If you are caring for an aging parent or spouse at home, North Dakota caregiver programs can pay you for that care and give you a free break from it.

The hard part is rarely whether help exists in North Dakota. It is knowing what is there and where to start. This guide maps every major caregiver program in the state for 2026, from Medicaid-paid pathways to VA benefits and free respite.

You do not have to figure this out alone, and you do not have to fund all of it from your own savings.

North Dakota Caregiver Programs at a Glance

Program What It Offers Who Qualifies Cost to You
HCBS waiver (Family Personal Care) Pays a spouse or close relative who lives in the same home for personal care ND Medicaid members 65+, or 18 to 64 with a disability, who meet a nursing-facility level of care Paid by Medicaid
Medicaid State Plan personal care Pays an enrolled Qualified Service Provider, which can be an adult child or other relative, live-in or not; never a spouse or legal guardian ND Medicaid members, with prior authorization; up to 120 hours a month, 240 with a nursing-facility level of care, or 300 if impaired in at least five of seven daily activities, at nursing-facility level of care, none for laundry, shopping or housekeeping Paid by Medicaid
SPED or Expanded SPED Family Home Care Pays a spouse or listed relative who lives with the person 24 hours a day People eligible for SPED or Expanded SPED (which requires Medicaid eligibility); anyone who gets or would qualify for Medicaid and meets level-of-care screening must seek Family Personal Care first Ask the program
NFCSP respite grants Free in-home respite, adult day, training, counseling Caregivers of adults 60+ or a person with dementia; respite only if the person cared for is frail; no Medicaid required Free
VA PCAFC Monthly stipend VA called nontaxable in its 2020 proposed rule; can pay a spouse All of VA's PCAFC conditions, not the rating alone Free (VA benefit)
VA Aid and Attendance (A&A) Lifts a single veteran's 2026 pension to as much as $29,093/yr Wartime veteran or surviving spouse under the $163,699 net-worth limit Free claim help from County and Tribal VSOs

Which North Dakota Programs Pay Family Caregivers?

For many families, this is the real question: can the person already doing the caregiving get paid for it? In North Dakota, the answer is often yes. Most routes run through Medicaid's home and community-based services, and North Dakota's SPED programs add one more.

North Dakota Health and Human Services funds in-home long-term care through its consolidated Medicaid home and community-based services (HCBS) waiver, effective January 1, 2026, which serves people 65 or older and adults 18 to 64 with a physical or other disability who meet a nursing facility level of care. CMS's list of North Dakota's waivers shows no separately named Elderly and Disabled (E&D) waiver and no standalone Traumatic Brain Injury (TBI) waiver. The waiver covers personal care, homemaker, respite, chore, and other community supports.

Family Personal Care: a Live-In Spouse or Relative

The main paid-family route is the waiver's Family Personal Care service. Your loved one can choose a legal spouse or one of these relatives as the paid provider: a parent, grandparent, adult child, adult sibling, adult grandchild, adult niece, or adult nephew. Payment goes only to a spouse or family member who lives in the same home, and the relative must enroll as a Qualified Service Provider (QSP). It pays for help with daily activities such as bathing, dressing, toileting, transferring and eating, not for housework, laundry, meal preparation, shopping or transportation. Family Personal Care is not available to someone eligible to receive such services through the Medicaid State Plan or Early Periodic Screening Diagnosis and Testing (EPSDT), and its cost is limited to a maximum monthly cap set by the Department or through legislative action. In its January 2026 renewal application, the state reported more than 1,150 enrolled QSPs statewide and no waiting list for waiver services.

Family Personal Care also has hour rules. The provider must give at least three hours of care a day; below that, live-in care moves to Medicaid State Plan personal care's daily rate, if the provider is eligible for it. Reimbursable hours cannot exceed 10 a day, and the state is not obligated to pay for care beyond 10 hours. If a spouse or guardian with decision-making authority wants to be the paid provider, the case manager must pre-approve the arrangement and send the State Medicaid Agency a narrative explaining why it is in your loved one's best interest.

If You Do Not Live With Your Loved One

The same-home rule belongs to Family Personal Care, not to Medicaid as a whole. A relative who does not live with your loved one can be paid under the waiver's Waiver Personal Care service, because relatives and legal guardians qualify by meeting the same Qualified Service Provider standards as anyone else. A live-in relative cannot provide Waiver Personal Care and must use Family Personal Care or, if eligible, Medicaid State Plan personal care instead.

