Medicaid rules are different from state to state, and I know only a little about Medicaid-funded caregivers in 2 western states, but out here there's often an agency that sends out the helpers, and the client deals with the agency. That's how it worked in WA. In OR there doesn't seem to be an agency, and the client works directly with the caseworker as you are doing.

The trouble with this is that the caseworker often doesn't know that much about the situation. You might have to state your case at some length to the caseworker if that person will listen. If you seem to be getting the brushoff, you can ask to speak to that person's supervisor. Then start over, stating your case to the supervisor but without complaining about the caseworker (because you don't want to alienate the caseworker, and going over her/his head to the supervisor is apt to be resented).

You're taking a risk by going this route--the risk of alienating a caseworker you may have to continue to deal with--but if you can be extremely polite about it, it's worth a try.

It sounds as if you've had quite a problem even getting a helper, and I hope that some prompt action will be taken to resolve the dispute.

When I had helpers, there sometimes was a bad spell when I went through a series of unsatisfactory situations, and then I'd have better luck for a while. Some helpers lasted several years. I've heard of situations where a helper stayed on with a client for 10-20 years. These were Medicaid-system helpers.