Key takeaway
North Dakota pays family caregivers through Medicaid Personal Care Services, the HCBS Waiver, and two state-funded programs (SPED and Expanded SPED). Most adult relatives can be hired; spouses are generally not paid under Medicaid.
- Medicaid Personal Care Services (PCS) authorize in-home hours; family members can be Qualified Service Providers.
- SPED (Service Payments for Elderly and Disabled) is state-funded and pays for in-home services.
- Expanded SPED helps older adults with slightly higher income/assets remain at home.
- Veterans can use Aid & Attendance or Veteran Directed Care (VDC can pay a spouse).
Overview
North Dakota offers several paths for family members to be paid for caring for an aging or disabled loved one. The state uses a unique Qualified Service Provider (QSP) model under its Medicaid and state-funded programs, which means family members — adult children, siblings, grandchildren, and even some friends — can apply to be enrolled QSPs and bill for personal care hours they provide.
For people who qualify medically and financially, Medicaid Personal Care Services and the HCBS Waiver fund the most hours. For those who don’t qualify for Medicaid, SPED and Expanded SPED — administered by the North Dakota Department of Health and Human Services — provide state-funded in-home support. Veterans can layer on Aid & Attendance or Veteran Directed Care where available.
Programs that pay family caregivers in North Dakota
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Medicaid Personal Care Services (PCS) (Medicaid State Plan) | Medicaid-eligible adults who need help with activities of daily living as documented by a functional assessment. | Personal care hours billed by a Qualified Service Provider (QSP); family members (other than spouse/legal guardian) can become QSPs and be paid for care. |
| Medicaid HCBS Waiver (Aged & Disabled) (Medicaid waiver) | Medicaid-eligible; needs nursing-facility level of care; meets income/asset rules (typically ~300% of SSI for income; $3,000 asset limit for waiver recipients). | Provides personal care, respite, adult day, and home modifications. Family QSPs can be paid; spouses and legal guardians excluded. |
| Service Payments for Elderly and Disabled (SPED) (State-funded) | North Dakota residents 18+ with functional impairment; income/asset limits set by ND HHS; primarily for adults not on Medicaid. | Funds personal care, respite, and chore services from QSPs, including family members other than the spouse. |
| Expanded SPED (State-funded) | Age 60+ with greater functional needs; slightly higher income/asset thresholds than SPED. | Same QSP-based service delivery as SPED, expanded to additional older adults who would otherwise face nursing-home placement. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse needing help with ADLs; meets VA income/asset rules. | Increases monthly pension that the veteran can use to pay an adult child or other relative. Spouse cannot be paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veteran enrolled in VA health care who needs nursing-facility level of care at a participating VAMC. | Provides a self-directed care budget; spouses, adult children, and others can be paid through a fiscal management service. |
North Dakota Medicaid programs
North Dakota Medicaid funds family caregivers through two main paths: the Personal Care Services (PCS) benefit and the HCBS Waiver for Aged and Disabled adults. Both rely on the Qualified Service Provider (QSP) model.
Personal Care Services (PCS)
PCS is a Medicaid State Plan benefit covering personal care, homemaker, and supervision tasks. A case manager authorizes hours after a functional assessment, and a QSP — including a family member — delivers the services and bills Medicaid.
- Family members can become individual QSPs by completing the ND HHS QSP application and background check.
- Spouses and legal guardians cannot be paid as QSPs for their own family member.
- Hours are based on assessed need; PCS does not require nursing-facility level of care.
HCBS Waiver (Aged & Disabled)
The HCBS Waiver helps people who would otherwise need a nursing facility stay at home with more comprehensive supports. The waiver offers more services and hours than PCS alone.
- Requires nursing-facility level of care plus financial eligibility (typically income up to ~300% of SSI, assets within state limits).
- Funds personal care, respite, adult day, home modifications, and assistive technology.
- QSPs deliver and bill for personal care — most family members are eligible.
State-funded options: SPED and Expanded SPED
SPED (Service Payments for Elderly and Disabled) and Expanded SPED are North Dakota’s state-funded long-term care programs. They serve adults who need help to remain at home but don’t qualify (or don’t yet qualify) for Medicaid.
