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North Dakota home care payment guide
Last updated: September 13, 2026
North Dakota uses different payment routes for medical home health and ongoing personal care. Medicare can cover qualifying skilled home health. State and Medicaid programs may help with personal care, meals, housework, supervision, or respite.
This guide shows where to start, what each route may cover, and what to try next.
Bottom Line
Start with North Dakota’s Aging and Disability Resource Link (ADRL) at 1-855-462-5465. Ask for an in-home care screening across SPED, Expanded SPED, Medicaid personal care, and the Medicaid HCBS waiver. You can also use the state’s Care Choice directory.
For medical home health after illness or injury, ask the doctor about Medicare. For long-term personal care, check North Dakota’s state and Medicaid programs early.
Need Help Right Now?
If an older adult is unsafe alone today, tell the doctor, discharge planner, ADRL, or emergency responder exactly what is happening. If there is immediate danger, call 911. For suspected abuse, neglect, exploitation, or serious self-neglect, use North Dakota HHS guidance to report vulnerable-adult concerns.
During a hospital or nursing-facility discharge, clearly describe any unsafe bathing, transfers, toileting, medicines, meals, or time alone.
Start Here
- Call ADRL: 1-855-462-5465. Ask for screening for all home- and community-based options, not just one program.
- Apply for Medicaid if needed: North Dakota accepts Medicaid applications online, on paper, by mail, or through a Human Service Zone. The Medicaid application page lists the current routes.
- Separate medical from nonmedical care: Ask the doctor about Medicare home health for skilled needs. Use ADRL for longer-term personal care, homemaker help, respite, and related supports.
If you are helping a parent or spouse, the related GFS guide to paid family caregiving explains the caregiver-payment question in more detail.
Quick Reference: Which Route Should You Try First?
| Situation | Best first route | Important limit |
|---|---|---|
| Skilled nursing or therapy is needed at home after illness, injury, or decline | Medicare home health | Medicare does not pay for round-the-clock care or personal care when that is the only need |
| Long-term help with bathing, dressing, meals, housework, or similar daily tasks | ADRL screening for SPED, Ex-SPED, Medicaid personal care, or HCBS waiver | Financial and functional rules differ by program |
| Person is 55+ and needs nursing-home-level care but wants to stay in the community | PACE or Medicaid HCBS screening | PACE has service-area and provider-network rules |
| Family member wants to be paid as caregiver | Ask case manager about Family Home Care or Family Personal Care | Care must be authorized before QSP billing |
| Older adult is a veteran or surviving spouse | County or Tribal Veterans Service Officer | VA programs have separate health-care and pension eligibility rules |
First, Know Which Kind of Home Care You Need
Home care can mean different services, and the payer rules change with the type of care.
Skilled home health includes medically necessary nursing, therapy, and certain home health aide care. Medicare can cover qualifying part-time or intermittent care when a person is homebound, needs skilled services, has the required provider order, and uses a Medicare-certified home health agency. Original Medicare lists $0 for covered home health services; durable medical equipment generally has 20% coinsurance after the Part B deductible. Long-term personal care includes help with bathing, dressing, toileting, transfers, meals, laundry, or housework. Medicare does not pay for custodial personal care when that is the only care needed, or for 24-hour home care.
For a broader explanation of these service types, see GFS’s home care guide. If you are choosing between an agency and a person you hire directly, the agency versus caregiver guide can help you compare supervision, scheduling, backup coverage, and employer responsibilities.
North Dakota Programs That Can Help Pay for Care at Home
North Dakota HHS lists several home- and community-based long-term care programs on its home-care program page, including SPED, Expanded SPED, Medicaid personal care, the HCBS waiver, Older Americans Act services, and PACE.
| Program | What it may help with | Who should ask | Reality check |
|---|---|---|---|
| SPED | In-home and community supports | Older or physically disabled adults needing ongoing help | Income is considered; a service fee may apply |
| Expanded SPED | In-home and community services | Traditional Medicaid members meeting Ex-SPED rules | Requires a case-manager assessment |
| Medicaid personal care | Bathing, dressing, toileting, meals, and household tasks | Medicaid members needing daily help | Care depends on assessment and authorization |
| Medicaid HCBS waiver | Personal care, respite, household support, and other services | People meeting Medicaid and nursing-home-level care rules | Current waiver took effect January 1, 2026 |
| PACE | Coordinated medical care, home care, personal care, and transportation | Medicaid members 55+ meeting care and service-area rules | PACE uses its own care team and network |
SPED can be important even before Medicaid fits
The Service Payments for the Elderly and Disabled (SPED) program is a key North Dakota route. Current HHS materials say an adult may qualify with less than $50,000 in liquid assets, the required functional need, and a need expected to last more than 90 days. Income is considered and a service fee may apply. SPED is worth asking about even when standard Medicaid limits do not appear to fit.
