North Dakota foster home for adults: licensing a live-in home for up to four adults

Where the license threshold falls

Chapter 50-11 of the Century Code defines foster care for adults as food, shelter, security and safety, guidance and comfort provided around the clock in the caregiver’s home to a person 18 or older who is unable, neglects or refuses to provide for their own care ⁠¹. The rule describes the care as personal, nonmedical help with bathing, dressing, toileting, transfers, continence, eating and mobility inside the home ⁠².

The licensing trigger is low. You may not provide foster care to more than one adult, or to more than two adults who are related to each other, without a license ⁠¹. A “foster home for adults” is an occupied private residence where the owner or lessee regularly provides this care to four or fewer adults who are not related to the owner or lessee by blood or marriage, for pay ⁠¹. The law also bars anyone whose license was denied or revoked from providing foster care to even one adult unless HHS later licenses them ⁠¹.

The nearby license types are easy to confuse:

• Agency foster home for adults. This is the same four-or-fewer cap, but care comes from professional staff trained to serve older adults or adults with disabilities, not from a live-in owner ⁠¹. It is a separate model with its own handbook on the HHS QSP page ⁠⁴. The agency pays for its own criminal history checks ⁠¹. HHS’s QSP page says an agency foster home can be licensed only to serve Medicaid-eligible people and cannot accept private-pay residents ⁠⁴.
• Basic care facility. Room and board for five or more unrelated people, with response staff available at all times ⁠⁸. New basic care beds may not be added to the state’s licensed capacity between August 1, 2025 and July 31, 2029, except in limited cases ⁠⁸.
• Assisted living facility. A building with at least five living units serving five or more unrelated people ⁠⁷. See the North Dakota assisted living facility guide.
• Family foster care for children. You may hold both a children’s foster license and an adult foster home license. You may not serve adults and children at the same time without HHS’s prior written approval ⁠².

If you plan to grow past four residents, the foster home license cannot cover it, so plan for one of the facility licenses above.

Who can be the provider

Under N.D. Admin. Code 75-03-21-08, the provider must ⁠²:

• be at least 21 years old;
• live in the home continuously;
• have the physical health to provide care, be free of communicable disease, be emotionally and functionally stable, and not abuse drugs or alcohol;
• be literate and able to understand instructions and communicate in English;
• be an enrolled Qualified Service Provider; and
• pass the criminal background check under N.D.C.C. 50-11-02.4, 50-11-06.8 and 50-11-06.9.

Because the home must be “occupied” by its “owner or lessee” ⁠¹, a renter can qualify. However, the rule requires that a rented home be run free of the landlord’s “influence, control, and direction” ⁠².

Competency. The rule lists 21 caregiving procedures. Among them are infection control and handwashing, handling body fluids, bathing, incontinence care, help with eating, meal planning, help with self-administered medications, help with bill paying, transfers with a gait belt, turning and positioning in bed, and help with walking ⁠². A physician, registered nurse, occupational therapist, physical therapist or another person with a professional degree in a specialized area of care must verify your competence in writing on HHS forms. You show competence by demonstrating the procedure or by explaining it in detail, either verbally or in writing ⁠². The HHS handbook says the form is SFN 750. A current North Dakota CNA certification, or an LPN, RN, PT or OT license, can be used instead ⁠³. The rule also lets a provider meet the developmental disability competency standards instead of the 21 procedures ⁠². You must update competency every 30 months, or when your license or certificate expires ⁠³.

HHS can require a medical exam, a psychological evaluation or a drug and alcohol evaluation when it has reason to believe one is needed ⁠².

Background checks cover your whole household

The check covers anyone who provides care in the home and every adult who lives there but is not a resident ⁠¹. Spouses and adult children living at home are included. The handbook tells you to submit your QSP application first and then email [email protected] to request form SFN 60688, Criminal History Record Check Request ⁠³.

The statewide check is name-based. Fingerprints and a nationwide check are not required for someone who has lived in North Dakota continuously for 11 years (or since turning 18, if that is shorter) or who is on active military duty ⁠¹. The handbook puts it this way: anyone without 11 years in the state needs two sets of fingerprints, and the applicant pays any fingerprinting fee charged by the local agency ⁠³. For a foster home for adults, HHS pays for the criminal history record information itself ⁠¹.

