How to Pay for In-Home Care
How to Pay for Home Care in North Dakota
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
North Dakota families typically start by calling their local Aging and Disability Resource Link (ADRL) for older-adult or physical-disability screening, since it's the main front door for state-funded and Medicaid home and community-based services under SPED, Ex-SPED, or the HCBS Waiver. North Dakota has unusually explicit paid-family-care pathways: both Family Home Care and Family Personal Care require co-residence, case-manager approval, and QSP enrollment, though their daily rates differ, and legally responsible caregivers providing extraordinary care under four specified waivers may also qualify through the Family Paid Caregiver Pilot, subject to current waitlist and funding status. Other needs route through PACE, Money Follows the Person, DD waivers, or 1915(i) depending on age, disability, behavioral-health, and institutional-level-of-care criteria, and every plan can be layered with caregiver support and respite, Medicare Savings, LIHEAP/SNAP, tax credits or property-tax relief, and Veteran benefits.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
North Dakota State-Funded HCBS
Service Payments for the Elderly and Disabled (SPED)
YesHelps pay for: State-funded in-home and community services can offset personal care, homemaker and other supports that help an older adult or adult with physical disability remain at home.
Who qualifies: For older adults or adults with physical disabilities who have functional needs and meet program financial/functional rules. SPED is not the same as Medicaid.
How to start: Call ADRL for an HCBS intake and functional/financial screening.
Good to know: Family caregiver payment: Possible through approved QSP arrangements; relationship and service rules apply
Expanded SPED (Ex-SPED)
YesHelps pay for: Pays in-home/community services for people who would otherwise need licensed basic-care facility services.
Who qualifies: Requires functional and financial eligibility for Ex-SPED; program is intended as an alternative to basic care.
How to start: Request screening through ADRL.
Good to know: Family caregiver payment: Possible through approved QSP arrangements; verify service-specific rules
North Dakota Medicaid State Plan
Medicaid State Plan Personal Care
YesHelps pay for: Hands-on help with bathing, dressing, transfers, toileting, meals, housework and laundry can replace privately purchased aide hours.
Who qualifies: Must be eligible for ND Medicaid and have an assessed/authorized need for personal care. Service amount is determined by assessment and authorization.
How to start: Apply for Medicaid if needed, then request personal-care assessment through HHS/ADRL.
Good to know: Family caregiver payment: Yes in some approved family-provider arrangements, including Family Personal Care
Paid Family Caregiver / QSP
Family Home Care (FHC)
YesHelps pay for: Daily payment for room, board, supervision and personal services provided in the home by a spouse or qualifying family member.
Who qualifies: Provider must enroll as an FHC QSP; client and provider must live together; case manager approval/authorization is required. July 1, 2026 state rate sheet lists $77.69/day.
How to start: Have the HCBS case manager initiate the FHC provider pathway; then complete QSP enrollment.
Good to know: Family caregiver payment: Yes - spouse or qualifying relative can be paid
Family Personal Care (FPC)
YesHelps pay for: Daily payment for authorized personal-care help provided by a spouse or specified qualifying relative living with the participant.
Who qualifies: Provider must enroll as an FPC QSP; client must be pre-approved and provider/client must live together. July 1, 2026 rate sheet lists $165.98/day.
How to start: Ask the HCBS case manager whether FPC fits the assessed care plan before provider enrollment.
Good to know: Family caregiver payment: Yes - spouse and specified relatives are eligible
Qualified Service Providers
Individual QSP Personal Care
YesHelps pay for: Authorized personal-care tasks can be delivered by an enrolled individual QSP instead of an agency.
Who qualifies: Individual must meet QSP standards, enroll, and have a valid service authorization before billing.
How to start: Use the QSP database/Hub after case-manager authorization.
Good to know: Family caregiver payment: A relative may qualify if the specific relationship/service rules allow it; FHC/FPC are the clearer family routes
QSP Homemaker Service
Yes - household supportHelps pay for: Housekeeping, laundry, meal preparation and related household help can reduce private-pay homemaker costs.
Who qualifies: Service must be assessed, authorized and delivered by an enrolled QSP. July 1, 2026 rate sheet lists agency and individual rates with a 70-unit maximum.
How to start: Ask the case manager whether homemaker is authorized, then select a QSP.
Good to know: Family caregiver payment: Potentially, if enrolled/authorized and not barred by relationship rules
QSP Respite Care
Yes - respiteHelps pay for: Temporary relief for the primary caregiver can reduce the cost of hiring replacement care privately.
Who qualifies: Must be authorized in the care plan and delivered by a qualified provider. Current rate sheet lists a 216-unit monthly maximum for standard respite.
How to start: Ask the case manager to add/authorize respite and identify an available QSP.
Good to know: Family caregiver payment: Generally not paid to the caregiver being relieved; another qualified provider supplies respite
QSP Chore Service
IndirectHelps pay for: Heavy household chores, including certain snow-removal work, can offset services needed to keep the home safe and usable.