Expanded SPED is tied more closely to Medicaid
Expanded SPED, or Ex-SPED, is for adults on traditional Medicaid who receive Supplemental Security Income (SSI), or have income at or below the SSI level, and meet the functional rules. HHS says Ex-SPED has no service charge. Let ADRL check the full rule rather than self-screening from income alone.
Medicaid personal care can cover daily hands-on help
Medicaid State Plan personal care can help with bathing, dressing, transfers, toileting, meals, housework, and laundry. A case manager determines the services. If the person already has Medicaid, ask ADRL whether personal care or the HCBS waiver fits better.
The 2026 HCBS waiver is for higher long-term care needs
North Dakota’s current HCBS waiver took effect January 1, 2026. It serves eligible Medicaid members who meet nursing-home-level care and choose community services. Supports can include personal care, respite, household tasks, meal preparation, and nonmedical rides. The assessment determines what is authorized.
PACE is an all-in-one option for some older adults
North Dakota offers PACE to Medicaid members age 55 and older. The state’s PACE page requires residence in a PACE service area, nursing-home-level care, and safe community living with PACE. It can include home care, personal care, medicines, transportation, therapy, and other team-approved services. Call Northland PACE at 1-888-883-8959 to check the address and screening process.
2026 Medicaid Financial Rules: Do Not Use One Number for Every Case
North Dakota Medicaid has several coverage groups. A person over one income figure may still have a client-share route, and married couples may have special protections. Use the numbers below for orientation, not as a final eligibility decision.
| Rule | Current verified figure | What it means |
|---|---|---|
| Aged, blind, disabled Medicaid assets | Less than $3,000 single; less than $6,000 couple | Certain assets such as a home, one car, household goods, and qualifying burial arrangements are not counted under the state’s listed rule |
| ABD monthly income level | $1,197 for one person; $1,623 for two, effective April 1, 2026 | This is the state’s standard ABD income table, not a universal HCBS waiver ceiling; client-share and long-term-care rules can change the result |
| Long-term care assets | Less than $3,000 single; less than $6,000 couple | The person must also meet a Medicaid coverage group and the medical need for long-term care |
| SPED liquid assets | Less than $50,000 | SPED uses its own income and functional rules and may have a sliding service fee |
The Medicaid eligibility rules list the aged, blind, and disabled income table as effective April 1, 2026 and also describe a client-share route for some people with higher income and medical need. Married couples should ask specifically about spousal impoverishment prevention when one spouse needs long-term care.
Important: Do not give away money or property to try to qualify. North Dakota says some long-term-care cases can involve review of asset transfers over the prior five years. Get program-specific or legal guidance before moving assets.
North Dakota also has Medicaid estate recovery. HHS says it can apply after death when a member was 55 or older when Medicaid services were received, subject to listed protections and delays. Ask the Estate Recovery Unit or a qualified attorney before making estate decisions.
Can a Family Member Be Paid to Provide Home Care?
Sometimes. North Dakota uses Qualified Service Providers (QSPs) for many publicly funded services and has Family Home Care and Family Personal Care pathways. The state’s QSP information page says family-care provider enrollment should wait until a case manager is involved or the client is approved for the service.
The person first needs the right program, assessment, and service authorization. Then ask whether the specific family relationship is allowed and which QSP category applies. Do not assume past unpaid care will be reimbursed.
If the caregiver mainly needs relief rather than wages, the state’s Family Caregiver Support Program can provide information, counseling, training, respite, and certain supplemental supports to qualifying caregivers. It does not pay caregiver wages.
Veterans and Surviving Spouses: Check VA Help Early
Older veterans may have a second payment system to check. A free North Dakota VSO can help veterans and dependents with health care, pensions, long-term care, and other benefits.
