A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for New York Medicaid long-term care planning, so payments are not treated as gifts. Set out caregiving services, schedule and compensation in writing.
Serving New York. New York appointments require New York-commissioned notaries.
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 New York Medicaid long-term care planning, so payments are not treated as gifts.
What you'll need
Read this packet's instructions and confirm the recipient's required form.
Gather the names, dates and supporting records requested in the PDF.
Bring acceptable identification for any required notarial act.
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. New York Medicaid rules are complex; talk to an elder law attorney.
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.