Who qualifies: Assessed need and service authorization required; job/labor rules and rates vary by provider type.
How to start: Ask the HCBS case manager whether chore service is available under the person's funding program.
Good to know: Family caregiver payment: Possible if provider meets QSP requirements
QSP Companionship Service
Yes - companion supportHelps pay for: Companionship can offset paid supervision/social-support hours for an eligible participant.
Who qualifies: Authorization required. July 1, 2026 rate sheet lists agency/individual rates and a 40-unit monthly maximum for this service.
How to start: Ask the case manager whether companionship is part of the authorized plan.
Good to know: Family caregiver payment: Possible if the worker is an eligible enrolled QSP
QSP Supervision Service
Yes - supervisionHelps pay for: Supervision can reduce the need to privately purchase safety-monitoring/support hours.
Who qualifies: Must be assessed and authorized; billed by enrolled QSP under current service standards.
How to start: Ask the case manager to assess whether supervision is an appropriate covered service.
Good to know: Family caregiver payment: Possible if service/provider rules are met
Non-Medical Transportation
IndirectHelps pay for: Authorized rides/escort time can reduce transportation spending tied to community living and care-plan goals.
Who qualifies: Coverage depends on the person's program and authorization; separate driver/escort billing rules may apply.
How to start: Ask the case manager which non-medical transportation code/service is available.
Good to know: Family caregiver payment: Possible for an eligible enrolled individual QSP
Emergency Response System (ERS)
IndirectHelps pay for: Personal emergency response monitoring can reduce safety risk and substitute for some paid monitoring time.
Who qualifies: Must be authorized; current QSP rates include monthly monitoring and a one-time installation code.
How to start: Request ERS assessment/authorization through the case manager.
Good to know: Family caregiver payment: No
Home-Delivered Meals
IndirectHelps pay for: Prepared meals can reduce food-preparation workload and paid caregiver time.
Who qualifies: Available when authorized under an eligible HCBS funding source. July 1, 2026 rate sheet lists $10.17 per meal.
How to start: Ask the HCBS case manager or aging network about meal eligibility.
Good to know: Family caregiver payment: No
Extended Personal Care
YesHelps pay for: Additional personal-care tasks that require nurse education/delegation can offset higher-acuity private-pay care.
Who qualifies: Requires assessed need, authorization and qualified provider competency; nurse education may be part of the service process.
How to start: Ask the HCBS case manager whether Extended Personal Care is appropriate.
Good to know: Family caregiver payment: Possible when provider is qualified and authorized; service-specific rules apply
Adult Day Care
IndirectHelps pay for: Daytime care/supervision can reduce the number of in-home caregiver hours needed and provide caregiver relief.
Who qualifies: Must be authorized under an eligible program and delivered by a qualified provider.
How to start: Ask ADRL/case manager about adult day eligibility and local providers.
Good to know: Family caregiver payment: No direct family wage
Environmental Modification
IndirectHelps pay for: Home changes that improve access or safety can reduce the amount of hands-on help needed at home.
Who qualifies: Covered only when program criteria, assessment, authorization and service standards are met.
How to start: Ask the case manager to document the functional need and covered modification.
Good to know: Family caregiver payment: No
North Dakota Medicaid HCBS Waiver
HCBS Waiver for Older Adults / Physical Disabilities
YesHelps pay for: Medicaid waiver services help eligible people remain at home instead of entering a nursing facility.
Who qualifies: ND Medicaid; age 65+ or age 18-64 with qualifying physical disability; must meet nursing-facility level of care and choose community services.
How to start: Call ADRL for waiver screening and Medicaid coordination.
Good to know: Family caregiver payment: Yes through certain waiver/QSP services, including approved family-care pathways
Waiver Personal Care
YesHelps pay for: Intermittent personal-care and supervision with personal-care tasks can replace private-pay aide hours.
Who qualifies: Waiver enrollment and service authorization required. Current rate sheet lists up to 10 hours/day for the daily individual billing code.
How to start: Ask the waiver case manager whether personal care is authorized and which delivery model fits.
Good to know: Family caregiver payment: Possible through approved individual/family provider pathways
Waiver Community Support Service
Yes - supportHelps pay for: Daily support in the community can offset supervision and assistance costs for eligible waiver members.
Who qualifies: Must be in the waiver plan and delivered by a qualified agency/provider.
How to start: Ask the waiver case manager about Community Support Service.
Good to know: Family caregiver payment: Depends on provider arrangement
Waiver Companion Service
Yes - companion supportHelps pay for: Companion support can reduce privately paid social/supervision hours.
Who qualifies: Waiver enrollment and care-plan authorization required.
How to start: Ask the waiver case manager to assess companion-service need.