For veterans enrolled in VA health care, Veteran-Directed Care can provide a service budget for qualifying veterans who need personal care and help with daily activities. VA says a veteran may be able to hire a worker who is a family member or neighbor. The service must be available locally, and a VA social worker determines whether the veteran meets the clinical and community-care rules.
Separately, Aid and Attendance can add money to a VA pension for certain qualified veterans or survivors who need help with daily activities. It is not automatic because a person needs home care. A VSO can screen the routes without charging a fee.
GFS also has a state-specific guide to North Dakota veteran benefits.
How to Start Without Wasting Time
- Write down the care tasks. List exactly what the person cannot do safely: bathing, dressing, transfers, toileting, eating, medicines, meal preparation, laundry, housework, transportation, or being left alone.
- Call ADRL before shopping only by price. Ask for a screening across SPED, Ex-SPED, Medicaid personal care, HCBS waiver, PACE, caregiver support, and other local services.
- Apply for Medicaid if it may be needed. The state Apply for Help portal accepts Medicaid applications. The Customer Support Center is 1-866-614-6005.
- Ask about the care assessment. Financial eligibility alone does not decide how many services a person will receive. The case manager also reviews functional needs.
- Ask who can actually provide the service. Once services are authorized, ask which QSPs currently serve the person’s county and have capacity.
- Use private pay for gaps. If affordable, buy the most important hours while benefits are screened. Get rates, minimum visits, and cancellation terms in writing.
For broader state help beyond home care, the North Dakota assistance guide covers other senior programs. The North Dakota benefits portals guide can also help with online entry points.
Document Checklist
- Photo ID and proof of North Dakota residence.
- Medicare, Medicaid, and other insurance cards.
- Social Security, pension, retirement, wage, and other income records.
- Recent checking, savings, certificate-of-deposit, stock, bond, and other asset records when the program asks for assets.
- Information about the home, vehicle, burial arrangements, and spouse’s finances if a long-term-care Medicaid review requires them.
- Medication list, diagnoses, recent hospital or rehabilitation records, and doctor contact information.
- A written list of daily tasks the person cannot do safely or can do only with help.
- Names and schedules of relatives or friends already providing unpaid care.
- Any denial, approval, service authorization, or renewal notice already received.
North Dakota’s Medicaid page says applicants age 65 or older, blind, or disabled should be ready to provide proof of assets as well as income and identity. Keep copies of everything submitted.
Reality Checks for North Dakota Families
- Medicare is not long-term custodial care insurance. It can cover qualifying skilled home health, but not continuous personal care when that is the only need.
- One financial limit does not screen every program. SPED, Ex-SPED, Medicaid personal care, the HCBS waiver, and PACE do not use one identical test.
- Authorization and staffing are different problems. Even after a service is approved, ask which QSPs are available where the person lives.
- Burleigh and Cass have a 2026 provider limit. As of September 13, 2026, North Dakota Medicaid has a temporary moratorium on new QSP agency enrollments in Burleigh and Cass Counties. It began June 11, 2026, is described as a six-month moratorium that may be extended, and does not affect currently enrolled providers. This does not close the home-care programs.
- Family payment needs prior approval. HHS says claims for unauthorized services are denied. Get the case-manager authorization and QSP steps in place before counting on payment.
- Medicaid can affect estate planning. North Dakota has estate-recovery rules. Ask before transferring assets or making assumptions about the home.
- Private long-term care insurance varies by policy. If the person owns a policy, call the insurer and ask about benefit triggers, elimination periods, covered home-care providers, daily or monthly limits, and claim documents.
Common Mistakes to Avoid
- Asking only, “Does Medicare pay?” That can miss North Dakota programs designed for longer-term personal care.
- Calling every service a grant. Most home-care help here is a benefit, service, provider payment, or care program, not a cash grant.
- Understating the care need. Describe what happens on a bad day, not only what the person can do on a good day.
- Assuming too much income means no Medicaid route. Ask about client share and, for couples, spousal impoverishment protections.
- Hiring a relative first and asking for reimbursement later. Family caregiver payment normally requires the right program, service authorization, and QSP process first.
- Giving away assets. Transfers can create long-term-care Medicaid problems. Get qualified advice before moving money or property.
Denied, Delayed, or Overwhelmed?
