If you are caring for an aging parent or spouse at home, North Dakota caregiver programs can pay you a wage, fund free respite, and cover in-home care before your savings run out.

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 (consumer-directed) Pays a family member to provide in-home personal care ND Medicaid adults assessed at a nursing-facility level of care Free (paid by Medicaid)
NFCSP respite grants Free in-home respite, adult day, training, counseling Caregivers of adults 60+ or a person with dementia; no Medicaid required Free
VA PCAFC Monthly tax-free stipend; can pay a spouse Veteran with a 70%+ rating enrolled in VA health care Free (VA benefit)
VA Aid and Attendance (A&A) Adds up to $2,424/mo to a single veteran's 2026 pension Wartime veteran or surviving spouse under the net-worth limit Free to apply

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, and it runs through Medicaid's home and community-based services.

North Dakota Health and Human Services funds in-home long-term care through its consolidated Medicaid home and community-based services (HCBS) waiver, renewed effective January 1, 2026, which serves adults who are aged (65 or older) or disabled. As of that renewal, North Dakota no longer runs a separately named Elderly and Disabled (E&D) waiver or a standalone Traumatic Brain Injury (TBI) waiver; disabled adults are served under the single consolidated HCBS waiver. The waiver covers personal care, homemaker, respite, chore, and other community supports, and under consumer-directed services a family member can be hired, trained, and paid as your loved one's personal care attendant. Whether a spouse specifically can be the paid attendant must be confirmed with North Dakota Health and Human Services at 1-800-755-2604.

This waiver is for adults who are assessed to need a nursing-facility level of care but want to stay in their own home. The state-funded Basic Care Assistance Program is a separate route for low-income adults who need residential care but do not yet meet that nursing-facility level of care.

Because these services run through Medicaid, your loved one has to meet North Dakota's Medicaid financial rules. North Dakota applies a 60-month look-back on asset transfers before long-term care coverage begins, so gifts or transfers made in the five years before applying can delay eligibility. It is worth reviewing those with a caseworker early, before they become a surprise.

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. You can apply online or in person through your local Human Service Zone office.

2
Step 2

Request a level-of-care assessment

Call North Dakota Health and Human Services at 1-800-755-2604 and ask for a home and community-based services assessment. This is where the state confirms the nursing-facility level of care that the waiver requires.

3
Step 3

Choose self-direction and name your caregiver

Once approved, ask to self-direct the personal care benefit so a family member can be hired and paid as the attendant. Confirm whether a spouse can be paid, since that depends on the program.

4
Step 4

Plan around the look-back

North Dakota reviews asset transfers over a 60-month period, so go over any gifts or transfers from the past five years 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. Call 1-855-462-5465 to reach the Resource-LINK, or dial 211.

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 in North Dakota

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 Start a Medicaid application and request a home and community-based services assessment, the gateway to a paid family caregiver. 1-800-755-2604 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. Dial 211 for the broader social-services network. 1-855-462-5465
VA Caregiver Support Line Reaches a VA Caregiver Support Coordinator about the PCAFC stipend and other veteran caregiver benefits. 1-855-260-3274 www.caregiver.va.gov
Eldercare Locator A free national service that points you to caregiver support and respite in your North Dakota community. 1-800-677-1116 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 are the most reliable paid-caregiving route, and they are the one place a spouse can dependably be paid.

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 is calculated from the federal General Schedule GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a level factor (Level 1 is 0.625; Level 2 is 1.00 when the veteran cannot self-sustain in the community). The stipend is federal tax-free and can pay a spouse. To qualify, the veteran needs a service-connected disability rating of 70 percent or higher, a need for in-person personal care for at least six continuous months, and enrollment in VA health care.

For a spouse stepping into full-time care for a disabled veteran, this stipend is often the difference between managing and going under, so it is worth the paperwork. You can start the application online at the VA caregiver support page rather than by phone.

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 $2,424 a month ($29,093 a year); a veteran with one dependent receives up to $2,874 a month. The pension goes to the veteran, who often uses it to pay a family caregiver.

County or tribal veterans service officers help North Dakota veterans file the pension claim at no cost, so there is no reason to pay a for-profit consultant.

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, though a tax preparer who knows caregiver pay is worth a call before you file.

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 program, your wages may be excluded from federal gross income under IRS Notice 2014-7. This applies to many North Dakota self-directed caregiving arrangements and can be real money back in your pocket, so it is worth raising with your preparer.

North Dakota State Income Tax

North Dakota levies a state income tax, and how it treats Medicaid caregiver wages depends on your situation. Confirm the current rules with North Dakota's state tax office or a tax preparer before you file.

The PCAFC Stipend

The PCAFC monthly stipend is federal tax-free and is not reported on a W-2. For a spouse who left a job to provide care, that tax-free status is one less thing to worry about.

Your next step Ready to start? Call North Dakota Health and Human Services at 1-800-755-2604 and ask for a home and community-based services assessment, the first step toward a paid family caregiver arrangement.

Frequently Asked Questions

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

It depends on the program. Under North Dakota's Medicaid HCBS waivers, a family member can be hired and paid as a personal care attendant through self-direction, but whether a spouse specifically qualifies must be confirmed with North Dakota Health and Human Services at 1-800-755-2604. If your spouse is a veteran enrolled in VA care, the PCAFC stipend can pay a spouse.,

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. Call the ND Aging & Disability Resource-LINK at 1-855-462-5465 or dial 211.

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

North Dakota's Medicaid HCBS waivers serve adults who are assessed to need a nursing-facility level of care and who meet the state's Medicaid financial rules, including a 60-month look-back on asset transfers. Call North Dakota Health and Human Services at 1-800-755-2604 to request an assessment, and expect functional and financial reviews before paid care begins.

Which VA programs pay family caregivers in North Dakota?

The PCAFC stipend (for veterans with a 70 percent or higher service-connected rating, federal tax-free, can pay a spouse) and the Aid and Attendance pension (up to $2,424 a month in 2026 to a single veteran, who can pay a caregiver from it). 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 waivers and VA benefits are the main routes to paid family caregiving. Confirm family-hire rules with NDDHS at 1-800-755-2604. CaregiverRespite Care in North DakotaNorth Dakota funds respite care through Medicaid HCBS waiver consumer-directed care, free NFCSP grants with no income test, and the VA for veterans. 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, monthly rates up to $2,874, how to apply, and free help from NDDVA and county 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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