Family Home Care under North Dakota's Service Payments for the Elderly and Disabled (SPED) program pays a live-in spouse or listed relative for up to 10 hours of care a day. North Dakota SPED is a state program rather than Medicaid, and an applicant whose resources the case manager finds are above Medicaid's limits doesn't have to complete a Medicaid application; SPED's own limit, as of July 1, 2026, is $50,000 in liquid assets., North Dakota SPED Family Home Care isn't a way around Medicaid, though: if your relative would be eligible for Medicaid and meets level of care screening, the state's rules say Medicaid's Family Personal Care must be sought first.

In This Guide

Who Can Be Paid Through North Dakota SPED Family Home Care?

SPED, the Service Payments for the Elderly and Disabled program run by North Dakota Health and Human Services, is a state program that pays qualified service providers for home and community-based care for people 65 and older and people with disabilities.

North Dakota law defines Family Home Care as room, board, supervisory care and personal services given to an eligible older or disabled person by a spouse, or by a parent, grandparent, adult child, adult sibling, adult grandchild, adult niece or adult nephew, or the current or former spouse of one of those relatives. So a son-in-law or daughter-in-law can be a SPED Family Home Care provider, as the spouse of an adult child.

For SPED Family Home Care, your relative must live in the same residence as you on a twenty-four-hour basis, and you must both agree to the arrangement. Under Expanded SPED, the provider must also enroll as a Qualified Service Provider (QSP).,

Being a legal guardian isn't enough on its own; the state's Family Home Care chapter marks being a relative within that definition as required. If the person living with your relative isn't family, SPED pays a daily personal care rate instead. The sources we checked don't say whether a spouse can be the paid provider under that separate SPED personal care service, so ask the case manager.

How Many Hours Does North Dakota SPED Family Home Care Pay?

The real work may run all day, but the paid hours don't. North Dakota SPED Family Home Care needs at least one hour of care a day, which can include homemaker tasks within SPED's limits, and pays no more than 10 hours a day. You may give more than 10 hours, but North Dakota isn't obligated to pay for that extra care, because it comes from your close relationship and shared household.,

Your paid hours come from person-centered planning with a home and community-based services (HCBS) case manager and go into a service agreement, and every Family Home Care provider needs the live-in service agreement, form SFN 1654. Hours beyond the service agreement count as "natural supports," not paid time., As of the HHS policy manual revised July 1, 2026, North Dakota's SPED and Expanded SPED pay at most $4,873 a month per person across all services except adult foster care.

We haven't found a published Family Home Care rate. Typical pay: about $18.96 an hour (estimate based on home care aide wages in North Dakota, BLS, May 2025, median), which reflects aide wages, not a SPED rate.

Room and board is separate: the SPED payment can't include it. A flat monthly room-and-board rate applies, and if your relative lives in your home, they pay you that directly.

Does Your Relative Qualify for SPED Without Medicaid?

An adult generally qualifies for North Dakota SPED when they:

  • have functional impairments in at least two activities of daily living (ADLs) or four instrumental activities of daily living (IADLs), totaling at least four points if they live alone or six if they live with an able-bodied adult
  • have had the impairment, or expect to have it, for three months or longer
  • live in North Dakota in a private residence, not an institution
  • can direct their own care or have a legally responsible party to act for them
  • aren't responsible for 100% of the cost under SPED's sliding fee scale

Family help at home doesn't rule your relative out: under North Dakota's SPED rules, an applicant is eligible even with natural supports. As of the HHS policy manual revised July 1, 2026, a North Dakota SPED applicant's resources can't exceed $50,000 in liquid assets plus the value of any residence other than the primary home, and the primary home isn't counted. Under SPED, your relative also pays a share of the cost on a sliding fee schedule based on family size and income, which North Dakota adjusts each July 1.

Here's the rule that decides many families' route. Not every SPED applicant has to apply for North Dakota Medicaid, and an applicant whose resources the case manager finds exceed Medicaid's limits doesn't have to. When your relative may be eligible for Medicaid, refusing to apply generally makes them ineligible for SPED, with two exceptions in North Dakota's SPED policy manual. Under North Dakota's SPED rules, no Medicaid application is required when the service requested is a non-Medicaid-waiver or state-funded service. A North Dakota SPED applicant also doesn't need to file a Medicaid application when they appear to qualify for Medicaid but aren't on it yet, and the Medicaid State Plan personal care that could be authorized would come to under $241 a month (the SPED policy manual's threshold in its July 1, 2026 revision)., Family Home Care adds its own rule, though. If your relative receives or would be eligible for Medicaid and meets level of care screening, Family Personal Care must be sought instead of Family Home Care. Family Personal Care is the service through which live-in relatives are paid under North Dakota's Medicaid HCBS waiver. Our North Dakota Family Personal Care guide explains how that service pays a live-in relative, and our North Dakota spouse caregiver guide covers the spouse rules.

There are openings. If Family Personal Care would be detrimental to your household and Family Home Care is preferred, North Dakota's SPED policy manual says to contact the Program Administrator for consideration. Family Personal Care also doesn't have to be sought if your relative's Medicaid was closed for not meeting recipient liability, or it's clear they wouldn't meet it. And if care is needed right away, SPED services can be authorized while Medicaid eligibility is decided.

SPED or Expanded SPED: Which One Fits?

