Application for Waiver of Veterans’ Home Care Copayments

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

VHC clients are required to contribute to the cost of VHC services by paying a small co-payment of $5 per hour. This is capped at $5 per week for domestic assistance, $10 per week for personal care and $75 per 12 months for home and garden maintenance, noting there is a maximum of 15 hours of this service available in a 12 month period. There is no co-payment for Respite Care services.

If you can't afford the co-payments, you can apply for a waiver of your co-payment using the form below. Eligibility requirements are outlined in the form.