Medicaid State Plan personal care is a second Medicaid route. It pays only an enrolled Qualified Service Provider, which can be an adult child or other relative, and it never pays a spouse, a parent of a minor child or a legal guardian. A relative who lives with your loved one may choose its daily rate instead of Family Personal Care. The department must authorize care in advance, up to 120 hours a month, 240 hours with a nursing-facility level of care, or 300 hours for someone impaired in at least five of seven daily activities and at nursing-facility level of care, with none of those hours for laundry, shopping or housekeeping.

Basic Care, Medicaid Financial Rules and SPED

The Basic Care Assistance Program is a separate route for people below a nursing-facility level of care: it helps people who qualify for North Dakota Medicaid pay part of the cost of living in a licensed basic care facility, which suits those who are not severely impaired in daily activities.

Because these services run through Medicaid, your loved one has to meet North Dakota's Medicaid financial rules. For long-term care, that means less than $3,000 in countable assets for a single person or $6,000 for a couple; the home, one car, home furnishings, irrevocable burial plans and other personal items are not counted. When it decides long-term care eligibility, North Dakota Medicaid may review asset transfers over the prior five years, to make sure assets were not transferred or given to others.

North Dakota's state-funded SPED program and Expanded SPED (for people found eligible for Medicaid) offer Family Home Care, which pays a spouse or listed relative (a parent, grandparent, adult child, adult sibling, adult grandchild, adult niece or adult nephew, or the current or former spouse of one of them) when the person lives in the same residence as the provider on a 24-hour basis. Under Expanded SPED, the relative must also enroll as a Qualified Service Provider. The provider must give at least one hour of care a day, and no more than 10 hours a day are reimbursable. If your loved one receives or would qualify for Medicaid and meets level-of-care screening, Family Personal Care must be sought first.,

For the full breakdown of who can be paid, what the job pays, and how to set it up, see How to Get Paid as a Family Caregiver in North Dakota.

How to Apply for a North Dakota HCBS Waiver

Approval takes a few steps. North Dakota Health and Human Services confirms both a functional need and financial eligibility before paid care begins, so it helps to start early rather than wait for a crisis.

1
Step 1

Apply for North Dakota's Medicaid program

Waiver services require your loved one to have or qualify for Medicaid in North Dakota. To learn how to apply, contact North Dakota Health and Human Services' Medical Services Division toll-free at 1-800-755-2604.

2
Step 2

Meet the level-of-care requirement

The waiver serves only people 65 or older, or adults 18 to 64 with a physical or other disability, who meet a nursing facility level of care.

3
Step 3

Choose the service and name your caregiver

A legal spouse or a listed relative who lives in the same home is paid through Family Personal Care once enrolled as a Qualified Service Provider. A relative who lives elsewhere can be paid through Waiver Personal Care after meeting the same provider qualifications.

4
Step 4

Plan around the five-year review

North Dakota Medicaid may review asset transfers over the prior five years, so go over any gifts or transfers from that period with your caseworker before care starts.

Where Can You Get Free Respite in North Dakota?

Every caregiver needs to step away sometimes, and needing a break does not make you any less devoted to the person you love.

The National Family Caregiver Support Program, funded by Title III-E of the Older Americans Act, is administered through North Dakota Health and Human Services Adult and Aging Services and reached through the ND Aging & Disability Resource-LINK. Services include in-home respite, caregiver training, counseling, and supplemental services, and you do not need to be enrolled in Medicaid to use them. Information, help getting services, counseling and training carry no further condition, but for a family caregiver, respite and supplemental services require that the older person cared for be frail: unable to do at least two daily activities without substantial help, or, because of a cognitive or other mental impairment, needing substantial supervision because they behave in a way that poses a serious health or safety hazard to themselves or someone else. Call 1-855-462-5465 to reach the Resource-LINK.,

North Dakota's Medicaid waivers can also authorize respite within the care plan. For the full breakdown, see Respite Care in North Dakota.

Where to Get Help With North Dakota Caregiver Programs

When you are ready to make calls, these are the front doors, and every one of them is free.