Some convictions bar a person from being the applicant, living in the home or acting as a caregiver. These include homicide, kidnapping, felony simple assault, assault, domestic violence, gross sexual imposition, robbery, arson, endangering or exploiting an eligible adult, and fraudulent insurance acts, among others listed in 75-03-21-09.1 ⁠². For other offenses, HHS decides whether the person is “sufficiently rehabilitated.” Three years after final discharge from probation, parole or prison without a new conviction counts as prima facie evidence of rehabilitation. For certain lesser offenses, HHS may find rehabilitation after five years ⁠². Once you are enrolled, you must report any change in your conviction history to QSP Enrollment within five business days ⁠³.

The house: bedroom sizes and fixtures

Source: ⁠². Any limit on a resident’s ability to lock their door must be justified in the person-centered service plan or the service and rental agreement ⁠².

Cameras. For a resident whose care is paid wholly or partly by the state, an electronic monitoring device in the bedroom or bathroom is prohibited unless it complies with the federal home and community-based services settings rule (42 CFR 441.530) and is documented in the person-centered service plan ⁠². For a private-pay resident, a limited-range monitor is allowed if the resident approves it in writing. If the resident is incapacitated, a family member or legal representative can approve it ⁠¹⁠².

Water, sewage, safety and vehicles

• Location. The home must be served by a community or rural fire department ⁠².
• Water. Water must come from an approved community water system or from a source tested by a certified laboratory and approved by the Department of Environmental Quality. Submit the test report to HHS. A private septic system must meet N.D. Admin. Code chapter 62-03.1-03 ⁠².
• Garbage. Indoor refuse must be removed at least every second day. Outdoor refuse must be kept in rodent-proof containers and disposed of weekly ⁠².
• Pets and firearms. Submit proof of pet vaccinations. Store firearms unloaded in a locked cabinet in an area residents cannot readily reach ⁠².
• Inspections. The heating and electrical systems must be inspected at the time of the initial application ⁠². The handbook calls for a professional inspection report ⁠³. HHS may also require a fire inspection by a local fire inspector or the state fire marshal if it suspects a fire hazard or if you make structural changes ⁠². You must correct deficiencies within 60 days of the inspection report, and you pay the inspection fees and repair costs ⁠².
• Vehicles. Any vehicle that you or a household member drives with residents aboard must carry liability, uninsured motorist and underinsured motorist coverage ⁠². The handbook’s checklist asks for current proof of both home and auto insurance ⁠³.

Applying: QSP enrollment and the license packet

1. Enroll as an individual QSP. Create an account in the QSP Enrollment Portal (an ND Login works) ⁠³⁠⁴. Upload a government ID and direct-deposit proof. Also upload the certificates from the Fraud, Waste and Abuse training and the onboarding orientation, your National Provider Identifier, and SFN 750 or your license or certificate ⁠³. The QSP Hub (701-777-3432, NDQSPHub.org) offers one-on-one help by email, phone or video with enrollment ⁠³.

2. Request background checks. After you submit the application, email [email protected] for SFN 60688. Include every household member over 18 who is not a resident ⁠³.

3. Contact Aging Services to begin licensing. The handbook directs you to the same email address to be connected with an Aging Services program administrator ⁠³.

4. Assemble the licensing packet. The handbook lists these items ⁠³:

   • SFN 1013, Application to Provide Adult Foster Care;
   • SFN 361, Fire Safety Self Declaration;
   • SFN 823, Family Evacuation Disaster Plan;
   • proof that you completed a recent HHS-approved fire prevention and safety course;
   • the heating and electrical inspection report;
   • a floor plan showing escape routes;
   • your draft service and rental agreement;
   • example service logs and menus;
   • three reference letters;
   • proof of home and auto insurance; and
   • pet vaccination records.

   The rule adds a medical-history self-declaration and other items on request ⁠².

5. Home study. Aging Services staff complete SFN 669, the Initial Licensing Study, during a home visit ⁠³. The rule treats the licensing study report as part of a complete application ⁠².

6. Decision. HHS has 60 days from receiving a complete application to grant or deny the license. It can take 45 more days if it notifies you that it needs them ⁠¹⁠². HHS may attach limits or conditions to the license ⁠².

You may not present yourself as an adult foster home before the license is issued ⁠². If the provider or the address changes, you must file a new application immediately ⁠².