Good to know: Family caregiver payment: Depends on provider qualification and authorization
Waiver Respite Care
Yes - respiteHelps pay for: Short-term replacement care provides caregiver breaks without paying fully out of pocket.
Who qualifies: Waiver enrollment, assessed caregiver need and service authorization required.
How to start: Request respite through the waiver case manager.
Good to know: Family caregiver payment: Another qualified caregiver/provider generally supplies respite
Waiver Homemaker
Yes - household supportHelps pay for: Household tasks can be covered so paid personal-care hours can focus on hands-on needs.
Who qualifies: Must be in the person-centered plan and authorized.
How to start: Ask the waiver case manager whether homemaker service is covered for the participant.
Good to know: Family caregiver payment: Depends on provider rules
Waiver Home Alterations / Environmental Modifications
IndirectHelps pay for: Accessibility and safety changes can reduce caregiver burden and delay institutional placement.
Who qualifies: Must be necessary to support community living and approved under waiver rules.
How to start: Ask the waiver case manager for assessment, quotes and prior-authorization steps.
Good to know: Family caregiver payment: No
Waiver Specialized Equipment and Supplies
IndirectHelps pay for: Covered equipment can reduce out-of-pocket spending and sometimes reduce hands-on caregiver assistance.
Who qualifies: Must be waiver-covered, medically/ functionally justified and authorized.
How to start: Ask the waiver case manager about covered equipment and supplier requirements.
Good to know: Family caregiver payment: No
Transitional Living
Yes - supportive careHelps pay for: Time-limited skill-building/support can help an eligible person stabilize in community living.
Who qualifies: Waiver enrollment and authorization required.
How to start: Ask the waiver/transition case manager whether Transitional Living fits the plan.
Good to know: Family caregiver payment: Depends on provider rules
Residential Habilitation / Adult Residential Support
Yes - residential supportHelps pay for: Residential support can substitute for higher-cost institutional care when home-based arrangements are not sufficient.
Who qualifies: Waiver service; requires assessed need, eligible setting and authorization.
How to start: Ask ADRL/case manager about residential habilitation and agency foster-home options.
Good to know: Family caregiver payment: Depends on setting/provider rules
Supported Employment
IndirectHelps pay for: Employment support can preserve independence and income, indirectly helping fund community living and care costs.
Who qualifies: Must be authorized for an eligible waiver member and tied to employment goals.
How to start: Ask the waiver case manager about supported employment eligibility.
Good to know: Family caregiver payment: No
Transition / Community Living
Community Transition Services
IndirectHelps pay for: Supports can help a Medicaid member move from a qualifying facility into a home or apartment and establish community living.
Who qualifies: Requires qualifying transition circumstances and service authorization.
How to start: Ask ADRL/case manager or MFP transition staff about transition eligibility.
Good to know: Family caregiver payment: No
One-Time Transition Cost
IndirectHelps pay for: One-time purchases needed to establish a community residence can reduce move-in costs after institutional care.
Who qualifies: Current July 1, 2026 QSP rate sheet lists a $3,000 recipient maximum for the one-time transition cost service.
How to start: Coordinate through the transition/case-management team before buying items.
Good to know: Family caregiver payment: No
Money Follows the Person (MFP)
IndirectHelps pay for: Transition coordination, housing connections and community supports can help eligible Medicaid members leave qualifying institutions.
Who qualifies: For eligible Medicaid members with disabilities transitioning from qualified facilities to homes/apartments in the community.
How to start: Ask the facility discharge team, ADRL or MFP transition team for a referral.
Good to know: Family caregiver payment: No direct family wage
Integrated Medicare / Medicaid
Program of All-Inclusive Care for the Elderly (PACE)
YesHelps pay for: Comprehensive Medicare/Medicaid care can include home care, personal support, transportation, prescriptions and facility care when needed.
Who qualifies: Age 55+, live in a PACE service area, meet nursing-home level of care and be able to live safely in the community at enrollment.
How to start: Contact Northland PACE for screening; enrollment is voluntary.
Good to know: Family caregiver payment: No direct family wage
North Dakota Medicaid Eligibility
Workers with Disabilities Medicaid Buy-In
Indirect / enables coverageHelps pay for: Maintains Medicaid coverage while working, preserving access to covered services that can include HCBS/home-care benefits when otherwise eligible.
Who qualifies: Age 16-65, SSA disability standard, employed. 2026 income limit is 225% FPL ($2,993/month for one person); premium is 5% of gross countable income plus a $100 enrollment fee, with Native American exceptions.
How to start: Apply for Medicaid and submit required disability/incapacity information.
Good to know: Family caregiver payment: Depends on the covered service
Aged, Blind or Disabled Medicaid / Client Share
Indirect / enables coverageHelps pay for: Medicaid coverage can open access to state-plan and waiver services; a client-share option may help some people who are over the standard income level but have medical need.