SPED Expanded SPED
Medicaid Not every applicant must apply Must have applied for and been found eligible for Medicaid
Who 65 and older, or disabled 65 and older, or 18 and older and disabled or blind
Need Impairments in 2 ADLs or 4 IADLs Not severely impaired in toileting, transferring or eating, and either impaired in 3 of 4 IADLs (meals, housework, medicine, laundry) or has health, welfare or safety needs, such as supervision
Money $50,000 liquid assets (2026); sliding fee Income no higher than the SSI cash benefit
Family Home Care provider Spouse or listed relative, living together Spouse or listed relative, living together and enrolled as a QSP

Expanded SPED is the North Dakota SPED version for people already receiving Medicaid, and it pays for in-home and community-based services for people who would otherwise receive care in a licensed basic care facility.,, An Expanded SPED recipient must receive Supplemental Security Income (SSI) or have income no higher than SSI, and money paid from North Dakota general funds for Expanded SPED services is subject to estate recovery by law. See North Dakota Medicaid estate recovery.

Living With Family Home Care Day to Day

Your relative must have a daily personal care or supervision need that you meet. Chores like laundry, shopping and housekeeping count only when they benefit your relative, and SPED Family Home Care isn't meant mainly for housework. You can be authorized to give medications even if your relative can't direct them.

North Dakota law doesn't require a Family Home Care provider to be home 24 hours a day if your relative's welfare and safety are maintained, so a part-time job can work if your relative can be left alone for routine stretches and agrees to it. A Family Home Care provider can't hire someone to cover routine absences, and can't work full time (30 or more hours a week) unless an HCBS Program Administrator approves it.

If your relative can't be safely left alone, respite care must be authorized, because you can't hand their care to someone else. Under the North Dakota SPED rule, respite may be provided when your relative has a full-time primary caregiver, needs a qualified caregiver while you're away (or an unqualified one would be inappropriate), your need for relief is intermittent or occasional, and that need isn't because of your job or school. If you routinely give less than round-the-clock care, respite covers only absences outside your routine schedule. Our North Dakota respite care guide covers other ways to get a break.

If you're on Medicaid yourself, all income available to you, including Family Home Care pay, is counted under Medicaid rules. Family Home Care given out of state needs prior approval from the HCBS Program Administrator.

Is Family Home Care Pay Taxable?

IRS Notice 2014-7 lets a live-in caregiver exclude certain payments from income, but the notice is about payments under a state Medicaid 1915(c) waiver program. SPED Family Home Care is state-funded, so don't assume the exclusion covers it; ask a tax professional. See whether Medicaid waiver payments are taxable.

How to Apply, Step by Step

1
Step 1

Call the Aging and Disability Resource-LINK

To apply for home and community-based services funded through North Dakota Health and Human Services, the department says to call this line, toll free at 1-855-462-5465.

2
Step 2

Expect the Medicaid question

Other federal and third-party funding is sought first, so the case manager will ask whether Medicaid and Family Personal Care fit.,

3
Step 3

Plan the care

The HCBS case manager completes the plan of care and the service agreement that sets your paid hours. Say you want to be the paid caregiver.

4
Step 4

Sign the SFN 1654 agreement

The SFN 1654 live-in service agreement is required for every Family Home Care provider, and under Expanded SPED you must also enroll as a QSP.,

Frequently Asked Questions

What happens to Family Home Care if my mother goes onto Medicaid later?

Family Home Care is available under both North Dakota SPED and Expanded SPED, and Expanded SPED is for people receiving Medicaid whose income is no higher than SSI. Under Expanded SPED, you'd also need to enroll as a QSP. But if your mother meets level of care screening, the state's rules say Family Personal Care must be sought instead, so tell the case manager when her Medicaid status changes.,

Can I be paid if my father doesn't live with me?

Not through North Dakota SPED Family Home Care, which requires living together on a twenty-four-hour basis. Our guide to getting paid as a family caregiver in North Dakota covers the other routes.

Does SPED have a waiting list?

North Dakota SPED runs from a program pool: an adult must be entered in the SPED program pool before service payments can be authorized. Ask the Resource-LINK how long placement is taking.

Learn More

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. CaregiverHow to Get Paid to Care for Your Spouse in North DakotaNorth Dakota's Medicaid waiver lets a spouse be the paid Family Personal Care provider if you live in the same home. Here is how to qualify, plus VA routes. CaregiverCaregiver Programs in North Dakota: A Complete DirectoryNorth Dakota caregiver programs that pay a spouse or relative, live-in or not: Family Personal Care, SPED, free NFCSP respite, VA stipends and tax rules. MedicaidHow North Dakota Medicaid HCBS Waivers WorkNorth Dakota Medicaid HCBS waivers pay for home and community care instead of a nursing home. See who qualifies, what's covered, and how to apply in 2026. CaregiverNorth Dakota Family Personal Care: How a Live-In Spouse or Relative Gets PaidNorth Dakota Family Personal Care pays a live-in spouse or relative enrolled as a QSP. See who qualifies, which tasks count, and the 3- and 10-hour rules. Care TypesPaying for assisted living in North DakotaHow to pay for assisted living in North Dakota: SPED pays personal care, not room and board, with a $50,000 asset limit, plus basic care and Medicaid rules.

Find personalized help getting paid through North Dakota's SPED Family Home Care 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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