How to Pay for Home Care in North Dakota

Introduction

Paying for home care can be confusing because different types of care follow different payment rules.

Some families pay privately. Some people may qualify for Medicaid or a North Dakota state program. Some may receive limited support through aging services or other community programs. Medicare and most regular health insurance plans usually do not pay for ongoing non-medical long-term care, especially when the main need is help with daily activities such as bathing, dressing, meals, transportation, or homemaking.

This guide explains common ways to pay for home care in North Dakota, including private pay, Medicaid personal care, Home and Community-Based Services, SPED, Ex-SPED, Older Americans Act services, and where to start when you are not sure which path applies.

First, Know What Kind of Care You Are Trying to Pay For

Before looking at payment options, it helps to understand the difference between home care and home health.

Home care usually means non-medical help with daily life. This may include support with personal care, meals, light housekeeping, supervision, errands, transportation, companionship, or routines that help someone remain at home.

Home health usually means skilled medical care at home. This may include services such as skilled nursing, therapy, wound care, or other clinical services ordered by a healthcare provider.

This difference matters because payment rules are not the same. Medicare may cover certain skilled home health services when a person meets Medicare’s rules. That does not mean Medicare will pay for ongoing non-medical home care.

ND Home Health currently provides non-medical home support services only. This article focuses mainly on paying for non-medical home care and home support in North Dakota.

Common Ways to Pay for Home Care in North Dakota

Families usually pay for home care through one or more of these options:

Private pay may help cover flexible non-medical support at home. This is usually paid out of pocket by the client, family, or another private source.

Long-term care insurance may reimburse some home care services, depending on the policy.

Medicare or regular health insurance may cover certain skilled home health services when eligibility rules are met. These plans usually do not cover ongoing non-medical long-term care.

Medicaid State Plan Personal Care Services may help eligible people with daily living activities, but eligibility, assessment, and authorization are required.

The Medicaid Waiver for Home and Community-Based Services may help eligible people receive services at home or in the community instead of in a nursing facility.

SPED may provide services for older adults or people with physical disabilities who need help living independently at home.

Ex-SPED may help pay for in-home and community-based services for people who would otherwise receive care in a licensed basic care facility.

Older Americans Act services may include supports such as meals, transportation, health maintenance, and other services that help older adults remain independent.

The right option depends on the person’s care needs, income and assets, Medicaid status, functional limitations, program rules, provider availability, and whether services are approved.

1. Private Pay Home Care

Private pay means the person, family, or another private source pays directly for care.

For many families, private pay is the most straightforward way to begin non-medical home care because it does not usually require waiting for Medicaid approval, a state program assessment, or payer authorization. It may also give families more flexibility when they need help quickly, need extra hours, or want support that a public program does not cover.

Private pay may be a fit when:

• Care is needed soon
• The person does not qualify for Medicaid or a state-funded program
• The family wants support while waiting for a program decision
• The person needs help with homemaking, meals, errands, transportation, supervision, companionship, or daily routines
• The family wants more help than a program authorizes
• The person’s needs are real but do not meet the rules for a covered benefit

Private pay is also common when an adult child is helping arrange support for a parent who wants to stay at home but does not yet need facility-level care.

The main limitation is cost. Families should ask each provider clear questions before starting services:

• What services are included?
• What services are not included?
• Is there a minimum visit length?
• How does scheduling work?
• Are evenings, weekends, or short visits available?
• What happens if a caregiver is unavailable?
• Are transportation, errands, or mileage billed separately?
• Can services change if needs increase?

Private pay does not mean the family has to make every decision alone. It simply means payment is not being handled through Medicaid, Medicare, or another payer.

2. Long-Term Care Insurance

A regular health insurance plan is not the same thing as long-term care insurance.

Some people have a separate long-term care insurance policy that may reimburse certain types of home care. Whether it helps depends on the policy language. Families should review the policy before assuming home care will be covered.

Important questions include:

• What conditions must be met before benefits begin?
• Is there an elimination period?
• Which activities of daily living must the person need help with?
• Does the policy cover non-medical home care?
• Does the provider need to meet certain licensing or credential requirements?
• Are family caregivers covered, or only agency providers?
• Is there a daily, weekly, monthly, or lifetime benefit limit?
• What documentation is required for reimbursement?

Long-term care insurance can be helpful, but it is not automatic. The insurance company decides whether the policy requirements are met.

3. Medicare and Regular Health Insurance

Many families start by asking, “Will insurance pay for home care?”

For ongoing non-medical home care, the answer is often no.

Medicare may cover certain home health services when a person is eligible. Medicare-covered home health services may include medically necessary part-time or intermittent skilled nursing care, certain therapy services, medical social services, medical supplies, and part-time or intermittent home health aide care only when the person is also receiving skilled care at the same time.

Medicare does not usually pay for 24-hour-a-day care at home, home meal delivery, homemaker services such as shopping and cleaning when they are unrelated to the care plan, or custodial or personal care when that is the only care needed.

This is where many families get stuck.

A person may need real help at home, but that does not automatically mean Medicare or health insurance will pay for it. Help with bathing, dressing, toileting, meals, supervision, housekeeping, transportation, or companionship is often considered non-medical long-term support.

