A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Pennsylvania Medical Assistance (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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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 Pennsylvania Medical Assistance (Medicaid) long-term care planning, so payments are not treated as gifts.
What you'll need
Read this packet and check the receiving agency's required form.
Gather the names, dates and supporting records requested in this document.
Bring acceptable identification and any witnesses required by the packet.
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.
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.