Who qualifies: 2026 ABD income is 90% FPL ($1,197/month single) with $3,000 single / $6,000 couple countable-asset limits; client-share rules may apply above income limit.
How to start: Apply through HHS and ask specifically about ABD and client-share eligibility.
Good to know: Family caregiver payment: Depends on service
North Dakota Medicaid
Medicaid Home Health
Yes - skilled/medical home careHelps pay for: Skilled nursing, therapy and home-health services can reduce out-of-pocket medical home-care costs when coverage criteria are met.
Who qualifies: Must meet Medicaid covered-service, medical-necessity and provider requirements.
How to start: Ask the medical provider to order covered home health and confirm Medicaid authorization.
Good to know: Family caregiver payment: No direct family wage
Behavioral Health Medicaid
1915(i) State Plan HCBS
Indirect / supportiveHelps pay for: Behavioral-health-focused HCBS can fund community supports that reduce caregiving and stabilization costs.
Who qualifies: Must be on Medicaid/Expansion, have qualifying diagnosis, income at or below 150% FPL, qualifying functional score (WHODAS 25+ or DLA-20 5 or lower), and live in an HCBS-compliant setting.
How to start: Apply through the 1915(i) process/Human Service Zone and arrange required assessment.
Good to know: Family caregiver payment: Some caregiver supports, not a general family wage
1915(i) Respite
Yes - respiteHelps pay for: Short-term support while an unpaid caregiver attends to other needs can offset respite spending.
Who qualifies: Available only to eligible 1915(i) members when included in the person-centered plan.
How to start: Ask the 1915(i) care coordinator to assess and authorize respite.
Good to know: Family caregiver payment: No direct wage to the caregiver being relieved
1915(i) Training and Support for Unpaid Caregivers
IndirectHelps pay for: Training/support for an unpaid caregiver can improve sustainability and reduce avoidable paid-care costs.
Who qualifies: For eligible 1915(i) members; service must be tied to the person-centered plan.
How to start: Ask the care coordinator about Training and Support for Unpaid Caregivers.
Good to know: Family caregiver payment: No direct wage
1915(i) Housing Support / Community Transition
IndirectHelps pay for: Housing and transition services can reduce instability and the risk of higher-cost institutional care.
Who qualifies: 1915(i) eligibility plus service-specific need and plan authorization.
How to start: Work with the 1915(i) care coordinator on housing/transition goals.
Good to know: Family caregiver payment: No
Developmental Disabilities Medicaid
Traditional IID/DD HCBS Waiver
Yes - depending on serviceHelps pay for: Long-term supports help people with intellectual/developmental disabilities live with family or in community settings.
Who qualifies: Must have qualifying I/DD or related condition, meet ICF/IID level of care, Medicaid/waiver rules and service authorization.
How to start: Contact the DD Section for eligibility/intake and case management.
Good to know: Family caregiver payment: Yes through certain services/programs; rules vary
DD Family Care Option
Yes - family supportHelps pay for: A waiver family-support service can help sustain care in the family home.
Who qualifies: Available within the Traditional IID/DD waiver when authorized; service rules and family-provider requirements apply.
How to start: Ask the DD case manager specifically about Family Care Option.
Good to know: Family caregiver payment: Yes / family-focused; exact payee and service rules must be confirmed
DD Self-Directed In-Home Supports
YesHelps pay for: Self-directed in-home supports let eligible families exercise more control over workers and supports.
Who qualifies: Must be eligible for DD services/waiver and have self-directed In-Home Supports authorized.
How to start: Ask the DD case manager about the self-directed In-Home Supports option.
Good to know: Family caregiver payment: Potentially - subject to DD self-direction and worker rules
DD Extended Home Health Care
Yes - skilled/medical careHelps pay for: Extended home-health services can offset higher-acuity nursing/medical support costs in the home.
Who qualifies: Must be an authorized DD Family Support Service and meet medical/provider rules.
How to start: Ask the DD case manager about Extended Home Health Care.
Good to know: Family caregiver payment: No direct family wage unless separately qualified under another program
DD Homemaker
Yes - household supportHelps pay for: Household assistance can reduce the amount families pay privately for routine support.
Who qualifies: Available as an authorized DD residential/family-support service when criteria are met.
How to start: Ask the DD case manager about homemaker coverage.
Good to know: Family caregiver payment: Depends on provider/service rules
DD Environmental Modifications / Equipment & Supplies
IndirectHelps pay for: Home modifications and equipment can reduce caregiver burden and improve independence.
Who qualifies: Must be authorized under DD/waiver self-directed or provider-managed rules and meet necessity standards.
How to start: Ask the DD case manager to document need before purchase/installation.
Good to know: Family caregiver payment: No
Children / Disability Medicaid
Autism Spectrum Disorder Waiver
Yes - depending on serviceHelps pay for: HCBS for eligible children/youth with autism can offset intensive support costs and help maintain care at home.
