VA Form 10-10SH: State Veterans Home Application Guide – Veterans seeking long-term care options often turn to State Veterans Homes for nursing home care, domiciliary care, or adult day health care. VA Form 10-10SH plays a critical role in this process by providing the medical certification needed for VA per diem payments to these state-operated facilities.
This comprehensive guide explains everything USA veterans and their families need to know about the form, eligibility, the application process, and how it supports access to quality care.
What Is VA Form 10-10SH?
VA Form 10-10SH, titled State Home Program Application for Veteran Care Medical Certification, is an official Veterans Affairs document. It certifies a veteran’s medical need for care in a State Veterans Home (SVH) and supports VA reimbursement through the per diem program.
The current revision (as of recent updates) is dated around 2021–2025, with OMB Control No. 2900-0160 and an estimated completion time of about 20–30 minutes. It must be submitted along with VA Form 10-10EZ (Application for Health Benefits) or 10-10EZR at admission and for any changes in level of care.
State Veterans Homes are state-owned and operated facilities that provide nursing home care, domiciliary (residential) care, and adult day health care to eligible veterans. VA does not operate them directly but certifies them and provides per diem payments to help offset costs for qualifying veterans.
Who Needs to Complete VA Form 10-10SH?
This form is primarily completed by State Veterans Home staff (physicians, nurses, social workers, etc.), not directly by the veteran. It includes:
- Part I: Administrative — Facility and veteran basic info.
- Part II: History and Physical — Medical evaluation, diagnoses, and recommended level of care.
- Part III: Evaluation — Functional assessments (e.g., mobility, ADLs, mental status).
- Part IV: Social Work Assessment.
- Part V: VA Authorization for Payment — VA administrative and clinical review to approve per diem.
Veterans and families initiate contact with a State Veterans Home and provide supporting documents like DD-214, medical records, and the 10-10EZ.
Eligibility for State Veterans Homes and VA Per Diem
Eligibility has two layers: admission to the State Home (set by the state) and VA per diem approval (federal criteria).
General Veteran Requirements:
- Honorable or general discharge (not barred from VA benefits).
- Need for nursing home, domiciliary, or adult day health care.
- Many states prioritize veterans with service-connected conditions or specific needs; some admit eligible spouses or Gold Star parents.
VA Per Diem Specifics:
- For Nursing Home Care: Higher (“prevailing”) rate possible for veterans with ≥70% service-connected disability or TDIU if the care relates to SC conditions.
- For Domiciliary Care: Income and functional criteria apply (e.g., “no adequate means of support”).
- For Adult Day Health Care: Often requires VA health care enrollment.
Each state sets its own admission rules, residency requirements, and waitlists. Contact your state’s veterans affairs department or specific home for details.
How to Apply Using VA Form 10-10SH?
- Contact a State Veterans Home — Locate facilities in your state via VA resources or state VA offices.
- Submit VA Form 10-10EZ — For health benefits enrollment (often required alongside 10-10SH).
- Provide Medical and Service Records — DD-214, medical history, etc.
- Admission and Form Completion — SVH staff complete the 10-10SH, including medical certification.
- VA Review — Submitted to the local VA Medical Center for authorization of per diem payments.
Download the Official Form Here:
Download VA Form 10-10SH (PDF)
There is also an automated/web-based version for authorized SVH and VA users.
Benefits of the State Veterans Home Program
- High-quality, veteran-focused long-term care.
- VA per diem helps states keep costs manageable for residents.
- Options for different care levels: full nursing, supportive domiciliary, or daytime adult health programs.
- Many homes offer specialized services for dementia, rehabilitation, and more.
Per diem rates are adjusted annually; higher rates apply for certain service-connected veterans.
Common Questions About VA Form 10-10SH
Is the form for veterans to fill out themselves?
No—SVH staff handle most sections, though veterans provide information and sign related forms.
What if my veteran needs a change in care level?
A new or updated 10-10SH is required.
Where can I find a State Veterans Home near me?
Search on VA.gov or contact your state Department of Veterans Affairs.
Are there costs for the veteran?
Depends on income, assets, service connection, and state policies. VA per diem subsidizes care, but residents may pay a portion.
Tips for a Smooth Application
- Gather documents early: DD-214, medical records, financial info.
- Work closely with the State Home admissions team.
- Consult a VA-accredited representative or veterans service officer for assistance.
- Ensure the 10-10EZ is submitted concurrently.
For the most current information, always refer to official VA sources.
Official VA Form Page:
VA Form 10-10SH Information
State Veterans Home Program Overview:
Learn More About State Veterans Homes
Veterans deserve quality care in their later years. Understanding VA Form 10-10SH is a key step toward accessing State Veterans Home benefits. Reach out to your local VA or State Veterans Home today to begin the process.