Can I get paid to care for my spouse in North Dakota?
Yes — North Dakota lets a spouse be paid.
North Dakota is one of the states where the person who needs care can hire their own husband or wife and have the program pay for it. You do the caring you are already doing. The state pays you for it.
What has to be true
- Your spouse lives in North Dakota and needs long-term care help at home.
- Your spouse has Medicaid, or can qualify. We check that with you for free.
- You pass a background check. No license or certificate is needed.
- The care your spouse needs is written into their plan — that is what the hours are paid against.
What North Dakota pays family caregivers
$21.76/hr
Your exact pay is set by the program and your care plan. We'll tell you your real number before you enroll.
Source: North Dakota Medicaid program data · Updated September 2026
What North Dakota's rule actually says
yes — HCBS waiver Family Personal Care pays a spouse, adult child, or adult grandchild who lives with the participant; spouses and legal guardians are excluded from MSP-PC; pilot also covers spouses as LRIs
The programs this runs through in North Dakota: HCBS Waiver — Family Personal Care, Qualified Service Provider (QSP), Family Paid Caregiver Pilot (children). Who runs them: North Dakota Health and Human Services, Aging Services Division; Aging and Disability Resource Link 1-855-462-5465
137,800 people in North Dakota are 65 or older. Most of them are cared for at home, by a relative — usually without being paid for it.
How to start in North Dakota
Apply for the HCBS waiver online or through your local Human Service Zone office; the pilot is applied for through the Family Paid Caregiver Portal (familycaregiver.hhs.nd.gov).
no home-care agency, but the family caregiver must enroll as a Qualified Service Provider (QSP) with ND HHS; the waiver has no fully self-directed option
See if you qualify →Spouse questions in North Dakota, answered
Can I get paid to care for my husband or wife in North Dakota?
Yes. North Dakota allows it. The published rule: yes — HCBS waiver Family Personal Care pays a spouse, adult child, or adult grandchild who lives with the participant; spouses and legal guardians are excluded from MSP-PC; pilot also covers spouses as LRIs
Why do some states allow this and others don't?
Medicaid has long treated care between spouses as a family duty rather than paid work. Self-directed programs changed that in many states by making the person who needs care the employer — they choose their own worker, and in some states that can be a spouse. It is a state-by-state policy choice, not a federal rule.
How much would I earn in North Dakota?
Reported pay in North Dakota runs around $21.76/hr, though your exact rate is set by the program and the care plan.
Does my spouse need Medicaid first?
Yes. These are Medicaid programs, so your spouse has to qualify for North Dakota Medicaid and need long-term care help. Many families assume they earn too much and never apply. The rules for long-term care are not the same as regular Medicaid — check before you rule yourself out.
Is there a waitlist in North Dakota?
HCBS waiver is not an entitlement (~930 slots/yr) and a waitlist forms when full; pilot is capacity-limited (reported 75 families enrolled of 550+ applicants)
How do we start?
Apply for the HCBS waiver online or through your local Human Service Zone office; the pilot is applied for through the Family Paid Caregiver Portal (familycaregiver.hhs.nd.gov).
Sources: medicaidplanningassistance.org · hhs.nd.gov · hhs.nd.gov · Updated September 2026. Rules change — always confirm with the program.
Where most North Dakota caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in North Dakota — pick yours for the local picture.
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