That does not mean the person has no options. It means the family may need to look at private pay, Medicaid, North Dakota home and community-based programs, long-term care insurance, or local aging resources.

4. Medicaid and Medicaid-Funded Home Care Options

Medicaid may help pay for certain home care or personal care services in North Dakota if the person qualifies and the services are approved.

In North Dakota, several programs may be relevant for older adults, people with physical disabilities, and people who need help staying at home or in the community.

5. Home and Community-Based Services in North Dakota

Home and Community-Based Services are often called HCBS.

HCBS may help older adults and people with physical disabilities receive support at home or in the community instead of in an institution when possible.

HCBS is not one single service. It is a group of programs and service pathways. Some are Medicaid-related. Some are state-funded or federally supported. Some help with personal care. Others may help with meals, transportation, health maintenance, or other supports.

Service Payments for the Elderly and Disabled, SPED

The Service Payments for the Elderly and Disabled Program, usually called SPED, provides services for people who are older or physically disabled and who have difficulty completing tasks that help them live independently at home.

In plain English, SPED may be relevant when a person needs support to remain at home but may not fit neatly into another payment path. Families should not assume eligibility. They should ask North Dakota Health and Human Services or the Aging and Disability Resource Link whether SPED is appropriate for the person’s situation.

Expanded Service Payments for the Elderly and Disabled, Ex-SPED

The Expanded Service Payments for the Elderly and Disabled Program, usually called Ex-SPED, pays for in-home and community-based services for people who would otherwise receive care in a licensed basic care facility.

This program is different from SPED. The “expanded” part matters because it is tied to a higher level of need. Families should ask about Ex-SPED when a person’s needs are increasing and facility placement is being discussed or considered.

Medicaid State Plan Personal Care Services

Medicaid State Plan Personal Care Services helps people with daily living activities so they can continue living in their homes and communities.

Examples may include help with:

• Bathing
• Dressing
• Toileting
• Transferring
• Meal preparation
• Laundry
• Housework

This is one of the most relevant payment paths for families asking about hands-on help with daily routines.

A person must qualify, and services must be authorized. Families should ask what assessment is required, what services can be approved, how many hours or units may be authorized, and whether the preferred provider can deliver the authorized service.

Medicaid Waiver for Home and Community-Based Services

The Medicaid Waiver for Home and Community-Based Services allows North Dakota to use Medicaid funds to provide services that help eligible people who would otherwise require nursing home services remain in their homes or communities.

This option may be relevant when someone has significant care needs and wants to remain at home instead of moving to a nursing facility.

A waiver is not the same thing as general Medicaid coverage. It has its own eligibility rules, assessment process, and service authorization requirements.

Older Americans Act Services

Older Americans Act Services can include health maintenance, home-delivered meals, transportation, and other supports that help older adults maintain independence and remain in their homes and communities.

These services may not replace home care, but they can reduce pressure on families. For example, transportation or meal support may help a person remain safer at home while the family works through a longer-term care plan.

Where to Start If You Are Unsure Which Program Applies

If you are just beginning, do not start by memorizing program names. Start with the person’s needs.

Write down what help is needed on a normal day:

• Bathing
• Dressing
• Toileting
• Transferring
• Meal preparation
• Medication reminders
• Light housekeeping
• Laundry
• Transportation
• Grocery shopping
• Supervision
• Companionship
• Fall risk concerns
• Caregiver burnout
• Memory-related concerns
• Recent hospitalization or rehab stay

Then ask two questions:

1. Is this mainly non-medical daily support, or skilled medical care?
2. Does the person need help now, or is the family mainly exploring future options?

If the need is non-medical support and the family can pay privately, private pay may be the simplest starting point.

If the person may qualify for Medicaid, SPED, Ex-SPED, HCBS, or other North Dakota programs, contact the appropriate state resource early.

The North Dakota Aging and Disability Resource Link, also called ADRL, can help connect people to services that support independence and quality of life. Families can also use North Dakota CareChoice to search for resources such as in-home assistance, caregivers, respite care, financial assistance, food, transportation, and healthcare.

For home and community-based services funded through North Dakota Health and Human Services, families can contact Adult and Aging Services or the Aging and Disability Resource Link.

How to Apply for Medicaid in North Dakota

If Medicaid may be part of the payment plan, North Dakota Health and Human Services gives several ways to apply.

People can apply online through the state self-service portal. They can also apply on paper by completing the appropriate form and returning it to a human service zone office.

For people who are aged, blind, or disabled and only want Medicaid coverage, Medicare Savings Programs, or coverage in a basic care facility, North Dakota Health and Human Services lists a Health Care Application for the Elderly and Disabled.

Families should keep copies of applications, notices, assessments, and authorizations. These documents can affect which services are approved and which providers can help.

Questions to Ask Before Assuming Home Care Is Covered

Before starting services or assuming a program will pay, ask direct questions.

