Page Reviewed / Updated – May 18, 2023

Program Description

The North Dakota Department of Human Services offers a program called Service Payments for the Elderly and Disabled, abbreviated as SPED. This program has two levels, which provide similar services, but have differing eligibility requirements. These levels are referred to as regular SPED and Expanded SPED, or Ex-SPED. SPED is intended for individuals who are more functionally impaired than those enrolled in Ex-SPED.

Both programs provide a range of services intended to help senior and disabled individuals remain living at home or in their community. Although assisted living services are not among the included benefits, adult foster care, which provides a similar level of care to assisted living, just in a more intimate environment, is included. Both programs also allow for consumer direction of services. For clarification purposes, this means that individuals receiving care services have the right and the flexibility to choose their own service providers (assuming they meet the ND Department of Human Services standards).

Certain family members, usually adult children, can be hired as service providers and paid for their caregiving efforts. However, caregivers must live with the care recipient. Unlike many states that allow consumer direction, participants in the SPED and Ex-SPED programs are even able to hire their spouse to provide care. 

In addition to adult foster care and home care, the major benefits of this program include Personal Emergency Response Services (also called Medical Alert services), chore services, respite care, and minor modifications to the home to preserve the resident’s independence.

Eligibility Guidelines

Applicants for SPED and Ex-SPED must be at least 18 years of age and legal residents of North Dakota. Services are not provided to individuals in Medicaid-funded nursing homes. Therefore, program participants must either live at home or in adult foster care.

Other eligibility requirements for SPED and Ex-SPED vary slightly as follows:

Functional Requirements


Functionally, SPED applicants must have challenges completing at least two of their Activities of Daily Living (bathing, getting dressed, mobility, eating, etc.) without assistance OR four Instrumental Activities of Daily Living (shopping for essentials, managing finances, housework, etc.). In addition, these challenges must have been occurring for at least three months or be expected to last a minimum of three months.


Functionally, Ex-SPED applicants must have challenges completing at least three of four of the following instrumental activities of daily living: housecleaning, laundry, preparing meals, or administering medications; OR they must need supervision due to health, safety, or welfare issues. 

Must not have significant issues with their activities of daily living. 

Financial Requirements


Financially, the applicant’s monthly income is not considered in absolute terms. Rather, the applicant must have an inability to pay for their care. That being said, there may be a service fee, also called a cost share for services, which is determined based on one’s income. However, certain medical expenses, such as prescription drugs and health care premiums, can be deducted from one’s income, effectively lowering one’s income, and therefore, the cost of share.

Assets, however, are considered in fixed terms. As of 2023, applicants for SPED are limited to a maximum of $50,000 in liquid assets, which includes checking and savings accounts, stocks, certificates of deposit, etc. When calculating the value of assets, one should not include the value of their home, as this is considered an exempt asset.


Must be on Medicaid, and must be receiving Social Security Income (SSI) or have income that is at or below the SSI level. Currently, the SSI level for 2023 is $914.

Benefits and Services

The services available are the same whether the beneficiary is approved for SPED or Ex-SPED, with the exception of personal care, which is only available for SPED enrollees. However, make note, the reason personal care services are available to SPED participants is that they must be eligible for the Medicaid state plan as a program requirement. Therefore, personal care services are available via Medicaid for those enrolled in SPED.

Financial obligations between the programs may differ. Ex-SPED beneficiaries have the complete cost of services covered, while SPED beneficiaries may be charged a service fee. However, the fee for services is minor when compared to purchasing these same services from private elder care service providers. Services covered by these programs include:

  • Adult Day Care
  • Adult Foster Care
  • Assistance with Chores (such as removal of snow)
  • Family Home Care (payments to family members for caregiving)
  • Homemaker Services (assistance with in-home, non-care related chores, such as light cleaning and preparation of meals)
  • Home Modifications (minor changes to improve home access and safety, such as installation of grab bars)
  • Personal Care (SPED only – assistance with bathing, toiletry, etc.)
  • Personal Emergency Response System (medical alert)
  • Respite Care
  • Transportation Assistance (for non-medical purposes only)
  • Case Management

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How to Apply / Learn More

These programs are available statewide. To learn more or begin the application process, there are several paths. One can contact their local county human service zone, visit the Aging and Disability Resource webpage, or call the toll-free number at 855-462-5465. 

One may also find additional information about SPED and Ex-SPED here.