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Level of care requirements?

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    Level of care requirements?

    My caregiver of over a decade just retired. My nurse who has been helping me out ever since I met her with supplemental needs to fill in where the lack of level of expertise is needed when dealing with autonomic dysreflexic episodes and other care like proper skin care, etc. She offered to take on my case as a LPN in replace of my cdpap live-in who retired. To do this I would have to disenroll from my MLTC and go fee for service with straight medicaid.

    There's a big unknown as to what medicaid would give me if I disenroll here in NY and go onto straight medicaid. I tried calling medicaid and they said you have to disenroll from your mltc then they would have a nurse evaluate your level of care. That to me is very scary because I know these MLTC want to get rid of me or lower my services as much as possible. I don't think they would reenroll me with the amount of hours I currently have if I tried to receive services again.

    Does anyone have any experience with this sort of issue? Am I entitled to a LPN instead of a personal aid? I'm wondering what are the grounds for receiving an lpn?

    I'm c7-t1 complete with a bracual plexus injury to my left arm which is completely paralyzed. My fingers have no strength so I can't really do much on my own without assistance. I'm also a big boy 6'1 250pounds.
    Joe T.

    Every state has their own rules. Hopefully someone from NY can chime in here.

    In CA, you would not be able to be funded at a higher level for routine care from an LPN/LVN than from an IHSS program aide (currently $15/hour in most counties). Is she going to live-in? In CA it is also illegal to supplement your caregiver's salary with cash beyond what IHSS gives them. You can though provide additional benefits such as room and board as a supplement.

    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.