Who qualifies: Current Medicaid waiver; age and clinical/functional criteria apply. Family Paid Caregiver Pilot currently includes eligible autism-waiver participants, but pilot approvals are temporarily constrained.
How to start: Contact waiver/DD/autism staff and ask about both waiver services and the family-paid pilot.
Good to know: Family caregiver payment: Potentially through the Family Paid Caregiver Pilot if extraordinary-care criteria are met
Children with Medically Fragile Needs Waiver
YesHelps pay for: Services and supports help families keep medically fragile children at home rather than in institutional settings.
Who qualifies: Current HHS page says families have access to up to $25,300 for waiver services, excluding case management; fiscal-agent participation is required for payment.
How to start: Apply through Children and Family Services and complete waiver screening.
Good to know: Family caregiver payment: Potentially through Family Paid Caregiver Pilot for extraordinary care
Medically Fragile Waiver In-Home Supports / Institutional Respite
YesHelps pay for: In-home supports and respite can directly replace privately funded caregiver hours.
Who qualifies: Child must be enrolled in the Medically Fragile waiver; service authorization, fiscal-agent and service-limit rules apply.
How to start: Ask the waiver case manager which in-home/respite services are authorized.
Good to know: Family caregiver payment: Potentially under the Family Paid Caregiver Pilot for an eligible legally responsible caregiver
Children's Hospice HCBS Waiver
Yes - depending on serviceHelps pay for: Waiver supports can help eligible children with life-limiting conditions receive services in the home/community.
Who qualifies: Must meet Children's Hospice waiver eligibility and service-plan requirements.
How to start: Contact Medicaid waiver staff for screening and application steps.
Good to know: Family caregiver payment: Potentially through the Family Paid Caregiver Pilot for extraordinary care
Paid Family Caregiver / Disability
Family Paid Caregiver Pilot Program
Yes - caregiver paymentHelps pay for: State payment to a legally responsible family caregiver providing extraordinary care to a child or adult enrolled in one of four specified Medicaid 1915(c) waivers.
Who qualifies: Covers specified autism, medically fragile, children's hospice and Traditional IID/DD waivers. As of Aug. 2026 HHS says it cannot approve/deny applications while emergency rule changes are pending; applicants are being placed/processed in order and funding may limit enrollment.
How to start: Submit an application in the Family Paid Caregiver Portal and monitor HHS updates.
Good to know: Family caregiver payment: Yes - specifically for legally responsible family caregivers meeting pilot rules
Caregiver Support
North Dakota Family Caregiver Support Program
Yes - respite/supportHelps pay for: Information, assistance, counseling/training, respite and supplemental supports can reduce caregiver strain and some out-of-pocket costs.
Who qualifies: Supports caregivers of adults age 60+, dementia caregivers regardless of care-recipient age, and certain older relative caregivers; service-specific eligibility applies.
How to start: Call ADRL and ask for the Family Caregiver Support Program.
Good to know: Family caregiver payment: No caregiver wage
Lifespan Respite Care Grant
Yes - respiteHelps pay for: Capped respite funding can cover planned, unplanned or emergency respite when other public funding is unavailable.
Who qualifies: Caregiver must need respite and lack other public funding or be on a waiting list. HHS accepts referrals only from agencies and must pre-approve requests.
How to start: Ask an agency working with the caregiver/care recipient to submit the referral to Aging Services.
Good to know: Family caregiver payment: Caregiver selects/uses an approved respite arrangement; not a general wage program
Aging Network / Older Americans Act
Older Americans Act Supportive Services
IndirectHelps pay for: Home-delivered meals, transportation, health maintenance and other aging-network services can reduce household and care-support spending.
Who qualifies: Generally targeted to older adults, with service-specific priority/eligibility and local availability.
How to start: Call ADRL to identify local aging-network providers and programs.
Good to know: Family caregiver payment: No direct family wage
North Dakota Tax Relief
Family Member Care Tax Credit
Indirect - reimburses eligible expenses through tax creditHelps pay for: State income-tax credit can offset qualifying adult day care, home health agency, personal care attendant, homemaker, respite, companionship and certain medical expenses.
Who qualifies: Credit is 20%-30% depending on federal taxable income; reduced above $50,000 taxable income ($70,000 MFJ); maximum $2,000 per qualifying family member, up to $4,000 total. Expenses cannot be reimbursed by insurance or assistance programs.
How to start: Keep receipts and claim on Schedule ND-1FA with the state income-tax return.
Good to know: Family caregiver payment: No - qualifying services must be provided by a person/organization unrelated to the taxpayer or qualifying family member
Homestead Property Tax Credit
IndirectHelps pay for: Reduces property taxes for qualifying older or permanently/totally disabled homeowners, preserving funds for home care.
Who qualifies: Age 65+ or permanently/totally disabled; 2026 household income cannot exceed $70,000 and there is no asset limit. Credit tier depends on income. 2026 application deadline was April 1.