The handbook is dated January 2025, before the April 1, 2026 rule amendments, and HHS’s QSP page still lists that January 2025 edition on 2026-10-12 ⁠³⁠⁴. The sources do not say whether the form numbers or checklist changed with the amendments, so ask [email protected] for the current packet before you assemble it.

Statute and rule also allow other paths. On a recognized Indian reservation, HHS may accept an affidavit from the tribal agency instead of its own licensing process. On a military base, it may accept an affidavit from the base agency ⁠².

Running the home day to day

• Supervision. Provide 24-hour care and supervision of every resident unless the person-centered service plan or the service and rental agreement documents and justifies something less ⁠².
• Meals. Serve three meals a day, give residents access to food at any time, and offer choices. No more than 14 hours may pass between the end of the evening meal and breakfast. Meals must be regularly prepared in the home ⁠².
• Access. HHS, the human service zone and others serving a resident may enter without notice. You must report changes in who lives in the home immediately ⁠².
• Money and gifts. You may not take residents’ property as payment. You must document fair market value for anything you buy from a resident ⁠². Gifts worth $25 or more are prohibited, and smaller gifts are limited to two per calendar year ⁠². Notify HHS if you hold or will accept power of attorney for a resident, because HHS may treat it as a conflict of interest. Notify HHS in writing if you are asked to act as representative payee ⁠².
• Records. Keep each resident’s identifying details, contacts and emergency health-care decision-makers. Also record the daily care given and who gave it, reportable events, accidents with injury, and any property transferred to you or your family ⁠².

Relief coverage after April 1, 2026

As the live-in provider, you need approved relief coverage whenever you are away and a resident cannot safely be left alone ⁠². The April 2026 amendments split relief workers by how the resident’s care is paid for:

Source: ⁠¹⁠². A day counts toward the limit only when the relief worker provides more than 12 hours of care that day ⁠¹⁠². The rule prohibits using anyone else to provide services to residents ⁠². If respite for a state-funded resident goes beyond the state funding cap, you may pay a qualified respite provider yourself. You may not charge the resident, and you may not bill the daily rate for days you exceed the permitted absence ⁠². Residents or their legal representatives choose their respite provider ⁠². You remain responsible for residents’ care at all times ⁠².

The service and rental agreement

Before a resident moves in, give the resident (or their legal representative) and HHS a signed copy of your service and rental agreement ⁠². It must cover ⁠²:

• the landlord-tenant eviction and appeals process;
• unrestricted telephone access;
• house rules, including any limits on alcohol or tobacco;
• a sample menu;
• how resident funds are used and managed;
• billing and collection for board, room and care;
• your policy on nonemergency transportation;
• the resident’s right to furnish and decorate their bedroom, control their own schedule, have visitors at any time and be free from coercion and restraint; and
• an accurate description of the care you will provide, including whether the resident needs 24-hour supervision or how long they can safely be left alone.

Any later change must be in writing, signed by both sides and copied to HHS ⁠². To end a resident’s care, give the resident and HHS at least 30 days’ written notice. You must also follow landlord-tenant eviction law and help with the transfer ⁠².

Costs as published on 2026-10-12

Neither N.D.C.C. 50-11 nor N.D. Admin. Code 75-03-21 sets a license fee, and the HHS handbook lists none ⁠¹⁠²⁠³. The sources do not say whether HHS charges any application fee, so ask [email protected] to confirm that none applies. The costs the sources do assign to you are ⁠¹⁠²⁠³:

• fees for any inspection HHS requires;
• the cost of correcting deficiencies;
• any fingerprinting fee charged by a local agency; and
• water testing, if you are not on a community water system.

How residents’ care gets paid

The handbook states that private-pay-only providers generally need not enroll as QSPs, but that adult foster care requires individual QSP enrollment and a license in both private-pay and public-pay situations ⁠³. A state-funded resident first goes through a case manager’s functional and financial assessment. People who have not been assessed can call the Aging and Disability Resource-Link at 1-855-462-5465 ⁠³.

