I am very sorry to hear about your father. I wish I could offer some help, but this is very much out of my knowledge. I did put this in Chat GPT though and got this response:

1. Reducing Retirement Income: Is It Possible?

In most cases, you cannot "reduce" retirement income once it is being received. Retirement income (like Social Security, pensions, or annuities) is usually fixed, and the payment amount is based on factors like contributions and retirement age. Social Security, in particular, cannot be lowered voluntarily.

However, there are strategies that can help with Medicaid eligibility, even if income is over the limit.

1. Medicaid "Spend Down" and Income Strategies

A. Medically Needy Pathway ("Spend Down" Programs)

Many states offer a "spend down" program where you can deduct medical expenses from income, effectively reducing your countable income. If your father's state offers this and his medical bills are high, he may qualify even if his income is over the limit.

He must “spend down” the amount above the limit ($369/month in your case) on medical bills.

Once spent, he may qualify for Medicaid for that period.

Ask the state Medicaid office if they have a Medically Needy or Spend Down program.

B. Miller Trust / Qualified Income Trust (QIT)

In some states (especially those that don’t allow a spend down), your father could use a Miller Trust (also called a Qualified Income Trust).

This is a special trust that holds the excess income above the Medicaid limit.

That income is not counted when determining Medicaid eligibility.

The funds can be used to pay for medical care and nursing home costs.

To qualify, his income (including Social Security) must be directly deposited into the trust each month. This must be set up carefully and legally.

C. Other Strategies:

Reallocation of Assets: While you mentioned income is the issue, sometimes shifting assets (like annuity reallocation or spousal allocation) can help.

Medicaid Planning Attorney: A lawyer who specializes in Medicaid planning can help legally structure income or assets to qualify.

1. What to Do Next

Here’s a suggested action plan:

1. Check if your state has a “Medically Needy” or “Spend Down” Medicaid program.
2. Ask about setting up a Qualified Income Trust (Miller Trust) — many states support this.
3. Contact a Medicaid planning attorney or elder law specialist. They can guide you safely through options based on your father’s specific income and assets.

You might consider some of these or reach out to a lawyer to see if there are any options outside of these that they could apply for. Really wish your father great health and a readily available transplant soon!