North Dakota Health and Human Services The Medical Services Division answers questions about applying for Medicaid and the HCBS waiver, the gateway to a paid family caregiver. 1-800-755-2604https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND www.hhs.nd.gov/healthcare/medicaid
North Dakota Aging and Disability Resource Line Connects you to North Dakota Health and Human Services Adult and Aging Services for NFCSP respite, caregiver training, and counseling. 1-855-462-5465https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/ND
VA Caregiver Support Line Reaches a VA Caregiver Support Coordinator about the PCAFC stipend and other veteran caregiver benefits. 1-855-260-3274https://www.caregiver.va.gov/help_landing.asp www.caregiver.va.gov
Eldercare Locator A free national service that points you to caregiver support and respite in your North Dakota community. 1-800-677-1116https://eldercare.acl.gov/home · Accessed Sep 2, 2026 eldercare.acl.gov

What VA Caregiver Benefits Can North Dakota Veterans Use?

If your loved one served, do not skip this section. For many North Dakota families, a veteran's benefits add a second paid-caregiving route alongside Medicaid.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran. It starts from the federal General Schedule GS-4, Step 1 annual rate for the veteran's locality, divided by 12. That monthly base is then multiplied by one of four factors set by 38 CFR 71.40(c)(4)(i), and which one applies turns first on whether the veteran is in the current program or is a legacy participant or legacy applicant:

  • Current program (38 CFR 71.20(a)): 0.625, or 1.00 if VA determines the veteran is unable to self-sustain in the community.
  • Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the multiplier comes from the sum of the veteran's 2019 clinical ratings, and no self-sustain determination is required on this route. A sum of 21 or higher pays 1.00; 13 to 20 pays 0.625; 1 to 12 pays 0.25.
  • Qualifying under both (subparagraph (C)): a veteran who meets the current criteria and the legacy criteria is paid whichever of the two amounts is higher, so an assessment under the current program can never cut a legacy household's stipend.
  • The legacy floor (subparagraph (D)): a legacy participant under 71.20(b) is paid not less than what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still lives at the address on record. The legacy schedule runs eight years from October 1, 2020 and lapses October 1, 2028.

A legacy household whose 2019 ratings sum to 21 or higher reaches the full 1.00 rate on that schedule alone, so a family told the self-sustain finding is the only route to the full stipend may never ask for money it already qualifies for. Ask the Caregiver Support Coordinator which multiplier VA applied and on which schedule, and see How to Get Paid as a Family Caregiver in North Dakota for the worked detail.

VA called the stipend nontaxable in its 2020 proposed rule, and a spouse can serve as the caregiver. The stipend is paid only once the Primary Family Caregiver enrolls in direct deposit through the VA customer engagement portal.,

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:

  • A VA disability rating, individual or combined, of 70 percent or higher.
  • Discharge from the U.S. military, or a date of medical discharge.
  • A need for at least six months of continuous, in-person personal care services.
  • Enrollment in VA health care.

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process:

  • Participating in the program is in the veteran's best interest.
  • The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.
  • The veteran receives care at home, or will do so if VA designates a family caregiver.
  • The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.

You and the veteran apply together and take part in an application process that decides eligibility.

VA Aid and Attendance (A&A) Pension

Wartime veterans and surviving spouses who meet the functional criteria and fall under the 2026 net-worth limit of $163,699 may receive the Aid and Attendance pension. In 2026, a single veteran with Aid and Attendance receives up to $29,093 a year; a veteran with one dependent receives up to $34,488 a year. These are annual ceilings, not flat payments: VA pays the difference between that ceiling and the claimant's income for VA purposes, so someone with income receives less. That income is not gross income: non-reimbursable medical expenses above 5% of the ceiling may be deducted from it. The pension is paid to the veteran, not to a caregiver.,

County and Tribal Veterans Service Officers help North Dakota veterans and their dependents with pension claims, and their services are provided at no cost.

Will You Owe Taxes on Caregiver Pay in North Dakota?

Getting paid to care for someone you love raises a fair worry: will a tax bill eat into it? Here is the short version.

IRS Notice 2014-7 (Federal Exclusion)

If you live in the same home as the person you care for and are paid through a Medicaid waiver, your wages may be excluded from federal gross income under IRS Notice 2014-7. The notice covers section 1915(c) waiver payments for care in the caregiver's own home, where the person cared for lives under their plan of care, and North Dakota's HCBS waiver is a 1915(c) waiver whose Family Personal Care pays only family who live in the same home. Raise it with your preparer., The exclusion does not apply when the caregiver has a separate home, so a relative paid through Waiver Personal Care while living elsewhere should not count on it.