How to start: Plan for the next application cycle with the local assessor/county tax equalization office.
Good to know: Family caregiver payment: No
Renter's Refund
IndirectHelps pay for: Annual rent refund can provide up to $600 that can be redirected toward care and household needs.
Who qualifies: Generally age 65+ or permanently/totally disabled and income <= $70,000; refund formula applies. 2026 application period ended May 31.
How to start: Prepare for the next January-May application window and retain rent/income records.
Good to know: Family caregiver payment: No
Primary Residence Credit
IndirectHelps pay for: State property-tax credit lowers housing cost for eligible North Dakota homeowners.
Who qualifies: No age or income restriction; one credit per primary-residence household. 2026 credit was up to $1,600; annual application was due April 1, 2026.
How to start: Watch ND Tax for the next application window and apply annually.
Good to know: Family caregiver payment: No
Medicare Counseling
North Dakota SHIP Medicare Counseling
IndirectHelps pay for: Free unbiased counseling can identify Medicare, Medigap, Part D, MSP and Extra Help savings that preserve funds for home care.
Who qualifies: Available to Medicare beneficiaries and caregivers seeking Medicare assistance.
How to start: Call the Medicare Hotline for free counseling.
Good to know: Family caregiver payment: No
Medicare Cost Reduction
Medicare Savings Program (MSP)
IndirectHelps pay for: May pay Medicare premiums, deductibles and coinsurance, freeing household income for home-care needs.
Who qualifies: Income/asset limits apply. ND Insurance Department currently lists $1,816 monthly income/$9,950 assets for a single person and $2,455/$14,910 for a couple, plus burial-fund allowances.
How to start: Apply through HHS/Human Service Zone; SHIP can help screen.
Good to know: Family caregiver payment: No
Extra Help / Part D Low-Income Subsidy
IndirectHelps pay for: Reduces Medicare prescription drug premiums and cost-sharing, preserving income for care needs.
Who qualifies: Income and asset limits apply. ND Insurance Department currently lists $2,015 monthly income/$18,090 assets for single and $2,725/$36,100 for couple.
How to start: Apply through Social Security or ask SHIP for screening/help.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - limited skilled home healthHelps pay for: Part-time/intermittent skilled nursing, therapy and qualifying home health aide services can offset medical home-care costs.
Who qualifies: Must be homebound and need qualifying skilled services under Medicare rules; Medicare does not cover 24/7 custodial care or homemaker-only care.
How to start: Ask the treating clinician for a Medicare home-health order and use a Medicare-certified agency.
Good to know: Family caregiver payment: No direct family wage
Medicare Hospice Benefit
Yes - hospice-related home careHelps pay for: Hospice covers interdisciplinary end-of-life care, equipment, medications related to terminal illness, and limited respite, reducing family expenses.
Who qualifies: Requires hospice eligibility/certification and election of the Medicare hospice benefit.
How to start: Ask the clinician for hospice evaluation or compare Medicare-certified hospice providers.
Good to know: Family caregiver payment: No direct family wage
Food / Household Cost Offset
Supplemental Nutrition Assistance Program (SNAP)
IndirectHelps pay for: Food benefits reduce grocery spending, leaving more household funds available for caregiving and other essential costs.
Who qualifies: Income/resource and household rules apply; deductions can matter for older/disabled households.
How to start: Apply through the ND Self-Service Portal or Customer Support Center.
Good to know: Family caregiver payment: No
Energy / Home Cost Offset
Low Income Home Energy Assistance Program (LIHEAP)
IndirectHelps pay for: Helps with heating, weatherization, furnace cleaning/repair/replacement, emergency energy costs and cooling devices, preserving funds for care.
Who qualifies: Applications are year-round. For 2025-26, household income must be at/below 60% of ND median income; one-person monthly limit is $3,378.
How to start: Apply through the Self-Service Portal or Customer Support Center.
Good to know: Family caregiver payment: No
Veteran / North Dakota Tax Relief
Disabled Veteran's Property Tax Credit
IndirectHelps pay for: Reduces taxable value of a qualifying homestead for eligible service-disabled veterans, freeing funds for care.
Who qualifies: Generally requires 50%+ service-connected disability or qualifying individual-unemployability rating, honorable discharge/retirement, and ownership/residence requirements. 2026 application deadline was April 1.
How to start: Work with the local assessor and a VSO to prepare disability/discharge documentation for the next cycle.
Good to know: Family caregiver payment: No
VA Benefits
VA Homemaker & Home Health Aide
YesHelps pay for: VA may authorize community-based aides to help an eligible Veteran with ADLs and selected daily tasks at home.
Who qualifies: VA health-care eligibility, clinical need, authorization and local provider availability; copays may apply. Ask the Veteran's VA primary care/social work team for assessment and authorization.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide.
