Guides → North Dakota

Getting paid to care for a parent in North Dakota

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: North Dakota's door is Qualified Service Provider (QSP) system - the family member enrolls as an individual QSP and is paid through Medicaid State Plan Personal Care (MSP-PC), the Medicaid HCBS "Aged and Disabled" Waiver (which includes the live-in Family Personal Care service), or the state-funded SPED / Expanded SPED program (which is where the live-in Family Home Care service lives), run by North Dakota Health and Human Services (ND HHS), Adult and Aging Services Section. Pay: $27.92/hr ($6.98 per 15-minute unit) statewide for individual QSP personal care, homemaker, and respite under MSP-PC, SPED, and the waiver (effective 7/1/2026, per the ND HHS QSP rate sheet revised 7/23/2026). Two live-in family options pay flat daily rates instead: Family Personal Care $165.98/day and Family Home Care $77.69/day, both effective 7/1/2026, with no hourly cap - but you cannot bill either one for a day your parent is away from the home, including any day they go into the hospital. (The 10-hours-a-day limit you may see quoted applies to waiver live-in Personal Care, code S5102, not to Family Home Care or Family Personal Care.) A rural differential raises the individual unit rate to $9.43/15 min (21-50 miles), $11.15 (51-70 miles), or $12.45 (71+ miles) when you drive at least 21 miles round trip to reach your parent - you are not paid for the drive itself, only a higher rate for the care given on the days you travel. If you work more than 40 hours in a Sunday-Saturday week, ND HHS owes you FLSA overtime: you bill all your hours at the regular rate as usual and HHS sends a separate payment at half the regular rate for the extra hours (about one month behind for unit-rate providers, three months behind for daily-rate providers). Note: QSPs are self-employed independent contractors - these are gross billing rates, HHS withholds no Social Security or income tax and pays no benefits, so self-employment tax is on you. How many hours you actually get matters more than the rate: for Medicaid State Plan Personal Care the state authorizes up to 120 hours a month for most people (about $3,350 gross), up to 240 hours only if your parent meets nursing-facility level of care, and up to 300 hours only if they are impaired in at least 5 activities of daily living, meet nursing-facility level of care, and none of those hours go to laundry, shopping, or housekeeping. The 1,200-units-a-month figure is just the billing ceiling, not what most people are authorized.

Who can be the paid caregiver

Most family members can enroll as a paid QSP: adult children and stepchildren, adult siblings, adult grandchildren, adult nieces and nephews, parents, stepparents, and grandparents - and spouses, but only through Family Personal Care (waiver) or Family Home Care (SPED). Family Home Care also reaches in-laws: state rule counts the current or former spouse of any of those relatives. For Family Personal Care and Family Home Care you must live in the same home as your parent. Two things that disqualify people and are easy to miss: (1) If you are your parent's court-appointed LEGAL GUARDIAN, you cannot be paid for Medicaid State Plan Personal Care - state rule bars payment to the recipient's spouse, legal guardian, or parent of a minor child. Being the parent's power of attorney or informal helper is fine; being the legal guardian is what blocks MSP-PC. (2) If you live in the same home as your parent, you cannot be paid for ordinary waiver Personal Care either - Family Personal Care is the live-in route under the waiver. Everyone must also pass criminal background, sex-offender registry, abuse registry, and federal Medicaid-exclusion checks and complete QSP onboarding plus fraud/waste/abuse training.

The spouse question

Split rule, and the two live-in options come from two different pots of money. A spouse CANNOT be paid under Medicaid State Plan Personal Care (MSP-PC): NDAC 75-02-02-09.5(10) says no payment may be made for personal care provided by the recipient's spouse, legal guardian, or parent of a minor child, and ND HHS's own billing-code guide repeats it for codes T1019 and T1020. A spouse CAN be paid two ways. First, Family Personal Care (flat $165.98/day, you must live together) is a Medicaid HCBS waiver service - NDAC 75-03-23-06(7) and the ND HHS Family Personal Care QSP Handbook both allow the spouse. Second, Family Home Care (flat $77.69/day, you must live together) is a state-funded SPED or Expanded SPED service, NOT a waiver service (NDAC 75-03-23-05(6) and 75-03-24-05). That distinction matters: SPED is generally only open to people who do not already qualify for the Medicaid waiver or MSP-PC, so if your parent is on Medicaid the realistic spouse route is Family Personal Care, not Family Home Care. One more trap: under the waiver, a family member who lives in the same home as your parent cannot be paid for ordinary waiver Personal Care at all (NDAC 75-03-23-06(23)(a)-(b)) - if you live together, Family Personal Care is the only waiver route.

Waitlist reality

MSP-PC (Medicaid State Plan Personal Care) is an entitlement - if your parent qualifies for Medicaid and meets the functional test, there is no waitlist, though what they are authorized is capped by hours (usually 120/month). The HCBS Aged & Disabled Waiver is not an entitlement and slots are capped, but I found no official ND source reporting an active waiver waitlist as of August 2026 - ask the case manager for the current status rather than assuming either way. SPED and Expanded SPED are the ones with a waiting list written into state rule: your parent must first be entered into the 'SPED program pool' before any payment can be authorized, and names move from the pool to active status only as funding becomes available (NDAC 75-03-23-01(23) and 75-03-23-02(1)). People coming off the waiver, off MSP-PC, off Ex-SPED, or out of a hospital or nursing facility can skip the pool. SPED also has a $50,000 resource limit and an income-based sliding cost share. Separately, QSP enrollment itself takes roughly 2+ weeks after your paperwork is complete, and ND Medicaid financial approval can take up to about 3 months.