• Service authorization. You need a current service authorization from the case manager before providing paid care. It lists the authorized rate and tasks, and you may not assign those tasks to someone else ⁠³.
• Rate. The QSP rate sheet effective July 1, 2026 lists adult foster care (code S5140) at $160.74 per day, flat rate ⁠⁵. The case manager sets each client’s rate up to a maximum. You may not charge HHS more than you charge private-pay clients, and you must tell QSP Enrollment before changing your private-pay rate ⁠³.
• Client share. Recipient liability and SPED fees are deducted from your payment, and you must collect them from the resident yourself ⁠³.
• Billing. Claims must reach ND Medicaid within 180 days of the date of service. Do not bill for hospital days ⁠³.
• Taxes. QSPs are self-employed. HHS withholds no income or Social Security tax ⁠³.

If at least two licensed adult foster care providers live in the home, an AFC QSP may also enroll for other individual QSP services ⁠³.

Renewal, monitoring and sanctions

QSP enrollment runs for five years, but the license is shorter. The initial license lasts up to 12 months. Each later license lasts up to 24 months or until your QSP enrollment expires, whichever comes first ⁠²⁠³. QSP Enrollment emails a notice 60 days before your license expires and does not send notices by mail ⁠³. If your QSP enrollment closes and leaves a gap, you need new background checks ⁠³. Your QSP status may be closed if you go 12 months without billing HHS or without serving a public-pay client ⁠³.

HHS visits at initial licensure, at each renewal and when there is evidence of noncompliance. At renewal visits, every resident completes a home- and community-based setting experience interview ⁠². Correction orders allow up to 30 days for documentation, fire, safety and sanitation items. They allow up to 60 days for medical, psychological or drug and alcohol evaluations and for remodeling. HHS may extend a deadline by half the original period if the delay was beyond your control and you pursued the correction diligently ⁠².

If you miss a correction deadline, daily fiscal sanctions apply. They are $25, $15 or $5 per day depending on the rule violated, and statute caps each violation at $25 per day ⁠¹⁠². Sanctions are payable 15 days after notice, and you have 10 days to request a hearing ⁠¹. After a denial or revocation, you may not reapply for two years without HHS’s written permission ⁠². A provisional license of up to six months is available only to someone who previously held an unrestricted license ⁠². Violating chapter 50-11 is a class B misdemeanor ⁠¹.

What changed recently

• April 1, 2026. HHS amended 75-03-21. The amendments created the respite care provider in a facility role with its 96- and 192-day limits. They also limited temporary assistants to private-pay residents and revised the definitions, application, facility, insurance, general practice and substitute caregiver sections ⁠².
• July 1, 2026. A new QSP rate sheet took effect with the $160.74 adult foster care daily rate ⁠⁵.
• June 11, 2026. ND Medicaid placed a six-month moratorium, extendable in six-month periods, on new QSP agency enrollments in Burleigh and Cass counties ⁠⁶. It names agencies, so it does not appear to cover individual QSPs, which is how adult foster care providers enroll ⁠³⁠⁶. The notice says the six months run from June 11, 2026, and it does not say whether HHS will extend them or whether it reaches any adult foster care applicant. Ask QSP Enrollment before you apply.

If you are weighing other care models in the state, see the North Dakota home health agency guide and the state overview.

Sources

1. 1
   North Dakota Legislative Branch, N.D. Century Code chapter 50-11, Foster Care Homes for Children and Adults Checked 12 Oct 2026 · Back to text ↑
2. 2
   North Dakota Legislative Branch, N.D. Administrative Code chapter 75-03-21, Licensing of Foster Homes for Adults Checked 12 Oct 2026 · Back to text ↑
3. 3
   North Dakota Department of Health and Human Services, Qualified Service Provider (QSP) Adult Foster Care (AFC) Handbook, January 2025 Checked 12 Oct 2026 · Back to text ↑
4. 4
   North Dakota Department of Health and Human Services, Qualified Service Providers Checked 12 Oct 2026 · Back to text ↑
5. 5
   North Dakota Department of Health and Human Services, QSP Rates and Rural Differential Rate, effective July 1, 2026 Checked 12 Oct 2026 · Back to text ↑
6. 6
   North Dakota Department of Health and Human Services, Medicaid, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
7. 7
   North Dakota Legislative Branch, N.D. Century Code chapter 50-32, Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
8. 8
   North Dakota Legislative Branch, N.D. Century Code chapter 23-09.3, Basic Care Facilities Checked 12 Oct 2026 · Back to text ↑

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