Good to know: Family caregiver payment: No direct family wage
Veteran-Directed Care
YesHelps pay for: Flexible self-directed budget for eligible Veterans needing personal care; participant can exercise more choice over workers and services within local program rules.
Who qualifies: VA enrollment, clinical need and local VDC availability; program is not available in every location. Ask Fargo VA social work/care team whether VDC is available in the Veteran's service area.
How to start: Ask the VA social worker or care team about Veteran-Directed Care.
Good to know: Family caregiver payment: Often yes - family/friends may be hired subject to local VDC rules
VA Skilled Home Health
Yes - skilled careHelps pay for: VA may purchase skilled nursing, therapy and related home-health services from authorized community providers.
Who qualifies: Clinical need, VA eligibility/authorization and provider availability. Request through the VA care team.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No
VA Respite Care
Yes - respiteHelps pay for: VA may provide in-home, adult-day or facility respite to give caregivers a break.
Who qualifies: VA enrollment, clinical need and local availability/authorization. Ask VA social work or Caregiver Support about respite.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No direct wage
VA Adult Day Health Care
Indirect / daytime careHelps pay for: Health, rehabilitation, socialization and supervision in an adult-day setting can reduce in-home caregiver hours.
Who qualifies: VA eligibility, clinical need, authorization and local program/provider availability. Ask the VA care team whether adult day health care is appropriate and available.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No
VA Home Based Primary Care
Yes - medical home careHelps pay for: Interdisciplinary primary care delivered in the home can reduce travel and help medically complex Veterans remain at home.
Who qualifies: Generally for Veterans with complex chronic conditions for whom routine clinic care is difficult; VA clinical enrollment/acceptance required. Ask the VA primary care team for HBPC screening.
How to start: Ask the VA social worker or care team about VA Home Based Primary Care.
Good to know: Family caregiver payment: No
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Indirect - caregiver stipend supports home careHelps pay for: Eligible primary family caregivers may receive a monthly stipend plus training, support and other benefits.
Who qualifies: Veteran and caregiver must meet PCAFC clinical/service criteria; approval is not based solely on diagnosis or age. Contact Fargo VA Caregiver Support for application/screening.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes - eligible primary family caregiver
Program of General Caregiver Support Services (PGCSS)
IndirectHelps pay for: Coaching, education, peer support and caregiver resources can reduce burnout and help sustain care at home.
Who qualifies: For caregivers of Veterans enrolled in VA health care; no PCAFC stipend required to access general support. Contact Fargo VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of General Caregiver Support Services (PGCSS).
Good to know: Family caregiver payment: No monthly stipend under PGCSS
VA Pension with Aid & Attendance / Housebound
Indirect - cash benefit can help fund careHelps pay for: Additional pension amounts can help an eligible wartime Veteran or survivor with care and household costs when assistance or housebound status criteria are met.
Who qualifies: Pension eligibility plus Aid & Attendance or Housebound medical/functional criteria; income/net-worth rules apply. Work with a VA-accredited VSO to file the pension and supporting medical evidence.
How to start: Ask the VA social worker or care team about VA Pension with Aid & Attendance / Housebound.
Good to know: Family caregiver payment: No designated caregiver wage
VA Community Care Network Region 2
Yes - if authorized service includes home/community careHelps pay for: Authorized community care can provide covered services outside VA when eligibility/referral requirements are met.
Who qualifies: North Dakota is in CCN Region 2, administered by Optum Serve; community care generally requires VA authorization/referral. Start with the Fargo VA care team/community care office rather than self-referring as if it were ordinary insurance.
How to start: Ask the VA social worker or care team about VA Community Care Network Region 2.
Good to know: Family caregiver payment: Depends on the specific VA benefit
North Dakota Veterans Aid Loan
Indirect - loan proceeds can help with care-related or household costsHelps pay for: State loan can provide flexible cash for qualifying Veterans or un-remarried surviving spouses facing financial needs.
Who qualifies: Current program offers loans up to $8,000 at 8% interest, with terms up to 48 months; half of interest may be refunded for timely repayment. Eligibility and allowable use rules apply. Contact a local accredited Veterans Service Officer to apply.
How to start: Ask the VA social worker or care team about North Dakota Veterans Aid Loan.
Good to know: Family caregiver payment: No
North Dakota Disabled Veteran Property Tax Credit
IndirectHelps pay for: State property-tax relief can reduce housing costs for qualifying service-disabled Veterans and preserve funds for care.
Who qualifies: Generally 50%+ service-connected disability or qualifying IU paid at 100%, honorable discharge/retirement, and ownership/residence rules; credit varies by disability percentage. Apply through local assessor and use a VSO for disability/discharge documentation if needed.
How to start: Ask the VA social worker or care team about North Dakota Disabled Veteran Property Tax Credit.
Good to know: Family caregiver payment: No
Where North Dakota Families Can Start
Not sure where to begin? Match your situation to a contact below.