If Medicaid denies eligibility or a covered service, read the notice immediately. North Dakota’s Medicaid appeal page says an appeal generally must be requested within 30 days from the date the notice is mailed. It may be requested verbally or in writing.
Ask for the exact reason: financial eligibility, missing proof, level of care, service authorization, or another rule. If paperwork is missing, ask whether it can be supplied without starting over.
If Medicare home health is denied or reduced, the GFS guide to Medicare home-health denials explains the notices and next steps. If navigating local services is the problem, the GFS directory of North Dakota aging agencies can help identify local support.
If the person is in a nursing facility and wants to return home, ask about North Dakota’s Money Follows the Person program. HHS says it helps eligible Medicaid members with disabilities transition from qualifying care facilities to community living.
Backup Options When Full Home Care Is Not Available
A practical plan may combine smaller supports. Ask ADRL about home-delivered meals, transportation, caregiver respite, safety devices, and other Older Americans Act or state services that may reduce paid care hours.
For an unpaid caregiver who is reaching a breaking point, ask specifically for the Family Caregiver Support Program and respite. If the older adult cannot safely remain home even with available services, ask the case manager to explain other care settings and payment routes rather than waiting for a crisis.
Phone Scripts for the Most Important Calls
ADRL screening — 1-855-462-5465
“I am helping an older adult in North Dakota who needs help with bathing, dressing, meals, housework, and staying safe at home. Can you screen us for SPED, Expanded SPED, Medicaid personal care, the HCBS waiver, PACE, and caregiver support? What should we apply for first?”
Medicaid — 1-866-614-6005
“I am helping someone apply for Medicaid for long-term care at home. Which coverage group should we use, what financial records do you need, and could client-share or spousal-protection rules apply in this case?”
Family caregiver payment
“The person needs ongoing help and a family member is already providing care. Before we complete any provider forms, can the case manager tell us whether Family Home Care or Family Personal Care can be authorized for this relationship and what QSP steps come next?”
Veterans Service Officer
“The veteran needs help with daily activities at home. Can you screen for VA health-care home services, Veteran-Directed Care, pension with Aid and Attendance, and any caregiver support that may fit?”
Resumen Corto en Español
En Dakota del Norte, llame primero al Aging and Disability Resource Link (ADRL) al 1-855-462-5465. Pida una evaluación para SPED, Expanded SPED, cuidado personal de Medicaid, HCBS y PACE.
Medicare puede cubrir atención médica en el hogar, pero no paga cuidado personal continuo cuando esa es la única necesidad. Para Medicaid, prepare ingresos, bienes cuando correspondan, identificación y una lista de la ayuda diaria necesaria.
Un familiar puede recibir pago en algunas situaciones, pero el programa y los servicios deben aprobarse primero. Si Medicaid niega una decisión, guarde la carta: North Dakota HHS indica un plazo general de 30 días para apelar desde la fecha de envío del aviso.
Frequently Asked Questions
Does Medicare pay for home care in North Dakota?
Medicare can pay for qualifying part-time or intermittent skilled home health, including nursing, therapy, and limited aide care. It does not pay for 24-hour home care or personal care when that is the only service needed.
What is the best first call for long-term home care?
Call North Dakota’s Aging and Disability Resource Link at 1-855-462-5465. Ask for screening across SPED, Expanded SPED, Medicaid personal care, the HCBS waiver, PACE, and caregiver supports rather than asking about only one program.
Can someone qualify for SPED without qualifying for Medicaid?
Possibly. SPED has its own financial and functional rules. North Dakota HHS says applicants may qualify with less than $50,000 in liquid assets, required functional need, and services expected beyond 90 days. A service fee may apply. Expanded SPED is different and requires traditional Medicaid plus its other rules.
Can a family member get paid for caregiving?
Sometimes. North Dakota has Family Home Care and Family Personal Care QSP pathways. The client first needs the right program, assessment, and service authorization. HHS says provider enrollment should wait until a case manager is involved or the client is approved for the service.
Does North Dakota Medicaid have an asset limit for long-term care?
North Dakota HHS lists less than $3,000 for a single person and less than $6,000 for a couple for long-term-care assets. Other Medicaid, care-need, and married-couple rules also apply. Ask for a case-specific calculation.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Last verified: September 13, 2026. Next review: December 13, 2026.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: September 13, 2026 · Next review: December 13, 2026
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