Paid Family Caregiver Program in North Dakota for Disability

A Program That Pays Parents for Care They're Already Providing

North Dakota launched the Family Paid Caregiver pilot on April 1, 2024, creating a path for parents and spouses to receive financial reimbursement for providing extraordinary care to a family member with developmental disabilities. Before this program, "legally responsible individuals" — parents of minors, spouses — were categorically excluded from reimbursement under most Medicaid waiver service models.

For families who've been providing round-the-clock care without compensation while facing provider shortages across the state, this pilot changes the economics of caregiving.

Who Qualifies

Two requirements must be met simultaneously:

The care recipient must be actively enrolled in an eligible Section 1915(c) Home and Community-Based Services waiver. The qualifying waivers include the Traditional IID/DD HCBS Waiver (Waiver 0037) and the Autism Spectrum Disorder Waiver. If your young adult isn't enrolled in a waiver yet, the first step is contacting your regional Human Service Center to initiate the eligibility process for the Traditional IID/DD Waiver.

The caregiver must be a "legally responsible individual" — a parent of a minor child or a spouse — who provides care that meets the extraordinary care standard. This means the care recipient's needs must exceed typical developmental expectations, requiring intensive physical, medical, or behavioral interventions that go beyond what any parent or spouse would ordinarily provide.

The distinction matters: helping a 20-year-old with meal preparation isn't extraordinary care, but managing complex medication schedules, providing physical repositioning throughout the night, or implementing behavioral crisis protocols that require specialized training are examples of the intensive support the extraordinary-care assessment evaluates.

Reimbursement Rates

The pilot uses a dual rate structure based on the care recipient's age:

• Child under 18: $77.45 per day
• Adult 18 or older: $154.89 per day

The higher adult rate reflects the increased caregiving demands once school-based services and therapies end. For a family providing daily extraordinary care to an adult, the monthly reimbursement can reach roughly $4,647 — a meaningful offset against the income a parent may have given up to provide full-time care.

Why This Matters at the Turning-18 Transition

The shift from school-aged services to adult waiver services creates a predictable gap. During the school year, your child receives therapies, behavioral support, and structured programming through their IEP. After aging out or graduating, those services end. The adult waiver may be approved, but finding an actual provider — especially in rural areas or counties affected by Cass and Burleigh's Qualified Service Provider moratorium — can take months.

During that gap, you're the provider. The Family Paid Caregiver pilot can allow eligible caregivers to be compensated for that role instead of absorbing the full cost of care with no income replacement.

How to Apply

The pilot is administered through the developmental disabilities waiver infrastructure. The practical steps:

1. Confirm active waiver enrollment through your regional DD unit
2. Request an extraordinary care assessment — this evaluates whether the care needs meet the pilot's threshold
3. Complete the caregiver agreement paperwork through your regional Human Service Center
4. Begin documenting care hours and services provided

Because the pilot runs through the waiver system, your existing DD Program Manager is the primary contact. If your family is still working through the guardianship and benefits setup at 18, you can pursue the caregiver pilot in parallel — the two processes are independent.

Connecting the Legal and Financial Pieces

The Family Paid Caregiver pilot is one piece of a larger financial picture at 18. Your young adult may also qualify for SSI benefits ($994/month in 2026), ABLE account savings, and Disabled Adult Child benefits if a parent is retired, disabled, or deceased. Meanwhile, the legal decision-making framework — whether that's Supported Decision-Making, powers of attorney, or guardianship — determines who can sign the caregiver agreement and manage the reimbursement funds.

The North Dakota Adult Guardianship & Alternatives Guide maps how these financial programs and legal arrangements intersect, with a timeline showing when to apply for each one relative to your child's 18th birthday.

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