For Medicaid, HCBS, SPED, Ex-SPED, or another program, ask:

• Has the person been found eligible?
• Has a functional assessment been completed?
• Which services are approved?
• How many hours or units are authorized?
• When does the authorization begin and end?
• Is there a waiting period?
• Are there client share, spend-down, or cost-share requirements?
• Which providers can deliver the authorized services?
• Does the family need to choose a provider?
• What happens if needs increase?

For private pay, ask:

• What is the hourly rate?
• Is there a minimum visit length?
• Are there separate charges for mileage, transportation, errands, or supplies?
• Can the schedule change if needs change?
• What notice is required to cancel or adjust visits?
• How are caregiver absences handled?
• What services are outside the provider’s scope?

For insurance or long-term care insurance, ask:

• Is non-medical home care covered?
• What documentation is required?
• Does the provider need to meet certain requirements?
• Is preauthorization needed?
• Is reimbursement paid to the client or directly to the provider?
• Is there an elimination period?
• What is the maximum daily or monthly benefit?

These questions prevent a common problem: assuming that a service is covered before eligibility, authorization, or provider approval is confirmed.

Can Families Combine Payment Options?

Sometimes families use more than one payment path.

For example, a family may private pay for support while waiting for a Medicaid or HCBS assessment. Another family may use authorized program services for certain needs and private pay for extra hours or services that are not covered. Someone with long-term care insurance may use that policy for part of the cost and pay privately for anything not reimbursed.

This can be useful, but it needs to be handled carefully. Families should keep records, understand what each payer requires, and avoid assuming that one approval covers everything.

A practical approach is to separate needs into three categories:

• Needed right away: often private pay, family support, or short-term community support
• May be covered if eligible: Medicaid, HCBS, SPED, Ex-SPED, or Older Americans Act services
• Not usually covered: extra hours, convenience services, homemaking outside a care plan, or non-authorized support

This is not a guarantee of coverage. It is a way to organize the conversation.

How ND Home Health Can Help

ND Home Health can help families talk through the type of non-medical support they are looking for and what questions to ask next.

For example, a family may know that a parent needs help, but not know whether to ask for homemaking, companionship, supervision, transportation support, or personal care. They may also be unsure whether to begin with private pay, contact ADRL, apply for Medicaid, or ask about a state program.

ND Home Health can help clarify the care conversation, but ND Home Health cannot guarantee Medicaid approval, state program approval, payer authorization, provider assignment, service availability, or coverage.

If you are not sure where to start, call or text ND Home Health at 701-639-9380. We can talk through the kind of non-medical support you are looking for and help you understand what questions to ask. Program eligibility and coverage decisions are made by the appropriate payer or agency.

Frequently Asked Questions About Paying for Home Care in North Dakota

Does Medicare pay for home care in North Dakota?

Medicare may cover certain home health services if the person meets Medicare’s eligibility rules. These are usually skilled services, such as part-time or intermittent skilled nursing care or therapy services, and the care must meet Medicare requirements.

Medicare usually does not pay for ongoing non-medical home care when the only need is help with daily activities, homemaking, meal delivery, or long-term support.

Does regular health insurance pay for home care?

Most regular health insurance plans do not pay for ongoing non-medical long-term care.

Some insurance plans may cover skilled home health services when specific requirements are met. A separate long-term care insurance policy may help with non-medical home care, but only if the policy covers it and the person meets the policy’s benefit rules.

Does Medicaid pay for home care in North Dakota?

Medicaid may help pay for certain in-home services if the person qualifies and the services are authorized.

In North Dakota, families may hear about Medicaid State Plan Personal Care Services and the Medicaid Waiver for Home and Community-Based Services. These programs are not automatic. Eligibility, assessment, authorization, and provider requirements matter.

What is HCBS in North Dakota?

HCBS stands for Home and Community-Based Services. These services are meant to help eligible older adults and people with physical disabilities receive support at home or in the community instead of in an institution when possible.

What is SPED?

SPED stands for Service Payments for the Elderly and Disabled. SPED provides services for people who are older or physically disabled and who have difficulty completing tasks that help them live independently at home.

What is Ex-SPED?

Ex-SPED stands for Expanded Service Payments for the Elderly and Disabled. Ex-SPED pays for in-home and community-based services for people who would otherwise receive care in a licensed basic care facility.

Where should families start if they need help at home?

Start by writing down what help is needed, whether the need is urgent, and whether the person may qualify for Medicaid or a state program.

For direct assistance contact ND Home Health. We are happy to answer all questions and direct you into the right direction.

For North Dakota program guidance, contact the Aging and Disability Resource Link or search North Dakota CareChoice for resources such as in-home assistance, caregivers, respite care, financial assistance, food, transportation, and healthcare.

The Bottom Line

There is no single way to pay for home care in North Dakota.

Private pay is often the simplest option when a family needs flexible non-medical help. Medicaid and North Dakota home and community-based programs may help if the person qualifies and services are authorized. Medicare and most regular health insurance plans usually do not pay for ongoing non-medical long-term care.

The best first step is to identify the type of help needed, then match that need to the right payment path.

If you are comparing options for yourself or a family member, ND Home Health can help you talk through the kind of non-medical support you are looking for and what questions to ask next.

Call or text ND Home Health at 701-639-9380 to start the conversation.