North Dakota State Income Tax

North Dakota levies a state income tax, but its first bracket carries a 0% rate. For the 2025 tax year, a single filer owes no North Dakota income tax on taxable income up to $48,475, and a married couple filing jointly owes none up to $80,975. Confirm how your caregiver pay is treated with the North Dakota Office of State Tax Commissioner or a tax preparer before you file.

The PCAFC Stipend

VA called the PCAFC monthly stipend nontaxable in its 2020 proposed rule.

Your next step Ready to start? Call North Dakota Health and Human Services' Medical Services Division at 1-800-755-2604 and ask how to apply for Medicaid and the HCBS waiver, the first step toward a paid family caregiver arrangement.

Frequently Asked Questions

Can I get paid to care for my spouse in North Dakota?

Often, if you live together and your spouse qualifies for the waiver. The Medicaid HCBS waiver's Family Personal Care service pays a legal spouse who resides in the same home, once you enroll as a Qualified Service Provider. It is not available to someone eligible to receive such services through the Medicaid State Plan or EPSDT, and its cost is capped monthly. If you have decision-making authority over your spouse, the case manager must pre-approve the arrangement and send the State Medicaid Agency a narrative on why it is in your spouse's best interest. Reimbursable hours cannot exceed 10 a day. Medicaid State Plan personal care never pays a spouse. SPED Family Home Care can also pay a spouse who lives with the person, though anyone who receives or would qualify for Medicaid and meets level-of-care screening must seek Family Personal Care first. If your spouse is a veteran who meets all of VA's PCAFC conditions, the PCAFC stipend is a separate route that can pay a spouse. PCAFC requires that the same personal care not be simultaneously and regularly provided by or through another individual or entity, so ask VA how Medicaid-paid care would affect eligibility before counting on both.,

Can I get paid to care for my parent if we do not live together?

Yes, through Medicaid if your parent qualifies. Waiver Personal Care can pay a relative who does not live with your parent, provided you meet the same Qualified Service Provider standards as any other provider. Medicaid State Plan personal care also pays an enrolled Qualified Service Provider, including a relative, with prior authorization from the department. Family Personal Care and SPED Family Home Care pay only family who live with the person.,

Is there free respite in North Dakota without Medicaid?

Yes. The National Family Caregiver Support Program provides respite through North Dakota Health and Human Services Adult and Aging Services as a separate Older Americans Act program, so your loved one does not need to be on Medicaid. For a family caregiver, respite requires that the older person cared for be frail: unable to do at least two daily activities without substantial help, or, because of a cognitive or other mental impairment, needing substantial supervision for behavior that poses a serious health or safety hazard. North Dakota describes its respite as a short break for caregivers who provide 24-hour care. Call the ND Aging & Disability Resource-LINK at 1-855-462-5465.,

How does my loved one qualify for a paid-caregiver waiver?

North Dakota's Medicaid HCBS waiver serves people 65 or older, and adults 18 to 64 with a disability, who meet a nursing facility level of care and qualify for Medicaid, which may include a review of asset transfers over the prior five years. To learn how to apply, call the Medical Services Division of North Dakota Health and Human Services at 1-800-755-2604.

Which VA programs pay family caregivers in North Dakota?

PCAFC pays a monthly stipend to the Primary Family Caregiver of a veteran who meets all of VA's PCAFC conditions, not the rating alone; VA called it nontaxable in its 2020 proposed rule, and it can pay a spouse., The Aid and Attendance pension (up to $29,093 a year in 2026 for a single veteran) is paid to the veteran, not the caregiver. Call the VA Caregiver Support Line at 1-855-260-3274.

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverHow to Get Paid as a Family Caregiver in North DakotaNorth Dakota's HCBS waiver can pay a spouse or close relative who lives with the care recipient, and VA programs can pay veteran family caregivers. CaregiverRespite Care in North DakotaFree Family Caregiver Support Program respite, Medicaid waiver and SPED respite in North Dakota: who qualifies, what each covers, and the number to call. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. VA BenefitsVA Benefits for Seniors in North DakotaVA Aid and Attendance in North Dakota for 2026: who qualifies, pension ceilings up to $34,488 a year, how to apply, and free help from local service officers. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.

Find personalized help choosing a North Dakota caregiver program at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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