Get Paid to Care for Your Elderly Parent in North Dakota
North Dakota pays family caregivers through its Medicaid HCBS Waiver and State Plan Personal Care, but the caregiver must enroll as a Qualified Service Provider (QSP); these programs are provider-choice rather than fully self-directed. A co-residing adult child can be paid, and under the waiver even a spouse may qualify as a Family Personal Care provider.
This guide covers what North Dakota family caregivers need to know: the program structure, pay rates, who can be paid, eligibility, how to apply, and other programs that may supplement your income.
North Dakota pays family caregivers $13–$20 per hour through the Medicaid HCBS Waiver and State Plan Personal Care via Qualified Service Provider (QSP) option within the North Dakota Medicaid Home and Community Based Services (HCBS) Waiver. Your parent must meet a nursing-facility level of care but prefer to remain at home.
North Dakota's Main Program: Medicaid HCBS Waiver and State Plan Personal Care via Qualified Service Provider (QSP)
Medicaid HCBS Waiver and State Plan Personal Care via Qualified Service Provider (QSP) is a self-directed option within North Dakota's North Dakota Medicaid Home and Community Based Services (HCBS) Waiver, which provides home and community-based care for seniors and adults with disabilities who meet a nursing-facility level of need. Under self-direction, your parent (or you as their authorized representative) can hire, train, schedule, and supervise the personal-care attendant — and that attendant can be you, an adult child.
What the Program Pays For
Authorized self-directed services typically include:
- Personal care: bathing, grooming, dressing, oral hygiene
- Toileting assistance and incontinence care
- Mobility help: transferring, positioning, ambulation support
- Meal preparation and feeding assistance
- Light housekeeping directly related to health and safety
- Medication reminders (not administration, which requires a nurse)
- Supervision for individuals with cognitive impairment, including dementia
Pay Rates Across North Dakota
| Region | Typical Hourly Rate | Notes |
|---|---|---|
| Fargo / Cass County | $14–$20/hr | Largest QSP and agency network in the state |
| Bismarck / Central ND | $13–$19/hr | State HHS hub; Aging Services and waiver coordination |
| Rural / Western ND | $13–$18/hr | QSP model lets co-residing relatives provide care where agencies are scarce |
Rates are set within the participant's approved plan-of-care budget and the state's limits; the figures above are typical ranges, not guarantees.
Who Can Be Paid
Under the HCBS Waiver a co-residing spouse, adult child, or adult grandchild can be paid as a Family Personal Care QSP, but under State Plan Personal Care a spouse or legal guardian is excluded. Always confirm the current rules with North Dakota Department of Health and Human Services (HHS) - Medical Services Division before you count on a specific arrangement.
Eligibility Requirements
Your Parent Must:
- Be enrolled in full North Dakota Medicaid (not just a savings program)
- Meet the clinical criteria for a nursing-facility level of care
- Be enrolled in the North Dakota Medicaid Home and Community Based Services (HCBS) Waiver (or its self-directed option)
- Live in North Dakota in a community setting (not a nursing home)
- Be able to direct their own care, or have a legal/authorized representative who can
You (the Caregiver) Must:
- Be 18 years of age or older
- Meet the program's relationship rules (see above)
- Pass a criminal background check and registry search
- Complete any required caregiver orientation and training
- Be legally authorized to work in the United States
- Submit timesheets through a Qualified Service Provider (QSP) enrollment process
How to Apply: Step-by-Step
- Apply for North Dakota Medicaid. Apply online at www.applyforhelp.nd.gov or call 1-844-854-4825. Your parent must meet income and asset limits.
- Request a long-term-services assessment. Contact your local Medicaid or aging office to request a comprehensive functional assessment that determines whether your parent qualifies for the North Dakota Medicaid Home and Community Based Services (HCBS) Waiver.
- Enroll in the waiver. Once deemed eligible, your parent is enrolled in the North Dakota Medicaid Home and Community Based Services (HCBS) Waiver and assigned a case manager or care coordinator.
- Request the self-directed (HCBS / QSP) option. During care planning, ask specifically for the consumer/self-directed service model and state that you, the adult child, want to be the hired caregiver.
- Enroll with a Qualified Service Provider (QSP) enrollment process. Complete enrollment paperwork — W-4, I-9, and background authorization — so payroll, tax withholding, and timesheets are handled for you.
- Complete orientation. Finish any state-required caregiver orientation covering personal-care techniques, emergency procedures, and reporting.
- Begin care and submit timesheets. Provide care per the authorized plan and submit electronic timesheets; payroll is processed on a regular cycle with taxes withheld.
