North Dakota home care programs

Home health: the medical benefit

In North Dakota, skilled home health is Home Health Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with North Dakota Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In North Dakota the agency route is Medicaid State Plan - Personal Care Services (MSP-PC). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. Medicaid State Plan - Personal Care Services (MSP-PC) lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

North Dakota does not run a separate consumer-directed program. Personal care comes through agencies (Medicaid State Plan - Personal Care Services (MSP-PC)) and waiver providers (Medicaid Waiver for Home and Community Based Services, Medicaid Waiver for Medically Fragile Children, and Traditional IID/DD Home and Community Based Services Waiver), which employ the aides.

Structured family caregiving: a paid live-in family caregiver

North Dakota offers structured family caregiving through Family Personal Care (FPC). A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways North Dakota pays for care at home

Waiver in-home services: Medicaid Waiver for Home and Community Based Services, Medicaid Waiver for Medically Fragile Children, and Traditional IID/DD Home and Community Based Services Waiver. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Expanded Service Payments for the Elderly and Disabled (ExSPED), Family Home Care (FHC), and Service Payments for the Elderly and Disabled (SPED). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services).
• Needs daily help and wants an agency to supply and manage the aide: Medicaid State Plan - Personal Care Services (MSP-PC).
• Lives with a family member who provides care most of the day: Family Personal Care (FPC).
• Meets nursing-home level of care and needs more than personal care: Medicaid Waiver for Home and Community Based Services, Medicaid Waiver for Medically Fragile Children, and Traditional IID/DD Home and Community Based Services Waiver.