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.
Caregiver Form Application With Medicaid In Palm Beach
Category:
State:
Multi-State
County:
Palm Beach
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
For a successful Medicaid application, comprehensive financial documentation is key. In Florida, this includes five years of bank statements, proof of income, and records of any closed accounts. The state requires a thorough review of each applicant's financial history to ensure eligibility.
Applications for Florida Medicaid Waiver services (financial eligibility) are processed by the DCF. You may go to the DCF Public Benefits & Services website site or call DCF at 1- (866) 762-2237 for more information about Medicaid. All documents must be provided to DCF for financial eligibility determination.
Applications for Florida Medicaid Waiver services (financial eligibility) are processed by the DCF. You may go to the DCF Public Benefits & Services website site or call DCF at 1- (866) 762-2237 for more information about Medicaid. All documents must be provided to DCF for financial eligibility determination.
Determining your Income Limit Family SizeCoverage Groups 1 $2,648 $2,460 2 $3,594 $3,339 3 $4,541 $4,218 4 $5,486 $5,09621 more rows
Once all the information needed to make a determination is available, the Department will make a decision on eligibility within 45 days. The Department will review your application to determine if you are eligible for Medicaid and the level of Medicaid coverage you are eligible to receive.