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Personal Care Agreement - Colorado

Colorado · Fillable PDF · Free

A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Health First Colorado (Medicaid) long-term care planning, so payments are not treated as gifts. Set out caregiving services, schedule and compensation in writing.

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Who this form is for

  • Set out caregiving services, schedule and compensation in writing.
  • A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Health First Colorado (Medicaid) long-term care planning, so payments are not treated as gifts.

What you'll need

  • Read the packet and confirm the receiving agency's requirements.
  • Gather the names, dates and supporting records requested in this document.
  • Bring acceptable identification for a required notarial act.

How to complete it

  1. Describe the care (Page 1) List the services, schedule, and a reasonable rate of pay.
  2. Both sign before a notary A notarized, dated agreement is strong proof of when it was made. Bring a current, government-issued photo ID.
  3. Keep the agreement and the care log with your records. Medicaid rules are complex; talk to an elder law attorney.

Related Colorado forms

These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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