Check Your Parent's Eligibility
Our free Benefits Checker helps identify whether your parent qualifies for North Dakota's caregiver-pay programs and other benefits.
Check Eligibility NowOther Programs That May Pay North Dakota Family Caregivers
VA Veteran-Directed Care & PCAFC
If your parent is a veteran enrolled in VA healthcare, the Veteran-Directed Care program provides a monthly budget that can pay family caregivers, and the Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers a monthly stipend for eligible primary caregivers. Contact the caregiver support coordinator at your parent's VA medical center or call 1-855-260-3274.
Personal Care Agreement (Private Pay)
If your parent does not qualify for Medicaid, a formal written Personal Care Agreement lets them pay you from their own funds at fair-market rates. Drafted with an elder-law attorney, it must be prospective and reasonable — and it keeps payments from being treated as "gifts" during the Medicaid 5-year look-back.
State Respite & Caregiver Support
Through the National Family Caregiver Support Program, North Dakota's Area Agencies on Aging fund respite, training, and counseling. These rarely pay ongoing wages but reduce your out-of-pocket costs. Find your local agency through the Eldercare Locator (1-800-677-1116) or 1-855-462-5465.
Tax Implications for Family Caregivers
- W-2 wages: The financial management agency issues you a W-2; federal income tax, Social Security, and Medicare are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent (the Medicaid waiver participant), your self-directed wages may be excludable from federal gross income. Consult a CPA before filing — see IRS guidance on Medicaid waiver payments.
- Earned Income Tax Credit: These wages count as earned income and may qualify you for the EITC.
Maintain daily logs of services provided — date, time in, time out, and a brief description. Medicaid audits self-directed arrangements, and accurate records protect both you and your parent.
What North Dakota Caregivers Are Actually Earning
At 30 hours per week and about $16 per hour, you would earn roughly $2,080 per month. At 40 hours per week and $20 per hour, earnings reach about $3,466 per month — around $41,600 per year before taxes.
For comparison, a nursing home costs far more per year, and agency home care runs roughly $30–$40 per hour. A self-directed arrangement lets your parent receive care from someone they trust, while you earn income that partially replaces what you may have given up to provide care.
Contact Information
- North Dakota Department of Health and Human Services (HHS) - Medical Services Division: www.hhs.nd.gov/healthcare/medicaid | 1-844-854-4825
- Apply for Medicaid: www.applyforhelp.nd.gov
- State aging services: www.hhs.nd.gov/adults-and-aging | 1-855-462-5465
- Eldercare Locator (find local help): eldercare.acl.gov | 1-800-677-1116
- Medicaid (federal): medicaid.gov
Frequently Asked Questions
Family caregivers enrolled as QSPs in North Dakota generally earn roughly $13 to $20 per hour, with rates set by the state's HCBS rate methodology. Exact pay varies by service type and is paid through ND Medicaid after QSP enrollment.
A Qualified Service Provider (QSP) is an individual or agency enrolled with North Dakota HHS to deliver paid in-home care under Medicaid HCBS and State Plan Personal Care. A relative can become an individual QSP, must be at least 18, and meet provider standards.
It depends on the program. Under the HCBS Waiver's Family Personal Care, a co-residing spouse, adult child, or adult grandchild can be paid, but under State Plan Personal Care a spouse or legal guardian is excluded. An adult child can generally be paid under either pathway.
The North Dakota Medicaid Home and Community Based Services (HCBS) Waiver, along with the State Plan Personal Care benefit, lets family caregivers get paid once they enroll as a Qualified Service Provider (QSP).
Apply for Medicaid online at applyforhelp.nd.gov or call ND HHS at 1-844-854-4825. To become a paid caregiver, enroll as a QSP through Noridian at 701-277-6933 and contact the Aging and Disability Resource LINK at 1-855-462-5465.
Yes. A parent with dementia who qualifies for Medicaid HCBS can receive care from an adult child who enrolls as a QSP. The parent must meet Medicaid financial limits and the functional/level-of-care criteria.
Related Guides
- How to Get Paid to Care for Your Parent (National Overview)
- How to Apply for Medicaid for an Elderly Parent
- Caregiver Tax Deductions 2026
- VA Benefits for Elderly Parents
- Power of Attorney for an Elderly Parent
- Medicaid Spend-Down Rules
This guide is general information, not legal or financial advice. Program names, pay rates, and eligibility rules change and vary by county — confirm details with North Dakota Department of Health and Human Services (HHS) - Medical Services Division. Sources: www.hhs.nd.gov · www.hhs.nd.gov.