Personal Care Agreement - Michigan

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Michigan · 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 Michigan Medicaid long-term care planning, so payments are not treated as gifts. A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Michigan Medicaid long-term care planning, so payments are not treated as gifts.

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Who this form is for

A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Michigan Medicaid long-term care planning, so payments are not treated as gifts.

What you'll need

Read the packet and check the receiving agency's required form.
Gather the names, dates and supporting records requested in the document.
Review the packet's signing, identification and witness instructions.

How to complete it

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

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