Primary starting point for SPED, Ex-SPED, HCBS waiver, in-home services, caregiver support, respite and options counseling
Aging and Disability Resource Link (ADRL)
Apply for Medicaid, LIHEAP, SNAP and other assistance; case questions and document submission
ND HHS Customer Support Center
Online applications/reviews for Medicaid and economic-assistance programs
North Dakota Self-Service Portal
Help enrolling/revalidating as an individual, Family Home Care or Family Personal Care QSP; billing/service-authorization support
North Dakota QSP Hub
PACE screening/enrollment for adults 55+ who meet nursing-home level of care and live in the service area
Northland PACE
Traditional IID/DD waiver, Family Care Option, self-directed in-home supports and DD services
Developmental Disabilities Section
Questions about Medicaid 1915(c) waivers, including children's waivers
ND Medicaid Waiver / Medical Services
Applications/status for legally responsible family caregivers providing extraordinary care under eligible waivers
Family Paid Caregiver Pilot
Free unbiased Medicare counseling, MSP/Extra Help screening, Part D and coverage questions
ND SHIP / Medicare Assistance
Homestead, renter, Primary Residence and Disabled Veteran property-tax relief
ND Office of State Tax Commissioner - Property Tax
VA home-care referrals, community care, clinical services and Veteran benefits coordination
Fargo VA Health Care System
PCAFC stipend screening, PGCSS, respite and caregiver resources
Fargo VA Caregiver Support Team
Before You Rely on Any Payment Source
Planning Point
Why It Matters
Start with ADRL for older-adult/physical-disability home-care screening
North Dakota routes SPED, Ex-SPED, state-plan personal care, the older-adult/physical-disability HCBS waiver, caregiver support and many QSP services through Adult and Aging/ADRL. One intake can help identify which funding source fits first.
Family Home Care and Family Personal Care are different programs
Both can pay a spouse or qualifying family member who lives with the participant, but FHC includes room, board, supervision and personal services while FPC is built around personal-care tasks. Case-manager preapproval and QSP enrollment are essential.
Current FHC/FPC daily rates changed July 1, 2026
The July 1, 2026 QSP rate sheet lists Family Home Care at $77.69/day and Family Personal Care at $165.98/day. Treat these as program reimbursement rates, not a promise that every family will receive that amount; authorization and program rules control payment.
Family Paid Caregiver Pilot has a major August 2026 access constraint
HHS says a recent North Dakota Supreme Court decision requires emergency rule changes to the assessment scoring process. Until rules become effective, the Department says it cannot approve or deny applications; applicants may be waitlisted and funding is limited. Do not treat the pilot as immediately payable.
QSP agency enrollment moratorium is provider-facing, not loss of member eligibility
Effective June 11, 2026, ND Medicaid imposed a temporary 6-month moratorium on new NEMT agencies statewide and new QSP/DD agencies in Burleigh and Cass Counties. Existing enrolled providers are unaffected; families may still pursue member eligibility and use available providers.
The HCBS waiver requires nursing-facility level of care
The older-adult/physical-disability waiver is not simply an income-based benefit. A person must be on ND Medicaid, be 65+ or 18-64 with qualifying physical disability, and meet nursing-home level-of-care screening while choosing community services.
Live-in caregivers may be exempt from EVV for specified services
North Dakota lists live-in EVV exemptions for Family Home Care, Family Personal Care, Waiver Personal Care, and Medicaid State Plan Personal Care/SPED. Confirm the current billing/documentation workflow with the case manager or QSP Hub.
Workers with Disabilities can preserve Medicaid while employed
For 2026, the program uses a 225% FPL income limit ($2,993/month for one person), a 5% gross-countable-income premium and a one-time $100 enrollment fee, with stated Native American exceptions. This can preserve access to Medicaid-funded supports while working.
1915(i) is behavioral-health focused, not a general aging waiver
The 1915(i) can be valuable for respite, caregiver training, housing and transition supports, but it requires Medicaid/Expansion, a qualifying behavioral-health diagnosis, income at or below 150% FPL and a qualifying functional score.
Medically Fragile waiver has a published service-fund ceiling
The current HHS page states that families have access to up to $25,300 for waiver services, excluding case management, and must use a fiscal agent for payment. Verify the current individualized budget before committing to services.
PACE availability depends on age, level of care and service area
Northland PACE is the only PACE organization identified by ND HHS. Enrollment requires age 55+, residence in a PACE service area, nursing-home level of care and ability to live safely in the community at enrollment.
Plan early for annual North Dakota tax-relief windows
As of Aug. 14, 2026, the April 1 deadlines for the Homestead, Primary Residence and Disabled Veteran property-tax credits and the May 31 Renter's Refund window have passed for 2026. Keep documentation and calendar the 2027 application cycle rather than assuming retroactive relief.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in North Dakota to help you navigate the application process.
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