Provides QSP-delivered personal care, respite, and home-based services for adults 18+ with functional impairment. Cost share may apply based on income.
Extends SPED to additional older adults with slightly higher resources who are at imminent risk of nursing-home placement.
Who qualifies
- North Dakota residents 18+ (SPED) or 60+ (Expanded SPED) with documented functional needs.
- Income and assets within state-set thresholds; cost share may apply.
- Subject to available funding through the North Dakota Department of Health and Human Services.
Veterans’ programs
North Dakota veterans and surviving spouses can use two VA pathways to fund in-home care and pay a family caregiver: Aid & Attendance and Veteran Directed Care.
Aid & Attendance Pension
A&A increases the monthly VA pension for wartime veterans (or surviving spouses) who need help with daily living. The veteran can use the increase to pay an adult child or other relative.
- Wartime service, limited income/assets, and documented need for daily care are required.
- Spouses cannot be paid directly through A&A because household income is jointly counted.
Veteran Directed Care (VDC)
VDC provides a flexible VA-funded monthly budget that the veteran directs. Family — including a spouse — can be paid through a fiscal management service. Availability depends on the local VA Medical Center.
- Veteran must be in VA care and need a nursing-facility level of care.
- Not all North Dakota VA sites offer VDC — verify with your VA social worker.
Long-term care insurance
Long-term care insurance can pay a family caregiver if the policy includes in-home personal care benefits and allows direct payment to the policyholder.
What to check in the policy
- Verify that in-home personal care is a covered service.
- Cash or indemnity policies let the policyholder pay any caregiver, including family.
- Reimbursement policies usually require a licensed home care agency to bill for services.
If the policy reimburses only licensed agencies, a North Dakota-licensed home care agency can hire the family caregiver as a W-2 employee and bill the insurer for the care provided.
How to apply in North Dakota (step-by-step)
- Identify the most likely path: Medicaid PCS or HCBS Waiver, SPED/Expanded SPED, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security card, proof of income/assets, medical records, medication list, and DD-214 (if applicable).
- Start with the right agency:
- Medicaid PCS/Waiver and SPED: contact your local Human Service Zone office or ND Aging Services Division (1-855-462-5465).
- QSP enrollment: apply through North Dakota HHS to become a Qualified Service Provider (background check required).
- VA paths: connect with the Fargo VA Health Care System social worker or VAMC caregiver coordinator.
- LTC insurance: call the insurer to confirm how a family caregiver can be paid.
- Complete the functional assessment (and a level-of-care evaluation for the HCBS Waiver) and submit financial documentation.
- Once authorized, your family member submits service notes and the QSP bills ND HHS for services delivered.
- Keep care logs, complete annual reassessments, and renew QSP enrollment as required.
North Dakota paid caregiver FAQs
How do I become a Qualified Service Provider (QSP) in North Dakota?
Submit the QSP application through the North Dakota Department of Health and Human Services, complete the background check, take any required orientation, and meet the standards for the services you want to provide. Once enrolled, you can be hired by family members receiving Medicaid PCS, the HCBS Waiver, or SPED/Expanded SPED.
Can a spouse be paid as a caregiver in North Dakota?
Not under Medicaid PCS, the HCBS Waiver, or SPED. Spouses can be paid through the VA Veteran Directed Care program where available.
What is the difference between SPED and Medicaid PCS?
Medicaid PCS is for people who already qualify for Medicaid. SPED is state-funded for adults who do not qualify for Medicaid but need help to remain at home. Both use the same Qualified Service Provider model.
How long does it take to get approved in North Dakota?
Functional assessments are typically scheduled within a few weeks. Approval and QSP enrollment together often take 30–60 days, depending on background-check turnaround and documentation completeness.
Can I be paid to care for my parent in North Dakota?
Yes. Adult children, siblings, grandchildren, and other relatives (other than spouses or legal guardians) can become QSPs and be paid for personal care hours under Medicaid PCS, the HCBS Waiver, SPED, or Expanded SPED.
