This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Care Caregiver Form Application With Medicaid In King
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State:
Multi-State
County:
King
Control #:
US-00458BG
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FAQ
If you are hiring a caregiver as an independent contractor, you will need to provide them with a 1099 tax form at the end of the year. This form reports all payments that the caregiver received from you during the tax year.
Your loved one and you should complete a Health Care Power of Attorney. This legal tool appoints someone to make health-care decisions for you when you are unable to make them. You can also provide guidelines for how decisions should be made.
Receive approval for Medicaid. In some cases, it could take the state up to 45 days. Once you are approved for Medicaid, you'll receive a welcome packet from the state.
In Washington State, Medicaid is called Apple Health.
Contact Us Locked out of your account? Need to make changes to your health insurance? ... Apple Health is the name for Medicaid in Washington. Phone: 1-855-923-4633. Monday–Friday: a.m.– p.m. You have a right to information in your language.
If you need specific claim information or a copy of a claim, you can save time by calling: Automated Claim Information Line: 1-800-831-5227. Provider Hotline: 1-800-848-0811.
Income & Asset Limits for Eligibility 2025 Washington Medicaid Long-Term Care Eligibility for Seniors Type of MedicaidSingleMarried (both spouses applying) Income Limit Asset Limit Institutional / Nursing Home Medicaid $2,901 / month $3,000 Medicaid Waivers / Home and Community Based Services $2,901 / month†$3,0001 more row •
If you are helping care for a family member or friend, you are not alone! More than 820,000 Washington State citizens provide care to an adult who needs help with care.