payments to veterans (and surviving spouses) who need help with daily activities. For 2026 (rates effective December 1, 2025), the maximum annual pension with Aid & Attendance is $29,093 (about $2,424 a month) for a veteran with no dependents, $34,488 (about $2,874 a month) for a veteran with one dependent, and $18,697 (about $1,558 a month) for a surviving spouse with no dependents. The actual payment is that maximum minus the household’s countable income, after unreimbursed medical costs are deducted (source: VA pension rates).

Unlike VA healthcare programs, Aid & Attendance is a cash benefit — meaning families can use it to pay for non-medical home care agencies like AHVA. Many OC families who qualify for both VA healthcare home care AND Aid & Attendance pension have a powerful combination: skilled care largely covered by the VA plus a monthly cash benefit to fund ongoing non-medical support.

For a detailed breakdown of Aid & Attendance eligibility and 2026 rates, see our comprehensive guide: VA Aid & Attendance 2026: The Orange County Veteran’s Guide.