My wife and I receive social security checks which 100% of them go to maintaining our home & basic living expenses (namely food). We have no savings, our daughter helps us tremendously to manage month to month, yet I have a spend down of close to $400 for Medicaid which is an extreme hardship.
If the question is about home care services paid by Medicaid, the Medicaid agency in my state (Massachusetts) has regulations that allow people who have income over the Federal Poverty Limit to pay a deductible amount over the course of 6 months, and then qualify for Medicaid during the rest of the year. The deductible in my state is the amount that the family’s income before taxes and deductions exceeds the income standard for a six-month period. This deductible can be met when your out-of-pocket medical bills equal or exceed the deductible amount. There are many expenses that can quickly add up to meet the deductible: Medicare premiums and other health insurance premiums (which can be credited prospectively) medical treatment co-pays, over-the-counter remedies, supplies for incontinent adults, foot care, lifeline monitoring, alternative medical treatments such as acupuncture, and, of course, home health care.
If the question concerns a spouse who is already in a nursing home, federal law provides that "if either spouse establishes that the community spouse resource allowance (in relation to the amount of income generated by such an allowance) is inadequate to raise the community spouse’s income to the minimum monthly maintenance needs allowance" the state can allow an amount of assets adequate to provide a minimum monthly maintenance needs allowance (MMMNA). In my state, the community spouse may receive income in excess of the MMMNA if there are exceptional circumstances resulting in significant financial duress that justify the additional monthly income.
The take away concept here is: Mediciad regulations in many states make it possible for people to qualify for coverage. The regulations are intended to help people continue to live safely at home. The benefits of getting help from an elder law attorney who understands your specific circumstances usually make it worthwhile to consult a professional advocate near you.
However, having said that, Medicaid was NEVER intended for middle-class people. It was created for persons at or below the federal poverty income level.
The Medicaid formula is based on (1) income, (2) assets and (3) family size. For example, let's say a couple has a fairly low income but has a 401K and a second vehicle. Medicaid would say that you need to sell the second vehicle and dip into the 401K to pay for your own medical expenses.
In the case of a spouse who needs to go into a nursing home, the remaining spouse is allowed to keep the house, one vehicle and a small amount of income. But everything else is supposed to go towards nursing home care. Medicaid is NOT going to pay a dime until a person is fairly impoverished.
Again, I want to stress that Medicaid was never intended for middle-class persons. A lot of people don't understand this.
BTW....the worst thing adult children do is to help their parents pay their bills. This financial assistance could be considered as "income" from the standpoint of qualifying for Medicaid and it will delay when the parents can "spend down."
If they need help, better to pick up a few extra groceries for them when they do their own shopping, take them out to dinner once weekly, etc.
SS is never a sufficient income level to enable a person to afford a mortgage and the upkeep on a house, even with two SS checks coming into the household.
When the SS act was passed in 1935, the retiree benefit was meant to protect seniors from "total impoverishment" - not to enable them to live comfortably.
So, I am always left shaking my head. Why do retirees believe that they are supposed to be able to live middle-class on SS alone?
Now for a social worker you can contact their PCP, or get one through the hospital if they ever are admitted. Then last option would be to call APS adult protection service) and just ask them questions for info. You can call your local health dept too. Good luck to you all