Worth knowing: Key disqualifiers and gotchas: (1) Under Medicaid State Plan Personal Care, no payment can go to your parent's spouse, legal guardian, or the parent of a minor child. If you are the court-appointed guardian, MSP-PC is closed to you. A spouse's routes are Family Personal Care (Medicaid waiver, $165.98/day) or Family Home Care (state-funded SPED / Expanded SPED, $77.69/day) - both require living in the same home, and they are funded by different programs, so which one you can use depends on whether your parent is on Medicaid. (2) The flat daily rates are fragile income: you cannot bill Family Personal Care or Family Home Care for any day your parent is away from the home, including hospital stays (you may bill the day they come home and the day of death, but not the day they go in), and a Family Personal Care provider is not allowed to hire or arrange for someone else to cover while the client is away. Budget for that. (3) How many hours you get matters more than the rate: MSP-PC authorizes up to 120 hours a month for most people, 240 with nursing-facility level of care, and 300 only in the narrowest high-need cases. (4) Medicaid financial limits are strict (roughly $1,197/mo income and $3,000 assets for a single applicant in 2026 per secondary sources - verify with the Human Service Zone; ND also has a medically-needy pathway). If your parent is over the limits, SPED is the state-funded fallback, but SPED has its own $50,000 resource limit, an income-based sliding cost share, and a waiting pool. (5) QSPs are self-employed independent contractors: no withholding, no benefits, self-employment tax is on you - but ND HHS does owe you FLSA overtime for care beyond 40 hours in a Sunday-Saturday week, paid as a separate half-rate supplement one to three months later. Billing runs through Therap or MMIS and records must be kept 42 months. (6) Failed background/abuse-registry checks or federal Medicaid exclusion disqualify a caregiver, and you are not paid for care given before your service authorization is issued. (7) Rates changed 7/1/2026 - older pages (e.g. 'up to $21.76/hr' still on caringjobs.nd.gov) are outdated; the current individual personal-care unit is $6.98/15 min ($27.92/hr).

Other doors in North Dakota

ProgramWhat to know
SPED and Expanded SPED (Service Payments for the Elderly and Disabled)State-funded (non-Medicaid) in-home care for people who don't qualify for Medicaid; pays the same QSP rates ($6.98/15 min individual, 7/1/2026) including family QSPs and Family Home Care; income-based sliding cost share applies; funding depends on state appropriations.
Family Home Care (waiver/SPED service)North Dakota's structured-family-caregiving-style option: a live-in relative — including a spouse — is paid a flat $77.69/day (7/1/2026) for room, board, supervision, and personal care.
Family Personal Care (HCBS waiver service)Higher-need live-in option paying a flat $165.98/day (7/1/2026); spouse, adult child, sibling, grandchild, niece/nephew eligible; caregiver and parent must live together.
Veteran-Directed Care — Fargo VA Health Care SystemAvailable through the Fargo VA for enrolled veterans: a monthly flexible budget the veteran can use to hire family members (including spouses); ask the Fargo VA's Veteran Directed Care Coordinator via 701-232-3241.
ND Family Caregiver Support ProgramNon-pay support: respite, supplemental services, and counseling for unpaid caregivers of people 60+; reached through the same ADRL number, 1-855-462-5465.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Call the Aging and Disability Resource Link (ADRL) at 1-855-462-5465 (TTY 711), email CareChoice@nd.gov, or visit https://ndcarechoice.hhs.nd.gov (the older carechoice.nd.assistguide.net address still redirects there) - this is the front door; they refer your parent to an HCBS case manager for a functional assessment.
  2. 2. Apply for ND Medicaid (financial eligibility) online at applyforhelp.nd.gov or through your local Human Service Zone office; SPED or Expanded SPED is the fallback if your parent doesn't qualify for Medicaid.
  3. 3. The family caregiver enrolls as a Qualified Service Provider (Individual QSP, or Family Personal Care / Family Home Care QSP for live-in family and spouses) at the QSP Enrollment Portal: https://ndhousingstability.servicenowservices.com/nd_qsp. Free help: ND QSP Hub, 701-777-3432 or info@ndqsphub.org.
  4. 4. Complete background checks, QSP onboarding training, fraud/waste/abuse training, and direct deposit setup; approval typically takes about two weeks.
  5. 5. Once your parent is approved and you are enrolled, the case manager issues a service authorization listing your services, units, and rate. Do not provide care before you have that authorization - you will not be paid for it. You then log visits and bill ND HHS through the Therap electronic visit verification system, or bill MMIS directly (including on paper form SFN 1730 if you're set up that way).

Where to start: Aging and Disability Resource Link (ADRL), ND HHS - 1-855-462-5465 (TTY 711), CareChoice@nd.gov, https://ndcarechoice.hhs.nd.gov (the old carechoice.nd.assistguide.net address still redirects there). For caregiver-side enrollment help: ND QSP Hub, 701-777-3432, info@ndqsphub.org, https://www.ndqsphub.org

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

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Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.