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 Application Form With Insurance In Utah
Instant download
Description
Free preview
Form popularity
FAQ
Decision. For medical assistance, we have 30 days to process your application. We have 90 days if you claim to be disabled, unless you need more time.
Requirements to Become a Caregiver in Utah High school diploma or GED: Most employers require caregivers to have at least a high school diploma or GED equivalent. Background check: Caregivers in Utah must undergo a background check, including a criminal history check, to ensure the safety of their clients.
The look-back period begins the first date on which the person is both in a nursing home or receiving waiver services AND the person applies for Medicaid for nursing home services or the person applies for home and community based waiver services. The look-back period is 60 months prior to the application date.
Alternative out of pocket costs may be higher than nominal charges depending on the type of service, and they are subject to a cap not exceeding 5 percent of family income. In addition, Medicaid enrollees may be denied services for nonpayment of alternative copayments.
Check Your Eligibility Household SizeYou may qualify for Medicaid if you make less than: 1 $19,392/year 2 $26,232/year 3 $33,072/year 4 $36,912/year6 more rows
You may apply at any Department of Workforce Services (DWS) office. Please click here opens in a new tab and type in your zip code to find an office near you.
Asset Limit: 1 person - $2,000 2 people - $3,000 Each additional person add $25 Retroactive coverage is allowed. Refugees entering the United States are eligible to apply for and receive Medical Assistance for 8 months after their date of entry.
Check Your Eligibility Household SizeYou may qualify for Medicaid if you make less than: 1 $19,392/year 2 $26,232/year 3 $33,072/year 4 $36,912/year6 more rows